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Complications of
Bimaxillary
Orthognathic Surgery

INDIAN
ACADEMY

DENTAL

Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com
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
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


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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
Complications
Systemic
Local
Preoperative
Intraoperative
Postoperative
Short Term
 Long Term


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

Respiratory
Airway Compromise
 Aspiration
 Atelectasis
 Pneumonia


www.indiandentalacademy.com
Systemic
Anaesthetic Related
Anaphylaxis
 Malignant Hyperthermia
 Drug Toxicity


Pain
Psychiatric
Body Dysmorphic Disorder
 Conversion Disorder


www.indiandentalacademy.com
Local
As discussed in following slides
Balance of the orthodontic treatment
objective and surgical treatment
objective

www.indiandentalacademy.com
Preoperative
Inadequate planning
 Cephalometrics
 Impressions
 Facebow/articulator
 Model

surgery
 Surgical Wafers

www.indiandentalacademy.com
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
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
Operative
Mandible
 Inadequate

external oblique ridge

reduction
 Damage to dental and related structures

www.indiandentalacademy.com
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
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
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
Postoperative

Long Term

Relapse
Fixation
 Exposure

/ Infection

T.M.J. Pain
Neuronal Deficits
Patient Disatisfaction
www.indiandentalacademy.com
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
Reducing Complications
Meticulous Surgery
 Good

instrumentation
 Assistance
 Adequate force
 Careful dissection

Consider Autologous blood donation
Careful postoperative followup
www.indiandentalacademy.com
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