Orthognathic surgery without the use of postoperative intermaxillary fixation. A clinical and cephalometric evaluation of surgical correction of mandibular and maxillary deformities.

The present series of investigations was performed in order to study the clinical and cephalometric long-term postoperative stability of the maxilla and mandible after surgical correction of jaw abnormities. The patients studied had maxillary or mandibular anomalies, alone or in combination with each other. Standardized surgical methods for correction of jaw deformities were used. Rigid postoperative intermaxillary fixation was omitted in all cases. Masticatory function was recommended immediately after surgery and was increased at the patient's own pace. Patients were able to eat all kinds of food 2-4 weeks postoperatively, independent of type of surgical procedure. The clinical results were good. Intraoperative complications, such as bleeding, unpredictable segment fracture during the splitting procedure, and damage to the neurovascular bundle or roots were negligible. The incidence of postoperative infections was very low. Such infections were limited to the region close to the osteosynthesis material and cleared up as soon as the wires or screws were removed. Paresthesia of the lower lip was seen with the sagittal split procedure especially when it was combined with genioplasty, but disappeared within one year. Standardized pre- and postoperative clinical and roentgenological recordings were made. In order to evaluate the postoperative stability of the osteotomized jaw segments cephalometric analysis of headfilms taken preoperatively, immediately postoperatively and at least one year after surgery was performed. There were no clinically significant postsurgical changes in the position of the maxilla, either in solitary procedures or in bimaxillary corrections. With mandibular advancement the mandible had moved slightly upwards and with setback surgery there was a slight post-surgical forward-upward movement. Omission of postoperative intermaxillary fixation, in combination with swelling or difficulties in nasal breathing, disturbed the tight intercuspidation immediately after surgery. The small changes seen were thought to be the result of tighter inter-cuspidation at the follow-up registration than on the day after surgery.