Le Fort 1 Osteotomisi ve Bilateral Sagital Split Ramus Osteotomisi: Teknikler ve Komplikasyonlar
Özet
Bu bölüm, ortognatik cerrahide yaygın olarak kullanılan Le Fort 1 osteotomisi ve bilateral sagital split ramus osteotomisi (BSSRO) tekniklerini detaylı bir şekilde ele almaktadır. Maksillofasiyal deformitelerin düzeltilmesinde tercih edilen bu prosedürler hem fonksiyonel hem de estetik iyileşme sağlamayı hedeflemektedir.
Le Fort 1 osteotomisi, maksillanın mobilizasyonunu sağlayarak çene ve yüz uyumunu optimize ederken, BSSRO mandibulanın anteroposterior ve vertikal yönlerde yeniden konumlandırılmasına olanak tanımaktadır. Her iki cerrahi teknik, stabilizasyon amacıyla rijit fiksasyon yöntemleri ile desteklenmekte ve oklüzyonun doğru şekilde sağlanması için splintler kullanılmaktadır.
Ortognatik cerrahiye bağlı komplikasyonlar arasında kanama, enfeksiyon, nörolojik hasar, ödem, maloklüzyon, segment kırıkları ve nüks gibi durumlar yer almaktadır. Özellikle kondil malpozisyonu ve postoperatif stabilite kayıpları, cerrahi başarının uzun vadede sürdürülebilmesi açısından dikkat edilmesi gereken kritik faktörlerdir.
Sonuç olarak, Le Fort 1 osteotomisi ve BSSRO’nun başarılı bir şekilde uygulanabilmesi için cerrahi planlama, uygun tekniklerin seçimi ve komplikasyon yönetimi büyük önem taşımaktadır. Bu cerrahi yöntemlerin optimize edilmesi hem cerrahi başarının artırılmasına hem de hasta memnuniyetinin yükseltilmesine katkı sağlayacaktır.
This chapter provides a detailed analysis of Le Fort 1 osteotomy and bilateral sagittal split ramus osteotomy (BSSRO), which are commonly used techniques in orthognathic surgery. These procedures are preferred for the correction of maxillofacial deformities, aiming to achieve both functional and aesthetic improvements.
Le Fort 1 osteotomy facilitates the mobilization of the maxilla, optimizing the harmony between the jaw and facial structures, while BSSRO allows for the repositioning of the mandible in the anteroposterior and vertical directions. Both surgical techniques are supported by rigid fixation methods to ensure stabilization, and splints are used to achieve proper occlusion.
Complications associated with orthognathic surgery include bleeding, infection, neurological damage, edema, malocclusion, segment fractures, and relapse. In particular, condylar malposition and postoperative stability loss are critical factors that must be carefully managed to maintain long-term surgical success.
In conclusion, the successful application of Le Fort 1 osteotomy and BSSRO requires meticulous surgical planning, appropriate technique selection, and effective complication management. Optimizing these surgical approaches contributes to enhanced surgical outcomes and increased patient satisfaction.
Referanslar
Weinzweig J. Plastic surgery secrets plus: Elsevier Health Sciences; 2010.
Kim J-H, Kim S-G, Oh J-S. Complications related to orthognathic surgery. Maxillofacial Plastic and Reconstructive Surgery. 2010;32(5):416-21.
Obwegeser HL. Orthognathic surgery and a tale of how three procedures came to be: a letter to the next generations of surgeons. Clinics in plastic surgery. 2007;34(3):331-55.
Yamaguchi Y, Yamauchi K, Suzuki H, et al. The accuracy of maxillary position using a computer-aided design/computer-aided manufacturing intermediate splint derived via surgical simulation in bimaxillary orthognathic surgery. Journal of Craniofacial Surgery. 2020;31(4):976-9.
Reyneke J. Essentials of orthognathic surgery 2nd ed. Quintessence Publishing Co, Hanover; 2010.
Savoldelli C, Chamorey E, Bettega G. Computer-assisted teaching of bilateral sagittal split osteotomy: Learning curve for condylar positioning. Public Library Of Science ONE. 2018;13(4):e0196136.
Hong M, Kim M-J, Shin HJ, et al. Three-dimensional surgical accuracy between virtually planned and actual surgical movements of the maxilla in two-jaw orthognathic surgery. Korean Journal of Orthodontics. 2020;50(5):293-303.
Podčernina J, Urtāne I, Pirttiniemi P, et al. Evaluation of condylar positional, structural, and volumetric status in Class III orthognathic surgery patients. Medicina. 2020;56(12):672.
Hoffman GR, Islam S. The difficult Le Fort I osteotomy and downfracture: a review with consideration given to an atypical maxillary morphology. Journal of plastic, reconstructive & aesthetic surgery. 2008;61(9):1029-33.
Yamauchi K, Kanno T, Ariyoshi W, et al. Use of an alveolar distraction device for repositioning the maxillary segment to correct asymmetry of the maxillomandibular complex. Journal of oral and maxillofacial surgery. 2005;63(9):1398-401.
Krishnan DG, Perciaccante VJ. Maxillary Orthognathic Surgery. Peterson’s principles of oral and maxillofacial surgery: Springer; 2022. p. 1909-43.
Reyneke JP, Sullivan SM. Essentials of orthognathic surgery: Quintessence Publishing Company; 2003.
Proffit WR, White RP, Sarver DM. Contemporary treatment of dentofacial deformity: Mosby St. Louis; 2003.
Miloro M, Ghali G, Larsen P, et al. Peterson's principles of oral and maxillofacial surgery. Hamilton, Ont. 2004.
Erkmen E, Şimşek B, Yücel E, et al. Comparison of different fixation methods following sagittal split ramus osteotomies using three-dimensional finite elements analysis: Part 1: advancement surgery-posterior loading. International journal of oral and maxillofacial surgery. 2005;34(5):551-8.
Bloomquist DS, Lee JJ. Principles of mandibular orthognathic surgery. Peterson’s principles of oral and maxillofacial surgery. 2004;2:1135-78.
Lupori J, Kewitt G, Van Sickels J. Bilateral sagittal split osteotomy advancement and setback. Oral and maxillofacial surgery. 2000;2:297-310.
Panula K, Finne K, Oikarinen K. Incidence of complications and problems related to orthognathic surgery: a review of 655 patients. Journal of oral and maxillofacial surgery. 2001;59(10):1128-36.
Chow LK, Singh B, Chiu WK, et al. Prevalence of postoperative complications after orthognathic surgery: a 15-year review. Journal of oral and maxillofacial surgery. 2007;65(5):984-92.
Phillips C, Blakey III G. Short-term recovery after orthognathic surgery: a medical daily diary approach. International journal of oral and maxillofacial surgery. 2008;37(10):892-6.
Lanigan DT, Hey JH, West RA. Major vascular complications of orthognathic surgery: hemorrhage associated with Le Fort I osteotomies. Journal of oral and maxillofacial surgery. 1990;48(6):561-73.
Thastum M, Andersen K, Rude K, et al. Factors influencing intraoperative blood loss in orthognathic surgery. International Journal of Oral and Maxillofacial Surgery. 2016;45(9):1070-3.
Lin S, Chen C, Yao C-F, et al. Comparison of different hypotensive anaesthesia techniques in orthognathic surgery with regard to intraoperative blood loss, quality of the surgical field, and postoperative nausea and vomiting. International journal of oral and maxillofacial surgery. 2016;45(12):1526-30.
Steenen S, Becking A. Bad splits in bilateral sagittal split osteotomy: systematic review of fracture patterns. International journal of oral and maxillofacial surgery. 2016;45(7):887-97.
Bell W. Le Forte I osteotomy for correction of maxillary deformities. Journal of Oral Surgery (American Dental Association: 1965). 1975;33(6):412-26.
Deng J, Murphy BA, Dietrich MS, et al. Impact of secondary lymphedema after head and neck cancer treatment on symptoms, functional status, and quality of life. Head & neck. 2013;35(7):1026-35.
López-Ramírez M, Vílchez-Pérez MÁ, Gargallo-Albiol J, et al. Efficacy of low-level laser therapy in the management of pain, facial swelling, and postoperative trismus after a lower third molar extraction. A preliminary study. Lasers in medical science. 2012;27:559-66.
Lee J-H, Lee I-W, Seo B-M. Clinical analysis of early reoperation cases after orthognathic surgery. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2010;36(1):28-38.
Moroi A, Yoshizawa K, Iguchi R, et al. Comparison of the computed tomography values of the bone fragment gap after sagittal split ramus osteotomy in mandibular prognathism with and without asymmetry. International journal of oral and maxillofacial surgery. 2016;45(12):1520-5.
Kang MG, Yun KI, Kim CH, et al. Postoperative condylar position by sagittal split ramus osteotomy with and without bone graft. Journal of Oral and Maxillofacial Surgery. 2010;68(9):2058-64.
Yang HJ, Hwang SJ. Evaluation of postoperative stability after BSSRO to correct facial asymmetry depending on the amount of bone contact between the proximal and distal segment. Journal of Cranio-Maxillofacial Surgery. 2014;42(5):e165-e70.
Uckan S, Buchbinder D, Orhan M, et al. Management of early relapse after a sagittal split ramus osteotomy by gradual callus distraction: a case report. 2000.
Chang H-P, Tseng Y-C, Chang H-F. Treatment of mandibular prognathism. Journal of the Formosan Medical Association. 2006;105(10):781-90.
Han J, Park M, Park J, et al. Evaluation of dominant influencing factor for postoperative relapse after BSSRO for mandibular prognathism. Recent Advances in Orthodontics and Orthognathic Surgery. 2014;1:27-36.
Al-Din OS, Coghlan K, Magennis P. Sensory nerve disturbance following Le Fort I osteotomy. International journal of oral and maxillofacial surgery. 1996;25(1):13-9.
Hasegawa T, Tateishi C, Asai M, et al. Retrospective study of changes in the sensitivity of the oral mucosa: sagittal split ramus osteotomy (SSRO) versus intraoral vertical ramus osteotomy (IVRO). International journal of oral and maxillofacial surgery. 2015;44(3):349-55.
Verweij J, Mensink G, Fiocco M, et al. Incidence and recovery of neurosensory disturbances after bilateral sagittal split osteotomy in different age groups: a retrospective study of 263 patients. International journal of oral and maxillofacial surgery. 2016;45(7):898-903.
Agbaje JO, Salem A, Lambrichts I, et al. Systematic review of the incidence of inferior alveolar nerve injury in bilateral sagittal split osteotomy and the assessment of neurosensory disturbances. International journal of oral and maxillofacial surgery. 2015;44(4):447-51.
de Vries K, Devriese PP, Hovinga J, et al. Facial palsy after sagittal split osteotomies: A survey of 1747 sagittal split osteotomies. Journal of Cranio-Maxillofacial Surgery. 1993;21(2):50-3.
Koh K-M, Yang J-Y, Leem D-H, et al. Facial nerve palsy after sagittal split ramus osteotomy: follow up with electrodiagnostic tests. Maxillofacial Plastic and Reconstructive Surgery. 2011;33(2):190-7.
Al-Riyami S, Moles DR, Cunningham SJ. Orthognathic treatment and temporomandibular disorders: a systematic review. Part 1. A new quality-assessment technique and analysis of study characteristics and classifications. American Journal of Orthodontics and Dentofacial Orthopedics. 2009;136(5):624. e1-. e15.
Davis CM, Gregoire CE, Steeves TW, et al. Prevalence of surgical site infections following orthognathic surgery: a retrospective cohort analysis. Journal of Oral and Maxillofacial Surgery. 2016;74(6):1199-206.
Posnick JC, Choi E, Chavda A. Surgical site infections following bimaxillary orthognathic, osseous genioplasty, and intranasal surgery: a retrospective cohort study. Journal of Oral and Maxillofacial Surgery. 2017;75(3):584-95.
