Survey on Surgical Correction of Mandibular Deformities in Japan. Part 3: On Factors Affecting Perioperative Management, Intraoperative and Postoperative/Complications and Malunion of Segments.

Questionnaires were sent to oral and maxillofacial surgery, orthodontic and anesthesiology departments where board members of Japanese Association of Oral and Maxillofacial Surgeons, Japan Orthodontic Society, or Japanese Dental Society of Anesthesiology are working. Questionnaires included questions on surgical procedures for mandibular deformities, fixation methods between segments, the duration of postoperative intermaxillary fixation, complicatison of perioperative phase, and preoperative and postoperative orthodontic treatments.This paper, as part 3 of this study, presented the results of the survey on factors affecting perioperative management of patients, intraoperative and postoperative complications, and malunion of segments based on the replies from 10 anesthesiology departments and 99 oral and maxillofacial surgery departments.The results were as follows:1. Thirty-four out of 71 oral and maxillofacial surgery departments suggested preoperative orthodontic treatment, the number of the teeth remaining in the oral cavity, and the size of the tongue as the most important local factors for the success of orthognathic surgery in the treatment of mandibular deformities.2. Systemic diseases influencing surgical risk in general anesthesia were given as factors compromising perioperative patient management.3. Sixty out of 87 oral and maxillofacial surgery departments experienced intraoperative complications. Thirty-five experienced excessive bleeding and unintentional fractures of segments during sagittal splitting osteotomy. Several departments reported experience of damage to the inferior alveolar neurovascular bundle and the facial artery and vein.4. Seventy-six out of 90 oral and maxillofacial surgery departments reported postoperative complications. Anesthesia of the lower lip was reported by 45 departments. Infection, temporomandibular joint dysfunction, bleeding and facial nerve palsy were reported by several departments.5. Sixteen cases of malunion between osteotomized segments were reported by 16 oral and maxillofacial surgery departments. Twelve departments reported the surgical procedures, in which seven were sagittal splitting osteotomy and five were ostectomy of the mandibular body.