The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats. Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics, Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call 0091-9248678078

1. Complications of
Bimaxillary
Orthognathic Surgery
INDIAN
ACADEMY
DENTAL
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com

2. Definitions
Bimaxillary surgery involves
orthognathic procedures on both the
mandible and maxilla
Generally these procedures are the Le
Fort I osteotomy and the Bilateral
Sagittal Split osteotomy
Other procedures may include
genioplasty and rhinoplasty
www.indiandentalacademy.com

3. Historical Perspective
In the last twenty years bimaxillary surgery
has become accepted as a relatively safe
procedure
Prior to this complications were more
frequent due to the following
Poor instrumentation
 Lack of scientific studies
 Poor techniques
 Prolonged procedures
 Traditional methods of fixation
 Anaesthetic related problems

www.indiandentalacademy.com

4. Complications
All surgical procedures have complications
and morbidities
Most complications are prevented by
planning and awareness
If you never do surgery, you never get
surgical complications
If you do enough surgery you will have
complications
The aim is to minimise incidence of morbidity
www.indiandentalacademy.com

5. Complications
Systemic
Local
Preoperative
Intraoperative
Postoperative
Short Term
 Long Term

www.indiandentalacademy.com

6. Systemic
Cardiovascular / Renal
Hypovolaemia
 Shock
 Stroke
 Acute Renal Failure

Respiratory
Airway Compromise
 Aspiration
 Atelectasis
 Pneumonia

www.indiandentalacademy.com

7. Systemic
Anaesthetic Related
Anaphylaxis
 Malignant Hyperthermia
 Drug Toxicity

Pain
Psychiatric
Body Dysmorphic Disorder
 Conversion Disorder

www.indiandentalacademy.com

8. Local
As discussed in following slides
Balance of the orthodontic treatment
objective and surgical treatment
objective
www.indiandentalacademy.com

9. Preoperative
Inadequate planning
 Cephalometrics
 Impressions
 Facebow/articulator
 Model
surgery
 Surgical Wafers
www.indiandentalacademy.com

10. Operative
Failure to achieve the surgical objective
Haemorrhage
Maxilla
Devascularization
 Inability to mobilize maxilla
 Inability to reduce vertical height
 Unfavourable osteotomy pattern
 Condylar distraction
 Nasal septum deviation

www.indiandentalacademy.com

11. Operative
Mandible

Inappropriate split
Buccal plate fracture
 Lingual plate Fracture
 Condylar split


Inferior alveolar nerve
Nerve in proximal segment
 Neuropraxia, Neuronometsis, Axonometsis

Facial Nerve
 Lingual Nerve

www.indiandentalacademy.com

12. Operative
Mandible
 Inadequate
external oblique ridge
reduction
 Damage to dental and related structures
www.indiandentalacademy.com

13. Operative
Fixation problems
Inadequate Fixation
 Large osteotomy gaps
 Inadequate bony apposition
 Inadequate condylar position

Soft tissue Injuries

Lips, cheeks, nose
Damage to surrounding structures
Immediate relapse
www.indiandentalacademy.com

14. Postoperative
Short Term
Cardiovascular
Secondary Haemorrhage
 Avascular Necrosis maxillary segments
 Haematoma formation

Infection
Bone Healing / Fixation
Failed Fixation
 Delayed Union
 Mal / Nonunion

www.indiandentalacademy.com

15. Postoperative
Short Term
Early Relapse
Poor fixation
 Unstable final postion
 Condylar sag
 Idiopathic Condylar Resorption

Extrusion of teeth
Neuronal Deficit

Paraesthesia, anaesthesia, dysaesthesia,
hyperaesthesia
www.indiandentalacademy.com

16. Postoperative
Long Term
Relapse
Fixation
 Exposure
/ Infection
T.M.J. Pain
Neuronal Deficits
Patient Disatisfaction
www.indiandentalacademy.com

17. Reducing Complications
Adequate Planning
Listen to the patient concerns
 Set realistic goals for treatment
 Communication with orthodontist

Accuracy of preoperative work up
Assessment of growth
 Models
 Articulation
 Model surgery

www.indiandentalacademy.com

18. Reducing Complications
Meticulous Surgery
 Good
instrumentation
 Assistance
 Adequate force
 Careful dissection
Consider Autologous blood donation
Careful postoperative followup
www.indiandentalacademy.com

19. Thank you
For more details please visit
www.indiandentalacademy.com
www.indiandentalacademy.com