Section of Oral and Maxillofacial Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI.
Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, New Haven, CT.
J Craniofac Surg. 2022;33(2):632-635. doi: 10.1097/SCS.0000000000008141.
Patients with significant dentofacial deformities undergoing aesthetic and functional orthognathic surgery may often require genioplasty to advance the position of the pogonion relative to B point. No study to date has evaluated nationally registered data pertaining to addition of osseous genioplasty to bimaxillary orthognathic surgery and its associated clinical outcomes.
Data was extracted from the National Surgical Quality Improvement Program from 2010 to 2018 using current procedural terminology codes pertaining to Le Fort I osteotomy (LF), bilateral sagittal split osteotomy (BSSO), and osseous genioplasty (G) and divided into 2 cohorts: bimaxillary orthognathic surgery with and without osseous genioplasty. Thirty-day postoperative outcomes inherently recorded within National Surgical Quality Improvement Program were identified and recorded. Chi-squared analysis and unpaired 2-tail t tests were performed between the cohorts and their respective outcomes to determine significant relationships with significance set as P < 0.05.
There were 373 patients double- or triple-jaw patients identified from the years 2010 to 2018. The most common recorded indication for LF/BSSO was maxillary hypoplasia (27.3%) and mandibular hypoplasia (6.8%). The most common indications for LF/BSSO/G were maxillary hypoplasia (16.1%) and maxillary asymmetry (16.1%). In comparison to LF/BBSO only, LF/BSSO/GP was not associated with any differences in the rate of surgical (0.0% versus 0.31%, P = 0.72) or medical complications (0.0% versus 0.63%, P = 0.60), in addition to unplanned readmissions (0.0% versus 1.56% versus P = 0.41) or reoperations (0.0% versus 1.25%, P = 0.46). However, osseous genioplasty addition was associated with increased overall operating time (271.77 versus 231.75 minutes, P = 0.04).
Osseous genioplasty does not alter short-term, 30-day complication rate when performed with bimaxillary orthognathic surgery. As reoperation rates remained relatively unchanged, it can be inferred that immediate adverse events or patient dissatisfaction were not apparent within 30 days. Although mean operating time is slightly longer, cardiopulmonary resuscitation without medical comorbidity was achieved at the conclusion of the procedure.
接受美学和功能正颌手术的严重牙颌面畸形患者通常需要颏成形术来使颏部相对于 B 点向前移动。迄今为止，尚无研究评估与双颌正颌手术相关的国家注册数据及其相关临床结果。
从 2010 年至 2018 年，使用与 Le Fort I 截骨术（LF）、双侧矢状劈开截骨术（BSSO）和骨颏成形术（G）相关的当前程序术语代码，从国家手术质量改进计划中提取数据，并分为 2 个队列：有和没有骨颏成形术的双颌正颌手术。在国家手术质量改进计划中内在记录的 30 天术后结果被识别和记录。在队列及其各自结果之间进行卡方分析和未配对的 2 尾 t 检验，以确定与设定显著性水平为 P < 0.05 的显著关系。
在 2010 年至 2018 年间，共确定了 373 例双颌或三颌患者。LF/BSSO 最常见的记录指征是上颌发育不全（27.3%）和下颌发育不全（6.8%）。LF/BSSO/G 最常见的指征是上颌发育不全（16.1%）和上颌不对称（16.1%）。与 LF/BBSO 相比，LF/BSSO/GP 并没有导致手术（0.0%与 0.31%，P = 0.72）或医疗并发症（0.0%与 0.63%，P = 0.60）的发生率发生任何差异，此外，计划外再入院（0.0%与 1.56%，P = 0.41）或再手术（0.0%与 1.25%，P = 0.46）也没有差异。然而，骨颏成形术的加入与总手术时间的延长相关（271.77 与 231.75 分钟，P = 0.04）。
在进行双颌正颌手术时，骨颏成形术不会改变 30 天内的短期并发症发生率。由于再手术率相对不变，可以推断在 30 天内没有明显的即刻不良事件或患者不满意。尽管平均手术时间略长，但在手术结束时实现了无医疗合并症的心肺复苏。
