Risks and benefits of orthognathic surgery
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| Format: | Buch |
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| Sprache: | English |
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Philadelphia [u.a.]
Saunders
1997
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| Schriftenreihe: | Oral and maxillofacial surgery clinics of North America
9,2 |
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| 245 | 1 | 0 | |a Risks and benefits of orthognathic surgery |c David S. Precious, ... guest ed. |
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Datensatz im Suchindex
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|---|---|
| adam_text | RISKS AND BENEFITS OF ORTHCX3NATHIC SURGERY
CONTENTS
Preface ix
David S. Precious and Dennis T. Lanigan
Facial Aesthetics and Psychosocial Considerations 133
David S. Precious and J. E. Armstrong
Improvement in facial aesthetics for psychological reasons sometimes can
be a more important motivation for a patient to undergo orthognathic
surgery than is improvement in function. Functional deficits are usually
accompanied by a related aesthetic deficit, and aesthetic deficits are often
accompanied by anatomic, functional, and psychological deficiencies. In
order to minimize rise of unwanted outcome and maximize benefit of
orthognathic surgery, it is important that the goals and expectations of the
patient are realistic and achievable.
Speech and Velopharyngeal Function 147
George K. B. Sandor, Herbert A. Leeper, and Robert P. Carmichael
Based on a review of the literature, the risks and benefits of orthognathic
surgery on speech and velopharyngeal function seem to affect two main
areas. It would appear that articulation is likely to improve or remain
essentially unchanged following orthognathic surgery. Maxillary advance¬
ment surgery has the potential to lead to velopharyngeal incompetency,
resulting in hypernasal speech. This is especially so in cleft palate patients,
and in particular if borderline velopharyngeal competency is present pre
operatively. The identification of patients at risk for post surgical distor¬
tions of speech is facilitated preoperatively by a thorough speech assess¬
ment. Postoperative speech problems may be treated by a combination of
speech therapy, prosthodontic and surgical management. The indications
for these various treatment modalities are discussed.
Nasal Respiration, Nasal Airway Resistance, and
Obstructive Sleep Apnea Syndrome 167
R. H. Goodday
The oral and maxillofacial surgeon performs surgery that alters the nasal,
oral, and pharyngeal airway. This surgery may have either favorable or
ORAL AND MAXILLOFACIAL SURGERY CLINICS OF NORTH AMERICA
VOLUME 9 • NUMBER 2 • MAY 1997 V
unfavorable effects on nasal airway, nasal respiration, and sleep apnea.
The risks and benefits of these surgical alterations should be considered
when planning, performing, and assessing the outcome of orthognathic
surgery.
Relapse in Mandibular Orthognathic Surgery 179
Leslie A. Will
Relapse is a risk following mandibular orthognathic surgery which can
ultimately affect both the occlusal and aesthetic results of surgery. Mandib¬
ular advancement seems to be a less stable procedure than mandibular
setback. Relapse following mandibular advancement is multifactorial, in¬
cluding such factors as improper proximal fragment control, intersegment
instability, and condylar morphologic changes. Relapse with wire osteo
synthesis largely occurs early, during the period of intermaxillary fixation,
whereas relapse associated with rigid fixation tends to occur late, primarily ,
related to condylar morphologic changes. The success of orthognathic
surgery in normalizing dentofacial relationships must ultimately be meas¬
ured against the ability of nonsurgical treatment modalities to achieve the
same results. Orthognathic surgery still appears to be the treatment of
choice for patients in whom growth is complete, or for whom the dentofa¬
cial deformity is severe.
Relapse After Maxillary and Maxillomandibular Surgery 195
David S. Precious and J. E. Armstrong
Except in severe deformities, orthodontic treatment and orthognathic sur¬
gery are elective procedures, so strict parameters of assessment must be
applied when attempting to establish a risk benefit ratio. Pretreatment
projections of posttreatment outcomes must be made on the basis of a
combination of scientific prediction and artistic opinion. This article dis¬
cusses the risks and benefits of maxillary and maxillomandibular surgery
as they relate to relapse and long term stability, from both skeletal and
occlusal standpoints.
Nerve Injuries 207
William L. Frydman
There is a potential for neurosensory and motor deficits following orthog¬
nathic surgery. The etiology and incidences of nerve injuries following
common orthognathic surgical procedures are reviewed. There is an ex¬
tremely high incidence of neurosensory deficits involving the inferior
alveolar nerve, and a low incidence involving the lingual nerve immedi¬
ately following sagittal osteotomies, but fortunately the majority resolve
within the first 6 months. The incidence of facial nerve deficits associated
with sagittal osteotomies is extremely low, usually associated with man¬
dibular setbacks, and normally resolve spontaneously. The intraoral verti¬
cal oblique ramus osteotomy has a lower incidence of neurosensory defi¬
cits involving the inferior alveolar nerve, and motor deficits involving the
facial nerve, than does the sagittal osteotomy. Long term facial soft tissue
neurosensory deficits rarely occur in areas supplied by the infraorbital
nerve following a Le Fort I osteotomy.
Infection 219
William G. Abbott
Infections following orthognathic surgery are fortunately rare, and those
that have been reported have generally been localized, easily managed,
and did not affect the final results of treatment. Although it is controversial
vi CONTENTS
as to whether prophylactic antibiotics are necessary for orthognathic sur¬
gery, most oral and maxillofacial surgeons use them for intraoral proce¬
dures. There is general consensus that the initial dose of prophylactic
antibiotics should be given immediately preoperative, and then continued
intraoperatively, but the ideal duration of antibiotic coverage postopera
tively remains unclear at this time.
Vascular Complications Associated With Orthognathic Surgery 231
Dennis T. Lanigan
The risk of complications from hemorrhage associated with orthognathic
surgery has decreased due to improved methods to prevent and manage
bleeding. Avascular necrosis following orthognathic surgery is rare. Asep¬
tic necrosis of the maxilla is most commonly associated with multisegmen
tal Le Fort I osteotomies with significant transverse expansion and/or
superior repositioning. Significant avascular necrosis is unlikely to occur
after mandibular osteotomies if a minimal amount of mucoperiosteum
and muscle attachments are stripped from the osteotomized segment. The
occurrence and incidence of avascular necrosis of the mandibular condyle
following sagittal osteotomies remains controversial.
Jaw Function 251
Rick B. Grieman, Simon Weinberg, and Bodhan Kryshtalskyj
Orthognathic surgery can affect the biomechanical and physiological func¬
tioning of the stomatognathic system, and can therefore influence postop
eratively such parameters as bite strength, masticatory efficiency, and
range of motion. Orthognathic surgery can significantly alter occlusion,
and may thereby affect temporomandibular joint symptoms and head¬
aches. Most studies have reported a lower prevalence of signs and symp¬
toms of temporomandibular dysfunction after orthognathic surgery, al¬
though a small percentage of patients who were asymptomatic prior to
surgery will develop symptoms postoperatively. Changes in condylar
position and morphology can occur as a result of orthognathic surgery
which can have a significant impact on occlusal stability and joint function.
Internal Carotid Artery and Ophthalmic Injuries 271
Dennis T. Lanigan
Injuries to the internal carotid artery have been reported which have
resulted in thrombosis, hemorrhage, arteriovenous fistulae, and false aneu
rysms. Ophthalmic complications reported include decreased visual acu¬
ity, extraocular muscle dysfunction, nasolacrimal problems, and neuropar
alytic keratitis. These injuries to neural and/or vascular structures may
be related to unusual fracture patterns following the pterygomaxillary
dysjunction and maxillary down fracture, or from traction, compression,
or contrecoup injuries from forces transmitted during the pterygomaxillary
separation with an osteotome.
Index 279
Subscription Information Inside back cover
CONTENTS Vli
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| indexdate | 2024-12-23T14:30:01Z |
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| language | English |
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| physical | XI, 281 S. Ill. |
| publishDate | 1997 |
| publishDateSearch | 1997 |
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| publisher | Saunders |
| record_format | marc |
| series | Oral and maxillofacial surgery clinics of North America |
| series2 | Oral and maxillofacial surgery clinics of North America |
| spellingShingle | Risks and benefits of orthognathic surgery Oral and maxillofacial surgery clinics of North America Chirurgie (DE-588)4009987-8 gnd Gebissanomalie (DE-588)4156155-7 gnd Okklusionsstörung (DE-588)4123882-5 gnd Orthognathie (DE-588)4276928-0 gnd |
| subject_GND | (DE-588)4009987-8 (DE-588)4156155-7 (DE-588)4123882-5 (DE-588)4276928-0 (DE-588)4143413-4 |
| title | Risks and benefits of orthognathic surgery |
| title_auth | Risks and benefits of orthognathic surgery |
| title_exact_search | Risks and benefits of orthognathic surgery |
| title_full | Risks and benefits of orthognathic surgery David S. Precious, ... guest ed. |
| title_fullStr | Risks and benefits of orthognathic surgery David S. Precious, ... guest ed. |
| title_full_unstemmed | Risks and benefits of orthognathic surgery David S. Precious, ... guest ed. |
| title_short | Risks and benefits of orthognathic surgery |
| title_sort | risks and benefits of orthognathic surgery |
| topic | Chirurgie (DE-588)4009987-8 gnd Gebissanomalie (DE-588)4156155-7 gnd Okklusionsstörung (DE-588)4123882-5 gnd Orthognathie (DE-588)4276928-0 gnd |
| topic_facet | Chirurgie Gebissanomalie Okklusionsstörung Orthognathie Aufsatzsammlung |
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