Complications and compromised healing in mandibular bilateral sagittal split osteotomies

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

Smoking cessation and surgical planning decrease complications and compromised healing in patients undergoing orthognatic surgery Orthognatic surgery is surgery for the correction of discrepancies in the facial skeleton. The main aim of the thesis was to identify factors that increase complications and compromised healing in these patients. Medical records of orthognatic patients treated at the Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland were retrieved retrospectively for the first two studies. For the last two studies patients planned for bilateral sagittal split osteotomy (BSSO) were recruited at the Department before surgery and followed up for one year. The outcome variable in the first study was the removal of one symptomatic titanium miniplate, whereas in the second study it was a surgical site infection. The predictor variables were age, gender, smoking status, duration of operation, general diseases, dimensions of mandibular movement and osteosynthesis supporting material. The main outcome variable in the third study was neurosensory disturbance, whereas in the last study it was temporomandibular disorders at one year post-operative. The main predictor variable in the third study was the degree of manipulation of the mandibular nerve and in the last study TMD before surgery, evaluated by the Helkimo Dysfunction index. Explanatory variables age, gender, smoking status, mandibular advancement and duration of operation were also recorded for the statistical analyses. 19.0% of the inserted miniplates were removed in 153 BSSO patients. Plate-related reasons for removal were infection and screw-loosening. 9.1% of the patients (n= 286) in the second study had a surgical site infection. Smoking was the only significant predictor for infections or removal of osteosynthesis material. 90.2% BSSO patients (n= 41) reported altered sensations in the lower lip one year after surgery. The disturbance tended to increase the more the mandibular nerve was manipulated during surgery. Four patients had a visible nerve laceration and all of them experienced a major burden of the altered sensation. Two of these patients (4.9%) had neuropathic pain. Most patients were satisfied with the treatment, but the four patients with visible nerve lacerations were not. A substantial proportion (42.5%) of the patients in the last study had TMD as one of the reasons for seeking treatment. The TMD did not change after treatment in the majority of patients (60%), 30% improved and for 10% the situation impaired. The main finding was that smoking cessation will reduce infections and the need for removal of osteosynthesis material. Regarding neurosensory complications, the surgical technique does matter, and nerve manipulation and lacerations should be avoided at all costs. TMD symptoms improved for only 30% of patients undergoing BSSO. Thus BSSO is not a predictable treatment for TMD patients.
Original languageEnglish
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-2109-7
Electronic ISBNs978-951-51-2110-3
Publication statusPublished - 2016
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • 313 Dentistry

Cite this

@phdthesis{ff8ab3220f8e4e63b0a9edc005ff671c,
title = "Complications and compromised healing in mandibular bilateral sagittal split osteotomies",
abstract = "Smoking cessation and surgical planning decrease complications and compromised healing in patients undergoing orthognatic surgery Orthognatic surgery is surgery for the correction of discrepancies in the facial skeleton. The main aim of the thesis was to identify factors that increase complications and compromised healing in these patients. Medical records of orthognatic patients treated at the Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland were retrieved retrospectively for the first two studies. For the last two studies patients planned for bilateral sagittal split osteotomy (BSSO) were recruited at the Department before surgery and followed up for one year. The outcome variable in the first study was the removal of one symptomatic titanium miniplate, whereas in the second study it was a surgical site infection. The predictor variables were age, gender, smoking status, duration of operation, general diseases, dimensions of mandibular movement and osteosynthesis supporting material. The main outcome variable in the third study was neurosensory disturbance, whereas in the last study it was temporomandibular disorders at one year post-operative. The main predictor variable in the third study was the degree of manipulation of the mandibular nerve and in the last study TMD before surgery, evaluated by the Helkimo Dysfunction index. Explanatory variables age, gender, smoking status, mandibular advancement and duration of operation were also recorded for the statistical analyses. 19.0{\%} of the inserted miniplates were removed in 153 BSSO patients. Plate-related reasons for removal were infection and screw-loosening. 9.1{\%} of the patients (n= 286) in the second study had a surgical site infection. Smoking was the only significant predictor for infections or removal of osteosynthesis material. 90.2{\%} BSSO patients (n= 41) reported altered sensations in the lower lip one year after surgery. The disturbance tended to increase the more the mandibular nerve was manipulated during surgery. Four patients had a visible nerve laceration and all of them experienced a major burden of the altered sensation. Two of these patients (4.9{\%}) had neuropathic pain. Most patients were satisfied with the treatment, but the four patients with visible nerve lacerations were not. A substantial proportion (42.5{\%}) of the patients in the last study had TMD as one of the reasons for seeking treatment. The TMD did not change after treatment in the majority of patients (60{\%}), 30{\%} improved and for 10{\%} the situation impaired. The main finding was that smoking cessation will reduce infections and the need for removal of osteosynthesis material. Regarding neurosensory complications, the surgical technique does matter, and nerve manipulation and lacerations should be avoided at all costs. TMD symptoms improved for only 30{\%} of patients undergoing BSSO. Thus BSSO is not a predictable treatment for TMD patients.",
keywords = "Abscess, +etiology, Biocompatible Materials, Bone Plates, +adverse effects, Device Removal, Drainage, +instrumentation, Equipment Failure, Jaw Fixation Techniques, Malocclusion, +surgery, Mandible, Mandibular Advancement, +methods, Mandibular Nerve, +pathology, Orthognathic Surgical Procedures, +complications, Osteotomy, Osteotomy, Le Fort, Osteotomy, Sagittal Split Ramus, Pain, Postoperative, Patient Harm, Patient Satisfaction, Postoperative Complications, +psychology, Retrognathia, Risk Factors, Sensation Disorders, Smoking, Surgical Wound Dehiscence, Surgical Wound Infection, Time Factors, Titanium, +chemistry, Treatment Outcome, Trigeminal Nerve Injuries, Trigeminal Neuralgia, 313 Dentistry",
author = "Marina Kuhlefelt",
note = "M1 - 80 s. + liitteet Helsingin yliopisto Volume: Proceeding volume:",
year = "2016",
language = "English",
isbn = "978-951-51-2109-7",
publisher = "[M. Kuhlefelt]",
address = "Finland",

}

Complications and compromised healing in mandibular bilateral sagittal split osteotomies. / Kuhlefelt, Marina.

Helsinki : [M. Kuhlefelt], 2016. 80 p.

Research output: ThesisDoctoral ThesisCollection of Articles

TY - THES

T1 - Complications and compromised healing in mandibular bilateral sagittal split osteotomies

AU - Kuhlefelt, Marina

N1 - M1 - 80 s. + liitteet Helsingin yliopisto Volume: Proceeding volume:

PY - 2016

Y1 - 2016

N2 - Smoking cessation and surgical planning decrease complications and compromised healing in patients undergoing orthognatic surgery Orthognatic surgery is surgery for the correction of discrepancies in the facial skeleton. The main aim of the thesis was to identify factors that increase complications and compromised healing in these patients. Medical records of orthognatic patients treated at the Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland were retrieved retrospectively for the first two studies. For the last two studies patients planned for bilateral sagittal split osteotomy (BSSO) were recruited at the Department before surgery and followed up for one year. The outcome variable in the first study was the removal of one symptomatic titanium miniplate, whereas in the second study it was a surgical site infection. The predictor variables were age, gender, smoking status, duration of operation, general diseases, dimensions of mandibular movement and osteosynthesis supporting material. The main outcome variable in the third study was neurosensory disturbance, whereas in the last study it was temporomandibular disorders at one year post-operative. The main predictor variable in the third study was the degree of manipulation of the mandibular nerve and in the last study TMD before surgery, evaluated by the Helkimo Dysfunction index. Explanatory variables age, gender, smoking status, mandibular advancement and duration of operation were also recorded for the statistical analyses. 19.0% of the inserted miniplates were removed in 153 BSSO patients. Plate-related reasons for removal were infection and screw-loosening. 9.1% of the patients (n= 286) in the second study had a surgical site infection. Smoking was the only significant predictor for infections or removal of osteosynthesis material. 90.2% BSSO patients (n= 41) reported altered sensations in the lower lip one year after surgery. The disturbance tended to increase the more the mandibular nerve was manipulated during surgery. Four patients had a visible nerve laceration and all of them experienced a major burden of the altered sensation. Two of these patients (4.9%) had neuropathic pain. Most patients were satisfied with the treatment, but the four patients with visible nerve lacerations were not. A substantial proportion (42.5%) of the patients in the last study had TMD as one of the reasons for seeking treatment. The TMD did not change after treatment in the majority of patients (60%), 30% improved and for 10% the situation impaired. The main finding was that smoking cessation will reduce infections and the need for removal of osteosynthesis material. Regarding neurosensory complications, the surgical technique does matter, and nerve manipulation and lacerations should be avoided at all costs. TMD symptoms improved for only 30% of patients undergoing BSSO. Thus BSSO is not a predictable treatment for TMD patients.

AB - Smoking cessation and surgical planning decrease complications and compromised healing in patients undergoing orthognatic surgery Orthognatic surgery is surgery for the correction of discrepancies in the facial skeleton. The main aim of the thesis was to identify factors that increase complications and compromised healing in these patients. Medical records of orthognatic patients treated at the Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland were retrieved retrospectively for the first two studies. For the last two studies patients planned for bilateral sagittal split osteotomy (BSSO) were recruited at the Department before surgery and followed up for one year. The outcome variable in the first study was the removal of one symptomatic titanium miniplate, whereas in the second study it was a surgical site infection. The predictor variables were age, gender, smoking status, duration of operation, general diseases, dimensions of mandibular movement and osteosynthesis supporting material. The main outcome variable in the third study was neurosensory disturbance, whereas in the last study it was temporomandibular disorders at one year post-operative. The main predictor variable in the third study was the degree of manipulation of the mandibular nerve and in the last study TMD before surgery, evaluated by the Helkimo Dysfunction index. Explanatory variables age, gender, smoking status, mandibular advancement and duration of operation were also recorded for the statistical analyses. 19.0% of the inserted miniplates were removed in 153 BSSO patients. Plate-related reasons for removal were infection and screw-loosening. 9.1% of the patients (n= 286) in the second study had a surgical site infection. Smoking was the only significant predictor for infections or removal of osteosynthesis material. 90.2% BSSO patients (n= 41) reported altered sensations in the lower lip one year after surgery. The disturbance tended to increase the more the mandibular nerve was manipulated during surgery. Four patients had a visible nerve laceration and all of them experienced a major burden of the altered sensation. Two of these patients (4.9%) had neuropathic pain. Most patients were satisfied with the treatment, but the four patients with visible nerve lacerations were not. A substantial proportion (42.5%) of the patients in the last study had TMD as one of the reasons for seeking treatment. The TMD did not change after treatment in the majority of patients (60%), 30% improved and for 10% the situation impaired. The main finding was that smoking cessation will reduce infections and the need for removal of osteosynthesis material. Regarding neurosensory complications, the surgical technique does matter, and nerve manipulation and lacerations should be avoided at all costs. TMD symptoms improved for only 30% of patients undergoing BSSO. Thus BSSO is not a predictable treatment for TMD patients.

KW - Abscess

KW - +etiology

KW - Biocompatible Materials

KW - Bone Plates

KW - +adverse effects

KW - Device Removal

KW - Drainage

KW - +instrumentation

KW - Equipment Failure

KW - Jaw Fixation Techniques

KW - Malocclusion

KW - +surgery

KW - Mandible

KW - Mandibular Advancement

KW - +methods

KW - Mandibular Nerve

KW - +pathology

KW - Orthognathic Surgical Procedures

KW - +complications

KW - Osteotomy

KW - Osteotomy, Le Fort

KW - Osteotomy, Sagittal Split Ramus

KW - Pain, Postoperative

KW - Patient Harm

KW - Patient Satisfaction

KW - Postoperative Complications

KW - +psychology

KW - Retrognathia

KW - Risk Factors

KW - Sensation Disorders

KW - Smoking

KW - Surgical Wound Dehiscence

KW - Surgical Wound Infection

KW - Time Factors

KW - Titanium

KW - +chemistry

KW - Treatment Outcome

KW - Trigeminal Nerve Injuries

KW - Trigeminal Neuralgia

KW - 313 Dentistry

M3 - Doctoral Thesis

SN - 978-951-51-2109-7

PB - [M. Kuhlefelt]

CY - Helsinki

ER -