(30) Revision Orthognathic Surgery: Retrospective Analysis of Cases Detailing Preoperative Indications, Intraoperative Findings, and Postoperative Complications

Abstract:

Objective: The aim of this study was to investigate cases of revision orthognathic surgery (OGS) requiring re-osteotomy of the maxilla or mandible, examine presurgical indications for reoperation, analyze the intraoperative surgical findings and challenges, and evaluate postoperative outcomes.

Materials and methods: A retrospective cohort study of subjects undergoing revision OGS at a single institution between January 2001 and 2023 was undertaken. Subjects undergoing revision OGS were identified through an institutionally maintained database of surgical cases utilizing search query key words: revision, retreatment, previously failed, reoperation, and redo. Cases were additionally sorted by maxillary or mandibular revision surgery. Key variables of interest included indications for reoperation surgery, intraoperative findings, surgical interventions employed, postoperative hospital stay duration, and postoperative complications. Subjects were excluded from the study cohort if their index OGS was completed for syndromic craniofacial anomalies, revision surgery for index traumatic etiologies, or for inadequate documentation of preoperative, intraoperative, or postoperative variables of interest. Basic demographic and descriptive statistics on the study cohort were generated.

Results: The initial index query using search terms yielded 40 potential subjects undergoing revision maxillary OGS and 31 potential subjects undergoing revision mandibular OGS. Following retrospective chart review and the application of exclusion criteria, 20 subjects remained in the maxillary revision cohort, and 15 in the mandibular cohort. Primary indications for maxillary revision in the study cohort were relapse or malocclusion not remediable by orthodontic treatment alone, affecting 11 subjects (55.0%), and non-union/maxillary mobility in 8 subjects (40.0%). The primary indications for mandibular revision OGS in the study cohort were relapse or malocclusion not remediable by orthodontic treatment alone, impacting 13 subjects (86.7%). Primary indications for maxillary revision in the study cohort were relapse or malocclusion not remediable by orthodontic treatment alone 11 subjects (55.0%) and non-union/maxillary mobility in 8 subjects (40.0%). Primary indications for mandibular revision OGS in the study cohort were relapse or malocclusion not remediable by orthodontic treatment alone 13 subjects (86.7%).
Intraoperative findings in maxillary revision surgery included persistent scar tissue or fibrous adhesions in 14 subjects (70.0%), significant bony defects in 5 subjects (25.0%), and septal deviation or lack of nasal support in 4 subjects (20.0%). Unique intraoperative interventions employed for maxillary revision surgery included bone grafting in 7 subjects (35.0%), revision of osteotomy edges in 5 subjects (25.0%), and custom plate use in 1 subject (5.0%). Intraoperative findings in mandibular revision surgery included significant bony defects in 5 subjects (33.3%) and difficulty with fixation in 2 subjects (13.3%). Unique intraoperative interventions employed for mandibular revision surgery included bone grafting in 4 subjects (26.7%) and modified osteotomies in 2 subjects (13.3%).
The average hospital stay for maxillary and mandibular revision surgery was 1.8 days and 2.0 days, respectively. Early postoperative complications for maxillary revision surgery included infection in 2 subjects (10.0%) and loss of fixation in 1 subject (5.0%). Relapse at 24 months not amenable by orthodontics occurred in 3 subjects (15%). Early postoperative complications for mandibular revision surgery included infection in 2 subjects (13.3%) and loss of fixation in 2 subjects (13.3%). Long-term paresthesia in the V3 distribution was present in 2 subjects (13.3%), and dysgeusia was present in 1 subject (6.7%).

Conclusion: Indications for revision OGS appear to be most commonly associated with surgical relapse and non-union. Compared to reported historical complication rates of patients undergoing routine orthognathic surgery, revision OGS does not appear to be associated with increased frequency of postoperative complications.

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