Changes in the occlusal function of orthognathic patients with vertical malformations after combined orthodontic surgical therapy: a prospective clinical study

The aim of this study was to assess the changes in occlusal patterns during combined surgical and orthodontic therapy in patients with vertical jaw malformations. Twenty-six orthognathic patients (18 female, eight male; median age 25 years, interquartile range 11.5 years) and 10 control patients (five female, five male; median age 29.8 years, interquartile range 13.5 years) recruited from neutral configured patients attending the Department of Orthodontics, were investigated. Based on cephalometry, the patients were grouped into vertical skeletal configurations of either open, deep, or natural bite cases. Registrations of the occlusal contacts were taken using a digital occlusal sensor immediately before surgery and at 9 months after the surgical intervention. Before the intervention, open and deep bite patients showed significantly less efficient occlusal patterns than the untreated controls regarding total tooth contact (P < 0.001), time of occlusion (P = 0.002), occlusal asymmetry (P = 0.001), anterior tooth contact (P < 0.001), and posterior tooth contact (P < 0.001). After surgery, the parameters in the deep bite patients were similar to those in the controls; however, in open bite patients, total tooth contact (P = 0.003), occlusal asymmetry (P = 0.011), and posterior tooth contact (P = 0.035) differed significantly. In conclusion, combined orthodontic and surgical correction of vertical malocclusions was found to improve occlusal function in patients with deep bite to the level of controls.     

Factors influencing patient-reported quality of life in pretreatment orthognathic surgery patients

Objective:To investigate the relationship between condition-specific quality of life (QoL) and occlusal/skeletal traits of pretreatment orthognathic surgery patients.Materials and Methods:Patients referred for orthognathic surgery during the 2012–2014 period were asked to complete the Orthognathic Quality of Life Questionnaire (OQLQ) at consultation. Patient demographics, indices of treatment need, occlusal traits, and cephalometric variables were also recorded. Bivariate analyses were carried out between the OQLQ scores and the clinical measurements. Significant variables were added to a multivariate regression model to determine the effect of these predictive factors on OQLQ.Results:One hundred and two patients were recruited. Initial analyses showed that gender and overjet were significantly associated with the overall OQLQ score. Being female increased the overall OQLQ score by 15.6 points when compared to males (95% confidence interval [CI], 7.4–23.8). Females also had significant associations in the social and awareness domains of the OQLQ. The magnitude of overjet away from normal values was associated with poorer overall QoL, with significant relationships in the esthetic and functional domains. The Index of Orthognathic Functional Treatment Need was significantly associated with the functional domain of OQLQ, with patients in category 5 scoring a mean of 10.0 points more than patients in category 4 (95% CI, 2.1–17.8). The Index of Complexity, Outcome and Need and other cephalometric variables were not associated with the OQLQ.Conclusions:Females are more aware of their facial deformity and report a greater social detriment when compared to males. Patients with a higher orthognathic treatment need report greater functional disadvantage.     

Symptomatic venous thromboembolism in orthognathic surgery and distraction osteogenesis: a retrospective cohort study of 4127 patients

Venous thromboembolism is a common postoperative complication, and orthopaedic procedures are particularly at risk. We designed a retrospective, single centre, observational, cohort study of 4127 patients (mean (SD) age 27 (11) years) who had elective orthognathic operations or distraction osteogenesis between January 1970 and February 2012 at the VU University Medical Centre, Amsterdam, to investigate the incidence in this group over the 42-year period, 2 patients developed symptomatic venous thromboembolism (1 woman had a deep vein thrombosis (DVT) and 1 man had a DVT and pulmonary embolus) postoperatively. In relatively young patients with low to moderate risk factors and short hospital stay this type of operation is associated with a particularly low risk of developing thrombosis. It could be advisable to limit the use of thromboprophylaxis to patients at high risk or according to hospital guidelines.