Comparison of revision and primary orthognathic surgery: Indications and Sequelae
Robin Wu, BS, Alexander Wilson, BS, Derek Steinbacher, DMD, MD.
Yale University School of Medicine, New Haven, CT, USA.
Purpose
There is a paucity of literature on revision orthognathic surgery, which, as with any secondary procedure, is accompanied by greater complexity and difficulty. We reviewed our revision orthognathic series, to (1) identify the reasons for revision, and (2) compare pre, peri, and postoperative variables to a matched primary cohort.
Methods
This was a retrospective review of 32 age-matched patients (16 primary; 16 revisions) operated by the senior author. Data were combed for pre, peri, and postoperative outcomes. Statistical analysis used student T-tests and z-scores.
Results
The revision group performed repeat Le Fort, BSSO, and genioplasty in 69, 64, and 45%, respectively. A subset of cases were tertiary, where Le Fort, BSSO, and genioplasty we redone in 100%. Reasons for revision included undercorrection or relapse toward original deformity (50%), or creation of a new deformity (50%). Hardware malposition and TMJ changes were detected in some cases (19%, 13%). Bony and hardware malposition from intraoperative error, planning, or execution accounted for the majority (69%) of new discrepancies. 3D planning/VSP was not frequently initially utilized, compared to the revision (31% v. 88%; p<0.001).
There was a significantly higher percentage of asymmetry (p=0.002) and excess gingival show (p=0.034) in the revision series compared to the primary series and a significantly higher percentage of retrognathia (p=0.035) and maxillary hypoplasia (p=0.016) in the primary group. The proportion of perioperative complications was statistically identical between both groups.
Conclusion
Revision orthognathic surgery is challenging and used to address incomplete resolution of deformity, relapse, or iatrogenically created bony malposition. In this series, primary procedures effectively remedied anteroposterior problems, whereas revisions necessitated fine tuning of bony asymmetry and gingival show. Multiple past revisions lead to a higher likelihood of repeat operation.
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