Posnick J C, Choi E, Chavda A
Posnick Center for Facial Plastic Surgery, Chevy Chase, MD, USA; Georgetown University, Washington, DC, USA; University of Maryland School of Dentistry, Baltimore, Maryland, USA; Oral and Maxillofacial Surgery, Howard University College of Dentistry, Washington, DC, USA.
Past Chief Resident, Howard University Hospital, Washington, DC, USA; Currently Private Practice, Stockton and Modesto, California, USA.
Int J Oral Maxillofac Surg. 2017 Oct;46(10):1276-1283. doi: 10.1016/j.ijom.2017.05.014. Epub 2017 Jun 29.
The purpose of this study was to determine the incidence and causes of fixation hardware removal after bimaxillary orthognathic, osseous genioplasty, and intranasal surgery. A retrospective study was performed, involving subjects with a bimaxillary developmental dentofacial deformity (DFD) and symptomatic chronic obstructive nasal breathing. At a minimum, subjects underwent Le Fort I osteotomy, bilateral sagittal ramus osteotomies (SROs), septoplasty, inferior turbinate reduction, and osseous genioplasty. The primary outcome variable studied was fixation hardware removal. Demographic, anatomical, and surgical predictor variables were assessed. Two hundred sixty-two subjects met the inclusion criteria. Their mean age at operation was 25 years (range 13-63 years); 134 were female (51.1%). Simultaneous removal of a third molar was performed in 39.9% of SROs. Three of 262 Le Fort I procedures (1.1%) and two of 524 SROs (0.4%) required hardware removal. There were four cases of ramus wound dehiscence, four of ramus surgical site infection (SSI), one of chin SSI, two of maxillary sinusitis, and one of lingual nerve injury; none of these subjects underwent hardware removal. A limited need for fixation hardware removal after orthognathic procedures was confirmed. There was no statistical correlation between hardware removal and patient sex, age, pattern of DFD, simultaneous removal of a third molar, or occurrence of wound dehiscence, SSI, or lingual nerve injury.
本研究的目的是确定双颌正颌手术、颏成形术和鼻内手术后内固定器械取出的发生率及原因。进行了一项回顾性研究，纳入患有双颌发育性牙颌面畸形（DFD）和有症状的慢性阻塞性鼻呼吸的受试者。受试者至少接受了Le Fort I截骨术、双侧矢状劈开截骨术（SRO）、鼻中隔成形术、下鼻甲切除术和颏成形术。研究的主要结局变量是内固定器械取出。评估了人口统计学、解剖学和手术预测变量。262名受试者符合纳入标准。他们手术时的平均年龄为25岁（范围13 - 63岁）；134名女性（51.1%）。39.9%的SRO同时拔除了第三磨牙。262例Le Fort I手术中有3例（1.1%）和524例SRO中有2例（0.4%）需要取出内固定器械。有4例升支伤口裂开、4例升支手术部位感染（SSI）、1例颏部SSI、2例上颌窦炎和1例舌神经损伤；这些受试者均未取出内固定器械。证实正颌手术后对内固定器械取出的需求有限。内固定器械取出与患者性别、年龄、DFD类型、同时拔除第三磨牙或伤口裂开、SSI或舌神经损伤的发生之间无统计学相关性。
