J Korean Assoc Oral Maxillofac Surg.  2010 Feb;36(1):28-38. 10.5125/jkaoms.2010.36.1.28.

Clinical analysis of early reoperation cases after orthognathic surgery

• Lee JH
• Lee IW
• Seo BM

• KMID: 1457816
• DOI: http://doi.org/10.5125/jkaoms.2010.36.1.28

Abstract

The factors influencing the relapse and recurrence of skeletal deformity after the orthognathic surgery include various factors such as condylar deviation, the amount of mandibular set-back, stretching force by the soft tissues and muscles around the facial skeleton. The purpose of this report is to recognize and analyze the possible factors of reoperation after orthognathic surgery, due to early relapses. Six patients underwent reoperation after the orthognathic surgeries out of 110 patients from 2006 to 2009 were included in this study. In most cases, clincal signs of the insufficient occlusal stability, anterior open bite, and unilateral shifting of the mandible were founded within 2 weeks postoperatively. Although elastic traction was initiated in every case, inadequate correction made reoperation for these cases inevitable. The chief complaints of five cases were the protruded mandible combined with some degree of asymmetric face and in the other one case, it was asymmetric face only. Various factors were considered as a major cause of post-operative instability such as condylar sagging, counter-clockwise rotation of the mandibular segment, soft tissue tension related with asymmetrical mandibular set-back, preoperatively existing temporomandibular disorder (TMD), poor fabrication of the final wafer, and dual bite tendency of the patients.

Keyword

Relapse; Orthognathic surgery; Reoperation; Mandibular set-back

MeSH Terms

Bites and Stings
Congenital Abnormalities
Humans
Mandible
Muscles
Open Bite
Orthognathic Surgery
Recurrence
Reoperation
Skeleton
Temporomandibular Joint Disorders
Traction

Figure

• 

  Fig. 1. A patient with condylar sagging. A. Pre-operative intraoral photograph shows anterior openbite and crossbite. B. Intraoral photograph after 1st operation shows remained anterior openbite. C. Pre-operative transcranial radiographs show normal relation between mandibular condyle and articular fossa. D. Transcranial view after 1st operation shows antero-inferiorly positioned condyle: condylar sagging. E. Intraoral photograph after reoperation shows stable occlusion.

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  Fig. 2. A patient with large and asymmetric mandibular set-back. (Soft tissue tension increased post-operative instability.) A. Pre-operative photographs show anterior crossbite with deviation of lower dental midline to right side. B. Post-operative photographs after 1st operation show remained facial asymmetry. C. After reoperation, facial symmetry and stable occlusion were maintained.

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  Fig. 3. A patient with unsolved transverse arch discrepancy. A. Pre-operative photographs show anterior crossbite with lager mandibular angle on the right side. Also Lateral coss-bite is recognizable in the left side. B. Post-operative photographs after 1st operation show occlusal shifting and instability. C. After refixation, stable occlusion were maintained.

• 

  Fig. 4. A patient of posterior mandibular rotation combined with poor final wafer fabrication. A. Pre-operative photographs show facial asymmetry, anterior crossbite with deviation of lower dental midline to left side. B. Post-operative photographs after 1st operation show unsolved facial asymmetry and poor occlusal adaptation to the final wafer. C. After refixation, facial symmetry and stable occlusion were maintained.

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  Fig. 5. A patient of large and asymmetric mandibular setback combined with temporomandibular joint instability. A. Pre-operative bone scintigraphy shows increased uptake on both TMJ. B. Even after re-operation, persistent unstable occlusion with relapse tendency was noticed.

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  Fig. 6. A patient of centric relation-centric occlusion (CR-CO) discrepancy with dual bite. A. Pre-operative intraoral photographs show several missing teeth and poor occlusion with deviated dental midline. B. Post-operative photographs after 1st operation show no improvement of the occlusion.

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