Ortognatik cerrahi uygulanan hastalarda postoperatif komplikasyonların yönetiminde alternatif stratejiler

Year 2020, Volume: 2 Issue: 1, 36 - 45, 29.02.2020

Tugay Özkeskin Aysenur Uzun Cevat Turgut Mehmet Yaltırık

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

References

• 1. Friscia M, Sbordone C, Petrocelli M, Vaira LA, Attanasi F, Cassandro FM, et al. Complications after orthognathic surgery : our experience on 423 cases complications. Oral Maxillofac Surg. 2017;21(2):171–7.
• 2. Yaedú R, Almeida ÃM De, Mello B, Tucunduva RA, Zabotini S, Prado M, et al. Postoperative Orthognathic Surgery Edema Assessment With and Without Manual Lymphatic Drainage. J Craniofac Surg. 2017;28(7):1816–20.
• 3. Ferri J. Récidives et dégradations de résultats en chirurgie orthognathique. Rev Stomatol Chir Maxillofac Chir Orale. 2014;115(4):250–60.
• 4. Tabrizi R, Sadeghi HMM. Complications of Orthognathic Surgery. A Textb Adv Oral Maxillofac Surg. 2016;3(26):597–616.
• 5. Shin S, Kang Y, Kim S. The effect of botulinum toxin-A injection into the masseter muscles on prevention of plate fracture and post-operative relapse in patients receiving orthognathic surgery. Maxillofac Plast Reconstr Surg. 2018;40(1):36.
• 6. Azam A, Manchanda S, Thotapalli S, Babu Kotha S. Botox Therapy in Dentistry : A Review. J Int Oral Heal. 2015;7(March):103–5.
• 7. Ko EW, Huang CS, Lo L. Alteration of Masticatory Electromyographic Activity and Stability of Orthognathic Surgery in Patients With Skeletal Class III Malocclusion. J Oral Maxillofac Surg. 2013;71(7):1249–60.
• 8. Gassner H, Boggust AJ, Weaver AL, Sherris DA. Botulinum toxin to improve facial wound healing: A prospective, blinded, placebo-controlled study. Mayo Clin Proc. 2006;81(August):1023–8.
• 9. Kim H, Yun P, Kim Y. A clinical evaluation of botulinum toxin-A injections in the temporomandibular disorder treatment. Maxillofac Plast Reconstr Surg. 2016;38(1):5.
• 10. Rafferty KL, Liu ZJ, Ye W, Navarrete AL, Nguyen TT, Salamati A, et al. Botulinum toxin in masticatory muscles : Short- and long-term effects on muscle, bone, and craniofacial function in adult rabbits. Bone. 2012;50(3):651–62.
• 11. Glass G, Waterhouse N, Shakib K. Hilotherapy for the management of perioperative pain and swelling in facial surgery: a systematic review and meta-analysis. Br J Oral Maxillofac Surg. 2016;54(8):851–6.
• 12. Lateef TA, AL-Anee AM, Fattah Agha MT. Evaluation the Efficacy of Hilotherm Cooling System in Reducing Postoperative Pain and Edema in Maxillofacial Traumatized Patients and Orthognathic Surgeries. J Craniofac Surg. 2018;29(7):697–706.
• 13. Moro A, Gasparini G, Marianetti TM, Boniello R, Cervelli D, Nardo F Di, et al. Hilotherm Efficacy in Controlling Postoperative Facial Edema in Patients Treated for Maxillomandibular Malformations. J Craniofac Surg. 2011;22(6):2114–7.
• 14. Rana M, Gellrich N-C, Joos U, Piffkò J, Kater W. 3D evaluation of postoperative swelling using two different cooling methods following orthognathic surgery : a randomised observer blind prospective pilot study. Int J Oral Maxillofac Surg. 2011;40(7):690–6.
• 15. Szolnoky G, Seres L, Boda K, Kemény L, Dermatology D, Phlebo-lymphology A, et al. Manual Lymph Drainage Efficiently Reduces Postoperative Facial Swelling and Discomfort After Removal of Impacted Third Molars. Lymphology. 2007;40(3):138–42.
• 16. Ferreira TRR, Sabatella MZ, Silva TMS. Facial edema reduction after alveolar bone grafting surgery in cleft lip and palate patients: a new lymphatic drainage protocol. Rev Gaúcha Odontol. 2013;52(5):341–8.
• 17. Lietz-Kijak D, Kijak E, Szczegielniak J. The Impact of the Use of Kinesio Taping Method on the Reduction of Swelling in Patients After Orthognathic Surgery : A Pilot Study. Med Sci Monit. 2018;4(24):3736–43.
• 18. Ristow O, Hohlweg-majert B, Kehl V, Koerdt S, Hahnefeld L, Pautke C. Does elastic therapeutic tape reduce postoperative swelling, pain, and trismus after open reduction and internal fixation of mandibular fractures? J Oral Maxillofac Surg. 2013;71(8):1387–96.
• 19. Genc A, Cakarer S, Yalcin BK, Kilic BB, Isler SC, Keskin C. A comparative study of surgical drain placement and the use of kinesiologic tape to reduce postoperative morbidity after third molar surgery. Clin Oral Investig. 2019;23(1):345–50.
• 20. Dan AEB, Thygesen TH. Corticosteroid Administration in Oral and Orthognathic Surgery : A Systematic Review of the Literature and Meta-Analysis. J Oral Maxillofac Surg. 2010;68(9):2207–20.
• 21. Semper-Hogg W, Fuessinger MA, Dirlewanger TW, Cornelius CP, Metzger MC. The influence of dexamethasone on postoperative swelling and neurosensory disturbances after orthognathic surgery : a randomized controlled clinical trial. Head Face Med. 2017;13(1):1–9.
• 22. de Rezende RA, Silva DN, Frigo L. Effect of GaAlAs low-level laser therapy on mouth opening after orthognathic surgery. Lasers Med Sci. 2018;33(6):1271–7.
• 23. D’avila RP, Espinola LV, Freitas P De, Silva A, Landes C, Luz JG. Longitudinal evaluation of the effects of low-power laser phototherapy on mandibular movements, pain, and edema after orthognathic surgery. J Cranio-Maxillo-Facial Surg. 2019;47(5):758–65.
• 24. Kormi E, Snäll J, Törnwall J, Thorén H. A survey of the use of perioperative glucocorticoids in oral and maxillofacial surgery. J Oral Maxillofac Surg. 2016;74(8):1548–51.
• 25. Abukawa H, Ogawa T, Kono M, Koizumi T, Kawase-koga Y, Chikazu D. Intravenous dexamethasone administration before orthognathic surgery reduces the postoperative edema of the masseter muscle: a randomized controlled trial. J Oral Maxillofac Surg. 2017;75(6):1257–62.
• 26. Ahiskalioglu A, Aksoy M, Yalcin E, Ahiskalioglu EO, Kilinc A. The effects of a single dose of pre-emptive pregabalin on postoperative pain and opioid consumption after double jaw surgery: A randomized controlled trial. J Oral Maxillofac Surg. 2015;74(1):53.
• 27. Cillo Jr. JE, Dattilo DJ. Pre-emptive analgesia with pregabalin and celecoxib decreases postsurgical pain following maxillomandibular advancement surgery: A randomized control clinical trial. J Oral Maxillofac Surg. 2014;72(10):1909–14.
• 28. Liébana-Hermoso S, Manzano-Moreno FJ, Vallecillo-Capilla MF, Olmedo-Gaya MV. Oral pregabalin for acute pain relief after cervicofacial surgery : a systematic review. Clin Oral Investig. 2018;22(1):119–29.
• 29. Lee U, Choi Y, Choi GJ, Kang H. Intravenous lidocaine for effective pain relief after bimaxillary surgery. Clin Oral Investig. 2017;21(9):2645–52.
• 30. Bittencourt M, Paranhos L. Low-level laser therapy for treatment of neurosensory disorders after orthognathic surgery : A systematic review of randomized clinical trials. Med Oral Patol Oral Cir Bucal. 2017;22(6):780–7.
• 31. Dayane, Lady, Travassos K, Victor Y, Muniz S, Marinho K, Barros A, et al. Effect of Infrared Laser in the Prevention and Treatment of Paresthesia in Orthognathic Surgery. 2013;24(3):708–11.
• 32. Gasperini G, Siqueira ICR De, Costa LR. Does low-level laser therapy decrease swelling and pain resulting from orthognathic surgery ? Int J Oral Maxillofac Surg. 2014;43(7):868–73.
• 33. Eckardt L, Harzer W, Schneevoigt R. Comparative study of excitation patterns in the masseter muscle before and after orthognathic surgery. J Craniomaxillofac Surg. 1997;25(6)(344):52.
• 34. Teng TT, Ko EW, Shing C, Chen Y. The Effect of early physiotherapy on the recovery of mandibular function after orthognathic surgery for Class III correction: part I--jaw-motion analysis. J Cranio-Maxillofacial Surg. 2015;43(1):131–7.
• 35. Kato K, Kobayashi T, Kato Y, Takata Y, Yoshizawa M, Saito C. Journal of Oral and Maxillofacial Surgery , Medicine , and Pathology Changes in masticatory functions after surgical orthognathic treatment in patients with jaw deformities : Efficacy of masticatory exercise using chewing gum. 2012;24:147–51.