COMPLICATION INVOLVED WITH ORTHOGNATHIC

SURGERY

Common complication

Post operative nausea and

vomitingInfection

Excessive bleeding

Soft tissue damage

Localized skin burn

Loss of pulpal activity

Periodontal disease

Gingival recession

Nerve exposure

Temporary taste disrupt

Common complication

Instrument fracture

Instrument /screw loss

Foreign body

Bad split

Malunion

Condylar resorptionTMJ effect

Relapse - skeletal or

dental

Respiratory difficulty

Screw loosening

Neck pain

Intraoperative complication

Segmented bony fragments

Excessive bleeding

Soft tissue damage

Nerve exposure

Instrument fracture

Tooth damage

Postoperative complication

Sensory impairment

Haemorrhage

Infection

Dental malocclusion and relapse

TMJ dysfunction

Skeletal and bone complication

Respiratory difficulty

Neck pain

Gastrointestinal disease

SOFT TISSUE DAMAGE• Prolonged traction on lips and mucosa to

secure the operative field and facilitate access• Instrument scraping the soft tissue• Jaw osteotomies are carried out through

incisions in the mouth• Incisions are made in the mucosal lining

usually at the junction of cheek and lip with the upper or lower jaw

• For lower jaw surgery, there will be a 3mm “stab” incision at the angle of the jaw

• Generally heal to virtually invisible scars within 1-2 months after the operation, although rarely there may be a small depression or tiny scar remaining

• If a bone graft has been used from the hip, the scar will remain a little conspicuous for 6 to 8 months and it will never disappear entirely.

Transoral approach tothe mandibular angle

Transoral approach to the lateral mandibular body

Intraoral approach to the symphysis and body

Intraoral approach to the condylar processand ramus

HAEMORRHAGE

• During or after the operation• Reactionary haemorrhage - first 24 hours• Secondary haemorrhage occurs 5 to 7 days

usually the result of infection• If bleeding is excessive during an operation, a

transfusion may be required

Facial artery • Dissection • Osteotomy of the mandibular margin

Inferior alveolar artery• Sharp instruments severed it• Distal bone fragment tears the artery

WOUND INFECTION

• Uncommon in upper or lower jaw osteotomies• Minor, small abscess or redness of the skin• Serious or life-threatening.

NERVE INJURIES

• Trigeminal nerve–The nerve is dissected out over a distance of

approximately 4cm– Sensory neuropathy– Lower jaw osteotomies - numbness in the lower

lip and chin - immediate postoperative period–Temporary and usually wears off over a period

of several weeks to several months sometimes up to 12 months–Occasionally permanent

• Inferior alveolar– Cut during the bone dissection– Thorn during the separation and movement of the

distal segment– Unfavourable fracture – Large mandibular advancement

• The lingual nerve – Small risk during the operation of lower jaw

osteotomy– Lingual sensory neuropathy is not common in

mandibular osteotomy – Nerve stretching– Bruising of the nerve by retraction or screw

positioning.

SKELETAL AND BONE COMPLICATION

• Condylar resorption – Pre-existing TMJ derangement– High mandibular plane angle– Posteriorly inclined condylar neck– Large advancement

• Osteonecrosis of mandible– Overzealous stripping of pterygomasseteric sling

Dental malocclusion and relapse

• Anterior open bite – higher occurrence in high angle patients when

mandible is advanced

• Relapse– With rigid fixation, this is no longer a problem– the larger the jaw movement, the greater is the

chance and degree of relapse– Relapse may also occur after removal of the

orthodontic bands and braces

Reference• Saluja, S. (2014, Feb 25). Complication of Orthognathic

surgery. Retrieved from http://www.slideshare.net/shivanisaluja11/complications-orthognathic-surgery

• Maxillofacial & Orthodontics Unit (2013, March) A guide for patients considering orthognathic jaw surgery. Retrieved from http://www.qvh.nhs.uk/assets/patient_information/A%20guide%20for%20pts%20considering%20orthognathic%20surgery%20-Rvw%20March%202013.pdf