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  • Title: Influence of osteotomy procedure and surgical experience on early complications after orthognathic surgery in the mandible.
    Author: Al-Nawas B, Kämmerer PW, Hoffmann C, Moergel M, Koch FP, Wriedt S, Walter C.
    Journal: J Craniomaxillofac Surg; 2014 Jul; 42(5):e284-8. PubMed ID: 24289870.
    Abstract:
    INTRODUCTION: This study evaluated the influence of osteotomy procedure and surgical experience on early complication rates following orthognathic surgery in the mandible. MATERIALS AND METHODS: In a retrospective study, patients who underwent a mandibular osteotomy (Obwegeser-Dal Pont (ODP) and Hunsuk-Epker (HE)) were included. Incidence of "bad splits", "bleeding episodes", "delayed wound healing", "failed osteosynthesis" and "nerve lesions" at 2 months post-operatively were recorded. Surgical experience was classified as: beginner (<10), intermediate (10-40) and expert (>40). Complications were correlated to the surgical approach and the experience level of the surgeon. RESULTS: 400 patients were included. 200 underwent a bimaxillary approach. 186 patients were operated using the ODP technique, 214 according to HE. Multivariate analysis confirmed significantly more unwanted fractures and bleeding events for ODP when compared to HE (p = 0.28, p = 0.003). Experienced surgeons had more osteosynthesis failures (0.047) and significantly more nerve lesions than the other groups (p = 0.01). DISCUSSION: The HE osteotomy showed a more reliable fracture mechanism with less relevant bleeding episodes. Differences between the surgeons of varying training status were marginal with exception of a higher rate of osteosynthesis failure and temporary hypoesthesia in the experienced group.
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