악교정 수술의 합병증

Complications Related to Orthognathic Surgery

  • 김진하 (조선대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 김수관 (조선대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 오지수 (조선대학교 치의학전문대학원 구강악안면외과학교실)
  • Kim, Jin-Ha (Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University) ;
  • Kim, Su-Gwan (Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University) ;
  • Oh, Ji-Su (Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University)
  • 투고 : 2010.06.03
  • 심사 : 2010.08.23
  • 발행 : 2010.09.30

초록

Purpose: The purpose of this study was to evaluate the incidence of intra- and postoperative complications of orthognathic surgery and their relevance. Materials and Methods: The clinical records and X-rays of 418 patients who underwent surgery at Chosun University Dental Hospital, Korea, over a 12-year period between 1998 and 2009 were examined. Results: The followings are some of the most common complications which happened during the oper-ations: Inadequate osteotomy in 25 cases, excessive bleeding in 11 cases, nerve injuries in 6 cases, soft tis-sue injuries in 8 cases, and tooth injury, and insertion of foreign bodies in 4 cases respectively. The most frequent complications which happened after surgery are shown below. Paraesthesia in 262 cases, dyspnea in 78 cases, pain in cervical region in 49 cases, open bite in 14 cases, plus 62 cases where other complications occurred. Despite the great variety of complications, severe life threatening complication frequency seems to be extremely low. Conclusion: Orthognathic surgery appears to be a relatively safe procedure but complications related to orthognathic surgery do still occur. Accurate evaluation and precise surgery are needed to minimize complications.

키워드

참고문헌

  1. Wordford LM, Fields RT : Maxillofacial Surgery. Philadelphia, Churchill Livingstone, 1999, p.1205.
  2. Trauner R, Obwegeser H : The surgical correction of mandibular prognathism and retrognathia with consideration of the genioplasty. Oral Surg Oral Med Oral Pathol 10 : 677, 1957. https://doi.org/10.1016/S0030-4220(57)80063-2
  3. Bell WH, Schendel SA : Biological basis for modification of the sagittal ramus split operation. J Oral Surg 35 : 362, 1977.
  4. Limberg AA : Treatment of open bite by means of plastic oblique osteotomy of the ascending rami of the mandible. Dent Cosmos 67 : 1191, 1925.
  5. Caldwell JB, Letterman GS : Vertical osteotomy in the mandibular rami for correction of prognathism. J Oral Surg 12 : 185, 1954.
  6. Bays RA : Complications of orthognathic surgery. In : Kaban LB, Pogrel MA, Perrott DH, eds. Complications in Oral and Maxillofacial Surgery. Philadelphia, WB Saunders, 1997, p.193.
  7. Lop KC, Baldev S, Wai KC et al : Prevalence of postoperative complications after orthognathic surgery: A 15-year review. J Oral Maxillofac Surg 65 : 984, 2007. https://doi.org/10.1016/j.joms.2006.07.006
  8. Panula K, Finne K, Oikarinen K : Incidence of complications and problems related to orthognathic surgery : a review of 655 patients. J Oral Maxillofac Surg 59 : 1128, 2001. https://doi.org/10.1053/joms.2001.26704
  9. Morris DE, Lo LJ, Margulis A : Pitfalls in orthognathic surgery : avoidance and management of complications. Clin Plastic Surg 34 : e17, 2007. https://doi.org/10.1016/j.cps.2007.05.011
  10. Landefeld CS, Anderson PA, Goodnough LT et al : The bleeding severity index : Validation and comparison to other methods for classifying bleeding complications of medical therapy. J Clin Epidemiol 42 : 711, 1989. https://doi.org/10.1016/0895-4356(89)90066-8
  11. Williams JG, Cawood JI : Effect of intermaxillary fixation on pulmonary function. Int J Oral and Maxillofac Surg 19 : 76, 1990. https://doi.org/10.1016/S0901-5027(05)80199-7
  12. Goodson ML, Ravi M, Paterson AW : Pneumothorax after orthognathic surgery. British J Oral and Maxillofac Surg 48 : 180, 2010. https://doi.org/10.1016/j.bjoms.2009.08.038
  13. MacIntosh RB : Experience with the sagittal osteotomy of the mandibular ramus : a 13-year review. J Maxillofac Surg 9 : 151, 1981. https://doi.org/10.1016/S0301-0503(81)80036-7
  14. Turvey TA : Intraoperative complications of sagittal osteotomy of the mandibular ramus : incidence and management. J Oral Maxillofac Surg 43 : 504, 1985. https://doi.org/10.1016/S0278-2391(85)80028-8
  15. Van de Perre JP, Stoelinga PJ, Blijdorp PA : Perioperative morbidity in maxillofacial orthopedic surgery ; retrospective study. J Craniomaxillofac Surg 24 : 263, 1996. https://doi.org/10.1016/S1010-5182(96)80056-4
  16. el Deeb M, Wolford L, Bevis R : Complications of orthognathic surgery. Clin Plast Surg 16 : 825, 1989.
  17. Gong SG, Krishnan V, Waack D : Blood transfusions in bimaxillary orthognathic surgery: are they necessary? Int J Adult Orhodon Orthognath Surg 17 : 314, 2002.
  18. Nkenke E, Kessler P, Wiltfang J et al : Hemoglobin value reduction and necessity of transfusion in bimaxillary orthognathic surgery. J Oral Maxillofac Surg 63 : 623, 2005. https://doi.org/10.1016/j.joms.2005.01.005
  19. Fromme GA, MacKenzie RA, Gould AB et al : Controlled hypotension for orthognathic surgery. Anesth Analg 65 : 683, 1986.
  20. Epker BN : Vascular considerations in orthognathic surgery II. Maxillary osteotomies. Oral Surg Oral Med Oral Pathol 57 : 473, 1984. https://doi.org/10.1016/0030-4220(84)90302-5
  21. Lanigan DT, Hey JH, West RA : Major vascular complications of orthognathic surgery: false aneurysm and arteriovenous fistulas following orthognathic surgery. J Oral Maxillofac Surg 49 : 571, 1991. https://doi.org/10.1016/0278-2391(91)90337-L
  22. Moenning JE, Bussard DA, Lapp TH et al : Average blood loss and the risk of requiring perioperative blood transfusion in 506 orthognathic surgical procedures. J Oral Maxillofac Surg 53 : 880, 1995. https://doi.org/10.1016/0278-2391(95)90273-2
  23. Regan F, Taylor C : Blood transfusion medicine. BMJ 325 : 143, 2002. https://doi.org/10.1136/bmj.325.7356.143
  24. Gibbons AJ, Dhariwal DK, Benton A et al : Blood usage in maxillofacial surgery. Br J Oral Maxillofac Surg 40 : 350, 2002.
  25. Rohling RG, Haers PE, Zimmermann AP et al : Multimodal strategy for reduction of homologous transfusions in cranio-maxillofacial surgery. Int J Oral Maxillofac Surg 28 : 137, 1999.
  26. Lanigan DT, West RA : Management of postoperative hemorrhage following Lefort I maxillary osteotomy. J Oral Maxillofac Surg 42 : 367, 1984. https://doi.org/10.1016/S0278-2391(84)80008-7
  27. Schaberg SJ, Kelly JF, Terry BC et al : Blood loss and hypotensive anesthesia in oro-facial corrective surgery. J Oral Surg 34 : 147, 1976.
  28. Praveen K, Narayanan V, Muthusekhar MR et al : Hypotensive anesthesia and blood loss in orthognathic surgery : a clinical study. Br J Oral Maxillofac Surg 39 : 138, 2001. https://doi.org/10.1054/bjom.2000.0593
  29. Guernsey LH, DeChamplain RW : Sequelae and complications of the intraoral sagittal osteotomy in the mandibular rami. Oral Surg Oral Med Oral Pathol 32 : 176, 1971. https://doi.org/10.1016/0030-4220(71)90221-0
  30. Willmar K, Hogeman KE, Thiseus S : Sagittal split osteotomy in our experience : A follow-up study of 100 operated patients. Scand J Plast Reconstr Surg 13 : 445, 1979. https://doi.org/10.3109/02844317909013095
  31. Moser K, Freihofer HP : Long-term experience with simultaneous movement of the upper and lower jaw. J Maxillofac Surg 8 : 271, 1980. https://doi.org/10.1016/S0301-0503(80)80114-7
  32. Martis C, Karabouta I : Infection after orthognathic surgery, with and without preventive antibiotics. Int J Oral Surg 13 : 490, 1984. https://doi.org/10.1016/S0300-9785(84)80019-8
  33. Krizeb TJ, Gottlieb LJ, Koss N et al : The use of prophylactic antibacterials in plastic surgery : A 1980s update. Past Reconstr Surg 76 : 953, 1985. https://doi.org/10.1097/00006534-198512000-00032
  34. Velanovich V : A meta-analysis of prophylatic antibiotics in head and neck surgery. Plast Reconstr Surg 87 : 429, 1991. https://doi.org/10.1097/00006534-199103000-00006
  35. Ruggles JE, Hann JR : Antibiotic prophylaxis in intraoral orthognathic surgery. J Oral Maxillofac Surg 42 : 797, 1984. https://doi.org/10.1016/0278-2391(84)90348-3
  36. Peterson LJ : antibiotic prophylaxis against would infections in oral and maxillofacial surgery. J Oral Maxillofac Surg 48 : 617, 1990. https://doi.org/10.1016/S0278-2391(10)80477-X
  37. Bentley KC, Head TW, Aiello GA : Antibiotic prophylaxis in orthognathic surgery : A 1-day versus 5-day regimen. J Oral Maxillofac Surg 57 : 226, 1999. https://doi.org/10.1016/S0278-2391(99)90664-X
  38. DeClercq CAS, Abeloos JSV, Mommaerts MY et al : Temporomandibular joint symptoms in an orthognathic surgery population. J Cranio-Maxillofac Surg 23 : 195, 1995. https://doi.org/10.1016/S1010-5182(05)80010-1
  39. Kerstens HCJ, Tuinzing DB, Van Derkwast WAM : Temporomandibular joint symptoms in orthognathic surgery. J Cranio-Maxillofac Surg 17 : 215, 1989. https://doi.org/10.1016/S1010-5182(89)80071-X
  40. Laskin DM, Ryan WA, Greene CS : Incidence of temporomandibular symptoms in patients with major skeletal malocclusions: a survey of oral and maxillofacial training programs. Oral Surg 61 : 537, 1986. https://doi.org/10.1016/0030-4220(86)90088-5
  41. Scheerlinck JPO, Stoelinga PJW, Blijdorp PA et al : Sagittal split advancement osteotomies stabilized with miniplates. A 2-5 year follow-up. Int J Oral Maxillofac Surg 23 : 127, 1994. https://doi.org/10.1016/S0901-5027(05)80285-1
  42. Link JJ, Nickerson JW : Temporomandibular joint internal derangements in an orthognathic population. Int J Adult Orthod Orthognath Surg 7 : 161, 1992.
  43. de Jongh M, Barnard D, Birnie D : Sensory nerve morbidity following Lefort I osteotomy. J Maxillofac Surg 14 : 10, 1986. https://doi.org/10.1016/S0301-0503(86)80250-8
  44. Westermark A, Bystedt H, Von KL : Inferior alveolar nerve functions after mandibular osteotomies. Br J Oral Maxillofac Surg 36 : 425, 1998. https://doi.org/10.1016/S0266-4356(98)90457-0
  45. Fridrich KL, Holton TJ, Pansegrau KJ et al : Neurosensory recovery following the mandibular bilateral sagittal split osteotomy. J Oral Maxillofac Surg 53 : 1300, 1995. https://doi.org/10.1016/0278-2391(95)90588-X
  46. Teerijoki-Oksa T, Jaaskelainen S, Forssell K et al : An evaluation of clinical and electrophysiologic tests in nerve injury diagnosis after mandibular sagittal split osteotomy. Int J Oral Maxillofac Surg 32 : 15, 2003. https://doi.org/10.1054/ijom.2002.0325
  47. Jones DL, Wolford LM : Intraoperative recording of trigeminal evoked potentials during orthognathic surgery. Int J Adult Othod Orthognath Surg 5 : 167, 1990.
  48. Jaaskelainen SK, Peltola JK, Forssell K et al : Evaluating the function of the inferior alveolar nerve during mandibular sagittal split osteotomy with repeated nerve conduction tests. J Oral Maxillofac Surg 53 : 269, 1995. https://doi.org/10.1016/0278-2391(95)90223-6
  49. Jaaskelainen SK, Teerijoki-Oksa T, Forssell K et al : Intraoperative monitoring of the inferior alveolar nerve during mandibular sagittal split osteotomy. Muscle Nerve 23 : 368, 2000. https://doi.org/10.1002/(SICI)1097-4598(200003)23:3<368::AID-MUS8>3.0.CO;2-0
  50. Miloro M, Ghali GE, Larsen PE : Peterson's principles of oral and maxillofacial surgery. Hemilton, Decker Inc, 2004, p.281.