Complete Reoperation in Orthognathic Surgery. Issue 5 (May 2019)

• Record Type: Journal Article
• Authors: Wu, Robin T.; Wilson, Alexander T.; Gary, Cyril S.; Steinbacher, Derek M.
• Is Part Of: Plastic and reconstructive surgery. Volume 143:Issue 5(2019:May)
• Publication Date: 2019-05
• Subjects: Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/PRS.0000000000005532
• Languages: English
• ISSNs: 0032-1052

Abstract

Abstract : Background: Complete reoperation is defined as undergoing reoperative/repeated jaw osteotomies, in a patient who previously underwent orthognathic surgery. The purpose of this study is to (1) describe jaw positions at three time-points (before primary and before and after reoperative surgery), (2) investigate factors necessitating reoperation, and (3) outline the technical challenges. Methods: Repeated orthognathic surgery cases >1-year out were included. Demographic, radiologic, and perioperative data were compiled. Repeated osteotomies (Le-Fort and/or bilateral split sagittal osteotomy, with or without genioplasty), were compared to their respective primary procedures. Statistical analysis was performed using t tests and z -scores. Results: Fifteen patients were included (28.1 years; 71 percent female). Reoperative/repeated surgery was most often needed to address iatrogenic bony malposition and asymmetry. Relapse was a less common indication. Time between reoperative and primary surgery was 14 months. Sagittal discrepancies ( p = 0.029) were the most frequent reason for primary orthognathic surgery (e.g., mandibular hypoplasia ( p = 0.023). Reoperative/repeated orthognathic was performed for asymmetry ( p = 0.014). Repeated procedures used more 3-dimensional planning ( p < 0.001), required all three osteotomies ( p = 0.034), had longer operative times ( p = 0.078), and all required hardware removal ( p < 0.001). Anatomical outcomes were good with 100% patient satisfaction at long-term follow-up. Conclusions: Reoperative/repeated orthognathic surgery is challenging and underreported in the literature. Whereas primary orthognathic typically addressed sagittal discrepancies, reoperative/repeated osteotomies were needed to correct iatrogenic bone malposition and asymmetries. Challenges include: re-planning, scar burden, need to remove integrated hardware, and repeated osteotomy/fixation. Despite these difficulties, outcomes and patient acceptance were good. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. Abstract : Supplemental Digital Content is available in the text.