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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

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.


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,, Instagram: @dereksteinbacher

Copyright © 2019 by the American Society of Plastic Surgeons