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    Complications of Bimaxillary Orthognathic Surgery

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    Varun Arora
    This document discusses complications of bimaxillary orthognathic surgery. It begins by defining bimaxillary surgery and noting that complications were previously more common due to poor instrumentation, lack of studies, techniques and fixation methods. It then categorizes complications as systemic, local, preoperative, intraoperative, postoperative short term and long term. Examples are provided for each category including hemorrhage, infection, nerve damage, relapse and neuropathic deficits. The document concludes by stressing the importance of adequate planning, accuracy, meticulous surgery, consideration of blood donation and careful postoperative follow up to reduce complications.

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    Complications of Bimaxillary Orthognathic Surgery

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    Varun Arora
    412 views18 pages
    This document discusses complications of bimaxillary orthognathic surgery. It begins by defining bimaxillary surgery and noting that complications were previously more common due to poor instrumentation, lack of studies, techniques and fixation methods. It then categorizes complications as systemic, local, preoperative, intraoperative, postoperative short term and long term. Examples are provided for each category including hemorrhage, infection, nerve damage, relapse and neuropathic deficits. The document concludes by stressing the importance of adequate planning, accuracy, meticulous surgery, consideration of blood donation and careful postoperative follow up to reduce complications.

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    This document discusses complications of bimaxillary orthognathic surgery. It begins by defining bimaxillary surgery and noting that complications were previously more common due to poor instrumentation, lack of studies, techniques and fixation methods. It then categorizes complications as systemic, local, preoperative, intraoperative, postoperative short term and long term. Examples are provided for each category including hemorrhage, infection, nerve damage, relapse and neuropathic deficits. The document concludes by stressing the importance of adequate planning, accuracy, meticulous surgery, consideration of blood donation and careful postoperative follow up to reduce complications.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    412 views18 pages

    Complications of Bimaxillary Orthognathic Surgery

    Uploaded by

    Varun Arora
    This document discusses complications of bimaxillary orthognathic surgery. It begins by defining bimaxillary surgery and noting that complications were previously more common due to poor instrumentation, lack of studies, techniques and fixation methods. It then categorizes complications as systemic, local, preoperative, intraoperative, postoperative short term and long term. Examples are provided for each category including hemorrhage, infection, nerve damage, relapse and neuropathic deficits. The document concludes by stressing the importance of adequate planning, accuracy, meticulous surgery, consideration of blood donation and careful postoperative follow up to reduce complications.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 18

    Complications of Bimaxillary Orthognathic Surgery

    Dr N.J. Rutherford Associate Professor A.C.H. Smith

    Definitions
    Bimaxillary surgery involves orthognathic procedures on both the mandible and maxilla Generally these procedures are the Le Fort I osteotomy and the Bilateral Sagittal Split osteotomy Other procedures may include genioplasty and rhinoplasty

    Historical Perspective
    In the last twenty years bimaxillary surgery has become accepted as a relatively safe procedure Prior to this complications were more frequent due to the following
    Poor instrumentation Lack of scientific studies Poor techniques Prolonged procedures Traditional methods of fixation Anaesthetic related problems

    Complications
    All surgical procedures have complications and morbidities Most complications are prevented by planning and awareness If you never do surgery, you never get surgical complications If you do enough surgery you will have complications The aim is to minimise incidence of morbidity

    Complications
    Systemic Local Preoperative Intraoperative Postoperative
    Short Term Long Term

    Systemic
    Cardiovascular / Renal
    Hypovolaemia Shock Stroke Acute Renal Failure

    Respiratory
    Airway Compromise Aspiration Atelectasis Pneumonia

    Systemic
    Anaesthetic Related
    Anaphylaxis Malignant Hyperthermia Drug Toxicity

    Pain Psychiatric
    Body Dysmorphic Disorder Conversion Disorder

    Local
    As discussed in following slides Balance of the orthodontic treatment objective and surgical treatment objective

    Preoperative
    Inadequate planning
    Cephalometrics Impressions Facebow/articulator Model

    surgery Surgical Wafers

    Operative
    Failure to achieve the surgical objective Haemorrhage Maxilla
    Devascularization Inability to mobilize maxilla Inability to reduce vertical height Unfavourable osteotomy pattern Condylar distraction Nasal septum deviation

    Operative
    Mandible

    Inappropriate split
    Buccal plate fracture Lingual plate Fracture Condylar split

    Inferior alveolar nerve


    Nerve in proximal segment Neuropraxia, Neuronometsis, Axonometsis

    Facial Nerve Lingual Nerve

    Operative
    Mandible
    Inadequate

    external oblique ridge reduction Damage to dental and related structures

    Operative
    Fixation problems
    Inadequate Fixation Large osteotomy gaps Inadequate bony apposition Inadequate condylar position

    Soft tissue Injuries

    Lips, cheeks, nose

    Damage to surrounding structures Immediate relapse

    Postoperative
    Cardiovascular

    Short Term

    Secondary Haemorrhage Avascular Necrosis maxillary segments Haematoma formation

    Infection Bone Healing / Fixation


    Failed Fixation Delayed Union Mal / Nonunion

    Postoperative
    Early Relapse

    Short Term

    Poor fixation Unstable final postion Condylar sag Idiopathic Condylar Resorption

    Extrusion of teeth Neuronal Deficit

    Paraesthesia, anaesthesia, dysaesthesia, hyperaesthesia

    Postoperative
    Relapse Fixation
    Exposure

    Long Term

    / Infection

    T.M.J. Pain Neuronal Deficits Patient Disatisfaction

    Reducing Complications
    Adequate Planning
    Listen to the patient concerns Set realistic goals for treatment Communication with orthodontist

    Accuracy of preoperative work up


    Assessment of growth Models Articulation Model surgery

    Reducing Complications
    Meticulous Surgery
    Good

    instrumentation Assistance Adequate force Careful dissection

    Consider Autologous blood donation Careful postoperative followup

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