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Complete Reoperation in Orthognathic Surgery

Wu, Robin T., B.S.; Wilson, Alexander T., B.S.; Gary, Cyril S., M.D.; Steinbacher, Derek M., D.M.D., M.D.

Plastic and Reconstructive Surgery: May 2019 - Volume 143 - Issue 5 - p 1053e–1059e
doi: 10.1097/PRS.0000000000005532
Pediatric/Craniofacial: Ideas and Innovations
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Background: Complete reoperation is defined as undergoing reoperative/repeated jaw osteotomies, in a patient who previously underwent orthognathic surgery. The purpose of this study is to (1) describe jaw positions at three time-points (before primary and before and after reoperative surgery), (2) investigate factors necessitating reoperation, and (3) outline the technical challenges.

Methods: Repeated orthognathic surgery cases >1-year out were included. Demographic, radiologic, and perioperative data were compiled. Repeated osteotomies (Le-Fort and/or bilateral split sagittal osteotomy, with or without genioplasty), were compared to their respective primary procedures. Statistical analysis was performed using t tests and z-scores.

Results: Fifteen patients were included (28.1 years; 71 percent female). Reoperative/repeated surgery was most often needed to address iatrogenic bony malposition and asymmetry. Relapse was a less common indication. Time between reoperative and primary surgery was 14 months. Sagittal discrepancies (p = 0.029) were the most frequent reason for primary orthognathic surgery (e.g., mandibular hypoplasia (p = 0.023). Reoperative/repeated orthognathic was performed for asymmetry (p = 0.014). Repeated procedures used more 3-dimensional planning (p < 0.001), required all three osteotomies (p = 0.034), had longer operative times (p = 0.078), and all required hardware removal (p < 0.001). Anatomical outcomes were good with 100% patient satisfaction at long-term follow-up.

Conclusions: Reoperative/repeated orthognathic surgery is challenging and underreported in the literature. Whereas primary orthognathic typically addressed sagittal discrepancies, reoperative/repeated osteotomies were needed to correct iatrogenic bone malposition and asymmetries. Challenges include: re-planning, scar burden, need to remove integrated hardware, and repeated osteotomy/fixation. Despite these difficulties, outcomes and patient acceptance were good.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

New Haven, Conn.

From the Department of Surgery, Section of Plastic Surgery, Yale University School of Medicine.

Received for publication July 5, 2018; accepted October 31, 2018.

Presented at the 58th Annual Meeting of the New England Society of Plastic and Reconstructive Surgery, in Cape Cod, Massachusetts, June 2 through 4, 2017; and the 34th Annual Meeting of the Northeastern Society of Plastic Surgeons, in Newport, Rhode Island, September 8 through 10, 2017.

Disclosures:The authors have no financial interest to declare in relation to the content of this article

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Derek M. Steinbacher, D.M.D., M.D., Department of Surgery, Section of Plastic Surgery, Yale University School of Medicine, P.O. Box 8041, New Haven, Conn. 06520-8062, derek.steinbacher@yale.edu, Instagram: @dereksteinbacher

©2019American Society of Plastic Surgeons