Clinical investigation of patients with jaw deformity with comorbidities

Abstract

Background With improvements in the safety and stability of surgeries, the number of orthognathic surgeries is increasing. Most patients who undergo orthognathic surgeries are younger, and the number of orthognathic surgeries for patients with comorbidities is also increasing. We report a survey and clinical investigation of patients with comorbidities who underwent orthognathic surgeries at our department to improve the safety of orthognathic surgery. Results The participants included 296 men and 712 women, with a mean age of 28 years (13–19 years, n=144; 20–29 years, n=483; 30–39 years, n=236; 40–49 years, n=102; 50–59 years, n=39; ≥60 years, n=4). In total, 347 patients underwent one-stage Le Fort type I osteotomy and sagittal split ramus osteotomy (SSRO), 243 underwent SSRO, 287 underwent plate removal, 126 underwent genioplasty and plate removal, and five underwent other surgeries. In total, 529 patients had comorbidities (52%), including allergic diseases (n=220, 33%), respiratory diseases (n=107, 16%), neurologic and psychiatric diseases (n=69, 10%), gynecologic diseases (n=28, 4%), hematologic diseases (n=27, 4%), cardiovascular diseases (n=24, 4%), digestive diseases (n=22, 3%), metabolic and endocrine diseases (n=18, 3%), spinal diseases (n=11, 2%), ophthalmologic diseases (n=11, 2%), renal and urological diseases (n=9, 1%), and other diseases (n=117, 18%). Among the patients with comorbidities, 11 with hemorrhagic diatheses (hemophilia and von Willebrand disease), arrhythmia (atrioventricular block), psychiatric disease (adjustment disorder), and metabolic disease (diabetes) required cautious perioperative management. The patient with hemophilia was managed with regular low-dose recombinant factor VIII replacement therapy, and the patient with type I diabetes mellitus was administered continuous insulin infusion and sliding-scale insulin therapy; both patients had an uneventful course. Conclusions The study findings suggest that with the increase in orthognathic surgeries, oral and maxillofacial surgeons should adequately manage cases requiring cautious perioperative control and highlight the importance of preoperative screening. Despite the well-established safety and postoperative stability of orthognathic surgeries, oral surgeons should adopt appropriate additional preventive measures for patients with comorbidities.

Orthognathic Surgery in Patients With Von Willebrand’s Disease: A Report of Four Cases and Literature Review

“…In contrast, a recent study showed that although tranexamic acid effectively controlled intraoperative blood loss and improved the quality of the surgical site, it did not exhibit any effect on postoperative levels of hemoglobin or hematocrit or the need for blood transfusion [ 20 ]. Appropriate management of patients with bleeding disorders includes the presurgical development of management strategies aimed at minimizing bleeding by shortening the surgical duration and using local hemostatic agents [ 7 , 16 ]. In the current study, intravenous or topical administration of tranexamic acid was carried out postsurgically in all patients, and local hemostatic agents were used during surgery to control bleeding.…”

“…Surgical interventions present a critical hemostatic challenge in patients with VWD, necessitating careful perioperative management to minimize the risk of bleeding. Although previous studies have reported minor oral surgical treatment or dental extraction in patients with VWD, there is limited evidence of orthognathic surgeries in this population [ 4 , 7 ]. The current case report focuses on four patients with VWD (including one with type 3 VWD) who were successfully treated using orthognathic surgical intervention.…”