6.complication involved with orthognathic surgery ppt
TRANSCRIPT
COMPLICATION INVOLVED WITH ORTHOGNATHIC
SURGERY
Common complication
Post operative nausea and
vomitingInfection
Excessive bleeding
Soft tissue damage
Localized skin burn
Loss of pulpal activity
Periodontal disease
Gingival recession
Nerve exposure
Temporary taste disrupt
Common complication
Instrument fracture
Instrument /screw loss
Foreign body
Bad split
Malunion
Condylar resorptionTMJ effect
Relapse - skeletal or
dental
Respiratory difficulty
Screw loosening
Neck pain
Intraoperative complication
Segmented bony fragments
Excessive bleeding
Soft tissue damage
Nerve exposure
Instrument fracture
Tooth damage
Postoperative complication
Sensory impairment
Haemorrhage
Infection
Dental malocclusion and relapse
TMJ dysfunction
Skeletal and bone complication
Respiratory difficulty
Neck pain
Gastrointestinal disease
SOFT TISSUE DAMAGE• Prolonged traction on lips and mucosa to
secure the operative field and facilitate access• Instrument scraping the soft tissue• Jaw osteotomies are carried out through
incisions in the mouth• Incisions are made in the mucosal lining
usually at the junction of cheek and lip with the upper or lower jaw
• For lower jaw surgery, there will be a 3mm “stab” incision at the angle of the jaw
• Generally heal to virtually invisible scars within 1-2 months after the operation, although rarely there may be a small depression or tiny scar remaining
• If a bone graft has been used from the hip, the scar will remain a little conspicuous for 6 to 8 months and it will never disappear entirely.
Transoral approach tothe mandibular angle
Transoral approach to the lateral mandibular body
Intraoral approach to the symphysis and body
Intraoral approach to the condylar processand ramus
HAEMORRHAGE
• During or after the operation• Reactionary haemorrhage - first 24 hours• Secondary haemorrhage occurs 5 to 7 days
usually the result of infection• If bleeding is excessive during an operation, a
transfusion may be required
Facial artery • Dissection • Osteotomy of the mandibular margin
Inferior alveolar artery• Sharp instruments severed it• Distal bone fragment tears the artery
WOUND INFECTION
• Uncommon in upper or lower jaw osteotomies• Minor, small abscess or redness of the skin• Serious or life-threatening.
NERVE INJURIES
• Trigeminal nerve–The nerve is dissected out over a distance of
approximately 4cm– Sensory neuropathy– Lower jaw osteotomies - numbness in the lower
lip and chin - immediate postoperative period–Temporary and usually wears off over a period
of several weeks to several months sometimes up to 12 months–Occasionally permanent
• Inferior alveolar– Cut during the bone dissection– Thorn during the separation and movement of the
distal segment– Unfavourable fracture – Large mandibular advancement
• The lingual nerve – Small risk during the operation of lower jaw
osteotomy– Lingual sensory neuropathy is not common in
mandibular osteotomy – Nerve stretching– Bruising of the nerve by retraction or screw
positioning.
SKELETAL AND BONE COMPLICATION
• Condylar resorption – Pre-existing TMJ derangement– High mandibular plane angle– Posteriorly inclined condylar neck– Large advancement
• Osteonecrosis of mandible– Overzealous stripping of pterygomasseteric sling
Dental malocclusion and relapse
• Anterior open bite – higher occurrence in high angle patients when
mandible is advanced
• Relapse– With rigid fixation, this is no longer a problem– the larger the jaw movement, the greater is the
chance and degree of relapse– Relapse may also occur after removal of the
orthodontic bands and braces
Reference• Saluja, S. (2014, Feb 25). Complication of Orthognathic
surgery. Retrieved from http://www.slideshare.net/shivanisaluja11/complications-orthognathic-surgery
• Maxillofacial & Orthodontics Unit (2013, March) A guide for patients considering orthognathic jaw surgery. Retrieved from http://www.qvh.nhs.uk/assets/patient_information/A%20guide%20for%20pts%20considering%20orthognathic%20surgery%20-Rvw%20March%202013.pdf