Revista Española de Cirugía Oral y Maxilofacial
Print version ISSN 1130-0558
HUETO-MADRID, Juan A. and GUTIERREZ-SANTAMARIA, Javier. Complications in orthognathic surgery: A presentation of three cases and a review of the literature. Rev Esp Cirug Oral y Maxilofac [online]. 2012, vol.34, n.2, pp.56-74. ISSN 1130-0558.
The correction of dental-facial deformities by means of osteotomies of the facial bones is commonly known as orthognathic surgery. The most common surgical techniques employed are the LeFort 1 maxillary osteotomy, and sagittal mandibular osteotomy. These techniques are highly standardised and ensure predictable and stable results over time. The surgical complications rate is low, between 1% and 25%, and varies depending on how a complication is defined. Objectives: To present a literature review of the complications reported in corrective osteotomies of dental-facial deformities, and a description of the diagnosis and treatment of three cases. Material and method: Three cases with a complication are presented: two inadequate osteotomies ("bad split") in the sagittal mandibular osteotomy and one maxillary aseptic necrosis after a LeFort 1 maxillary osteotomy. Results: Two alternatives for correcting the mandibular bad split are presented, using bicortical screws and using a reinforced plate with screws threaded to the plate. In the maxillary aseptic necrosis, the clinical signs, the diagnostic tests used, the initial treatment, and finally the sequelae of this case are presented. Conclusions: The surgical correction of dental-facial deformities using orthognathic surgery is a safe treatment with predictable results. Despite the development of new materials and techniques, no surgical procedure is complication free. It is the responsibility of the surgeon to assess the risks of each case, to inform the patient and diagnose and treat the complications with the greatest diligence and efficacy.
Keywords : Orthognathic surgery; Complications; Sagittal osteotomy; LeFort I; Aseptic necrosis; Internal maxillary artery.