Ortognatik cerrahi uygulanan hastalarda postoperatif komplikasyonların yönetiminde alternatif stratejiler

Abstract

Ortognatik cerrahi işlemler, diş ve çenelerin maloklüzyonunun tedavisi ile fonksiyon ve estetiği iyileştiren multidisipliner bir girişimdir. Ancak postoperatif dönemde hastanın hayat kalitesini düşürüp ameliyatın başarısını etkileyebilecek ağrı, ödemi, trismus, yutma, çiğneme ve nefes almada güçlük, sinir hasarına bağlı duyu kusurları, temporomandibular eklem disfonksiyonu, baş-boyun hareketlerinde kısıtlılık, enfeksiyon, geri dönüş gibi komplikasyonlara neden olabilmektedir. Komplikasyonları önlemek için rutin uygulamada antibiyotik, analjezik ve soğuk tedavisi kullanılmaktaysa da birtakım girişimsel olan veya olmayan ek tedavi yöntemleri mevcuttur. Bu makalede, ortognatik cerrahi uygulanan hastalarda postoperatif şikayetlerin azaltılmasına yönelik alternatif yöntemler PubMed, MEDLINE, Google Scholar ve ClinicalKey veritabanlarının taranmasıyla derlenmiştir. Botulinum Toksin A, lazer fototerapi, kineziyoterapi, kortikosteroid enjeksiyonu, lidokain ve pregabalin enjeksiyonu, hiloterapi, manuel lenfatik drenaj ve fizyoterapi bu komplikasyonları azaltmak için en çok başvurulan yöntemlerdir. Bu alternatif tedavilerin klinik kullanımının artması ortognatik ameliyatlarının başarısını ve hasta konforunu önemli ölçüde arttıracaktır. Hangi yöntemlerin seçileceğine, ameliyatın türü ve hastanın şikayetlerine göre, hekim ile hasta birlikte karar vermelidir.

Keywords

• ortognatik cerrahi,ödem,ağrı

Alternative strategies for the management of postoperative complications in patients with orthognathic surgery

Abstract

Orthognathic surgical procedures provide correction of the dentoskeletal deformity with improvement on the function as well as the aesthetics of the patient through a multidisciplinary treatment. There is a wide variety of postoperative complications such as pain, swelling, trismus, difficulty in swallowing, mastication and breathing, neurosensory disturbances due to nerve damage, temporomandibular joint dysfunction, limitation of head and neck movements, infection and relapse which may decrease the quality of life of the patient or affect the operative success. Although antibiotics, analgesics and cold therapy are routinely used to prevent such complications, there are additional interventional or non-invasive treatments. In this article, alternative methods to reduce postoperative morbidity in patients undergoing orthognathic surgery were reviewed on PubMed, MEDLINE, Google Scholar and ClinicalKey databases. Botulinum Toxin A, laser phototherapy, kinesiotherapy, dexamethasone injection, lidocaine and pregabalin injection, hilotherapy, manual lymphatic drainage and physiotherapy were defined as the most commonly used methods. Increasing clinical use of these alternative therapies will significantly improve the success of orthognathic surgery and patient comfort. Depending on the type of surgery and the patient’s complaints, the physician and the patient should decide together which methods to be chosen.

Keywords

• ortognathic surgery,edema,pain

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