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Complications of
Bimaxillary
Orthognathic Surgery

INDIAN
ACADEMY

DENTAL

Leader in continuing dental education
www.india...
Definitions
Bimaxillary surgery involves
orthognathic procedures on both the
mandible and maxilla
Generally these procedur...
Historical Perspective
In the last twenty years bimaxillary surgery
has become accepted as a relatively safe
procedure
Pri...
Complications
All surgical procedures have complications
and morbidities
Most complications are prevented by
planning and ...
Complications
Systemic
Local
Preoperative
Intraoperative
Postoperative
Short Term
 Long Term


www.indiandentalacademy.c...
Systemic
Cardiovascular / Renal
Hypovolaemia
 Shock
 Stroke
 Acute Renal Failure


Respiratory
Airway Compromise
 Asp...
Systemic
Anaesthetic Related
Anaphylaxis
 Malignant Hyperthermia
 Drug Toxicity


Pain
Psychiatric
Body Dysmorphic Diso...
Local
As discussed in following slides
Balance of the orthodontic treatment
objective and surgical treatment
objective

ww...
Preoperative
Inadequate planning
 Cephalometrics
 Impressions
 Facebow/articulator
 Model

surgery
 Surgical Wafers

...
Operative
Failure to achieve the surgical objective
Haemorrhage
Maxilla
Devascularization
 Inability to mobilize maxilla
...
Operative
Mandible


Inappropriate split
Buccal plate fracture
 Lingual plate Fracture
 Condylar split




Inferior a...
Operative
Mandible
 Inadequate

external oblique ridge

reduction
 Damage to dental and related structures

www.indiande...
Operative
Fixation problems
Inadequate Fixation
 Large osteotomy gaps
 Inadequate bony apposition
 Inadequate condylar ...
Postoperative

Short Term

Cardiovascular
Secondary Haemorrhage
 Avascular Necrosis maxillary segments
 Haematoma format...
Postoperative

Short Term

Early Relapse
Poor fixation
 Unstable final postion
 Condylar sag
 Idiopathic Condylar Resor...
Postoperative

Long Term

Relapse
Fixation
 Exposure

/ Infection

T.M.J. Pain
Neuronal Deficits
Patient Disatisfaction
w...
Reducing Complications
Adequate Planning
Listen to the patient concerns
 Set realistic goals for treatment
 Communicatio...
Reducing Complications
Meticulous Surgery
 Good

instrumentation
 Assistance
 Adequate force
 Careful dissection

Cons...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Complications of bimaxillary orthognathic surgery /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Transcript of "Complications of bimaxillary orthognathic surgery /certified fixed orthodontic courses by Indian dental academy "

  1. 1. Complications of Bimaxillary Orthognathic Surgery INDIAN ACADEMY DENTAL Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Definitions Bimaxillary surgery involves orthognathic procedures on both the mandible and maxilla Generally these procedures are the Le Fort I osteotomy and the Bilateral Sagittal Split osteotomy Other procedures may include genioplasty and rhinoplasty www.indiandentalacademy.com
  3. 3. Historical Perspective In the last twenty years bimaxillary surgery has become accepted as a relatively safe procedure Prior to this complications were more frequent due to the following Poor instrumentation  Lack of scientific studies  Poor techniques  Prolonged procedures  Traditional methods of fixation  Anaesthetic related problems  www.indiandentalacademy.com
  4. 4. Complications All surgical procedures have complications and morbidities Most complications are prevented by planning and awareness If you never do surgery, you never get surgical complications If you do enough surgery you will have complications The aim is to minimise incidence of morbidity www.indiandentalacademy.com
  5. 5. Complications Systemic Local Preoperative Intraoperative Postoperative Short Term  Long Term  www.indiandentalacademy.com
  6. 6. Systemic Cardiovascular / Renal Hypovolaemia  Shock  Stroke  Acute Renal Failure  Respiratory Airway Compromise  Aspiration  Atelectasis  Pneumonia  www.indiandentalacademy.com
  7. 7. Systemic Anaesthetic Related Anaphylaxis  Malignant Hyperthermia  Drug Toxicity  Pain Psychiatric Body Dysmorphic Disorder  Conversion Disorder  www.indiandentalacademy.com
  8. 8. Local As discussed in following slides Balance of the orthodontic treatment objective and surgical treatment objective www.indiandentalacademy.com
  9. 9. Preoperative Inadequate planning  Cephalometrics  Impressions  Facebow/articulator  Model surgery  Surgical Wafers www.indiandentalacademy.com
  10. 10. Operative Failure to achieve the surgical objective Haemorrhage Maxilla Devascularization  Inability to mobilize maxilla  Inability to reduce vertical height  Unfavourable osteotomy pattern  Condylar distraction  Nasal septum deviation  www.indiandentalacademy.com
  11. 11. Operative Mandible  Inappropriate split Buccal plate fracture  Lingual plate Fracture  Condylar split   Inferior alveolar nerve Nerve in proximal segment  Neuropraxia, Neuronometsis, Axonometsis  Facial Nerve  Lingual Nerve  www.indiandentalacademy.com
  12. 12. Operative Mandible  Inadequate external oblique ridge reduction  Damage to dental and related structures www.indiandentalacademy.com
  13. 13. Operative Fixation problems Inadequate Fixation  Large osteotomy gaps  Inadequate bony apposition  Inadequate condylar position  Soft tissue Injuries  Lips, cheeks, nose Damage to surrounding structures Immediate relapse www.indiandentalacademy.com
  14. 14. Postoperative Short Term Cardiovascular Secondary Haemorrhage  Avascular Necrosis maxillary segments  Haematoma formation  Infection Bone Healing / Fixation Failed Fixation  Delayed Union  Mal / Nonunion  www.indiandentalacademy.com
  15. 15. Postoperative Short Term Early Relapse Poor fixation  Unstable final postion  Condylar sag  Idiopathic Condylar Resorption  Extrusion of teeth Neuronal Deficit  Paraesthesia, anaesthesia, dysaesthesia, hyperaesthesia www.indiandentalacademy.com
  16. 16. Postoperative Long Term Relapse Fixation  Exposure / Infection T.M.J. Pain Neuronal Deficits Patient Disatisfaction www.indiandentalacademy.com
  17. 17. Reducing Complications Adequate Planning Listen to the patient concerns  Set realistic goals for treatment  Communication with orthodontist  Accuracy of preoperative work up Assessment of growth  Models  Articulation  Model surgery  www.indiandentalacademy.com
  18. 18. Reducing Complications Meticulous Surgery  Good instrumentation  Assistance  Adequate force  Careful dissection Consider Autologous blood donation Careful postoperative followup www.indiandentalacademy.com
  19. 19. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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