Our Summary

This research paper analyzes the complications, cost, and socioeconomic factors related to two types of jaw surgery: LeFort I osteotomy (LF1) and bilateral sagittal split osteotomy (BSSO). The study looked at surgeries performed in the US from 2010 to 2020 on patients aged 12 and above.

The research found that patients who had the LF1 surgery were more likely to have complications, infections, and need blood transfusions than those who had the BSSO surgery.

Hospitals that performed a lot of these surgeries (high-volume hospitals) were more likely to do double-jaw procedures and less likely to have surgical complications. These hospitals also charged less for patient admissions related to these surgeries.

The study also found that people with higher incomes were more likely to have these surgeries at high-volume hospitals. Additionally, white patients were 1.5 times more likely to go to a high-volume hospital further away for their surgery instead of a local one.

The research concludes that more studies are needed to understand the factors contributing to these differences in complications, cost, and patient choices.

FAQs

  1. What are the common complications associated with LeFort I osteotomy (LF1) and bilateral sagittal split osteotomy (BSSO)?
  2. Are high-volume hospitals better equipped for performing jaw surgeries and why are they less expensive?
  3. How do socioeconomic factors influence a patient’s choice of hospital for orthognathic surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about orthognathic surgery is to choose a high-volume hospital with experienced surgeons, as they are less likely to have complications and may offer lower costs for the procedure. Additionally, it is important to follow post-operative care instructions carefully to ensure proper healing and successful outcomes.

Suitable For

Orthognathic surgery, including LeFort I osteotomy and bilateral sagittal split osteotomy, is typically recommended for patients with severe malocclusion, facial asymmetry, obstructive sleep apnea, temporomandibular joint disorders, and other jaw-related issues that cannot be corrected with orthodontic treatment alone. These patients often experience difficulty chewing, speaking, and breathing due to the misalignment of their jaws.

Patients who undergo orthognathic surgery are usually in their late teens or early adulthood, as their jaw growth is complete and stable. However, orthognathic surgery can be performed on patients of any age, depending on their specific needs and overall health.

Overall, orthognathic surgery is recommended for patients who have significant jaw discrepancies that affect their quality of life and cannot be corrected with orthodontics alone. These patients should be in good overall health and have realistic expectations about the outcomes of the surgery. It is essential for patients to consult with an oral and maxillofacial surgeon to determine if orthognathic surgery is the right treatment option for them.

Timeline

Before orthognathic surgery:

  1. Consultation with an orthodontist and oral surgeon to determine the need for surgery and create a treatment plan.
  2. Orthodontic treatment to align the teeth and prepare them for surgery.
  3. Pre-surgical assessments and tests to evaluate the patient’s overall health and suitability for surgery.
  4. Pre-operative counseling to discuss the procedure, potential risks, and expected outcomes.

After orthognathic surgery:

  1. Hospitalization for a few days to monitor the patient’s recovery and manage any post-operative pain.
  2. Follow-up appointments with the oral surgeon and orthodontist to monitor healing and adjust the bite as needed.
  3. Gradual return to normal activities, including eating solid foods and resuming regular oral hygiene practices.
  4. Long-term follow-up to monitor the stability of the surgical results and address any late complications or issues.

Overall, orthognathic surgery is a complex procedure that requires careful planning, coordination between multiple healthcare providers, and ongoing support for the patient’s recovery and long-term success.

What to Ask Your Doctor

Some questions a patient should ask their doctor about orthognathic surgery include:

  1. What are the potential complications associated with the specific type of jaw surgery I am considering (LF1 or BSSO)?
  2. How common are infections and the need for blood transfusions after this type of surgery?
  3. Are there any factors that may increase my risk of complications during or after the surgery?
  4. How experienced is the surgical team in performing this type of jaw surgery?
  5. What is the estimated cost of the surgery, including hospital fees, anesthesia, and follow-up appointments?
  6. Are there any alternative treatment options for my jaw condition that do not involve surgery?
  7. How long is the recovery process expected to be, and what kind of post-operative care will I need?
  8. Will I need to follow a specific diet or make any lifestyle changes after the surgery?
  9. Are there any long-term effects or risks associated with orthognathic surgery that I should be aware of?
  10. Can you provide me with information on high-volume hospitals that have a good track record for performing these surgeries with lower complication rates?

Reference

Authors: Kalmar CL, Chaker S, Pontell ME, O’Sick NR, Golinko MS. Journal: J Craniofac Surg. 2023 Jul-Aug 01;34(5):1410-1415. doi: 10.1097/SCS.0000000000009188. Epub 2023 Feb 20. PMID: 36804875