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Title: Complex Orthognathic Surgery, Triple jaw-Plus, in an Outpatient Setting: A Paradigm Shift
John Collar
*1, Mark Valdes
2, Derek M. Steinbacher
31Department of Surgery - Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT; 2Frank H. Netter, MD School of Medicine at Quinnipiac University, North Haven, CT; 3West River Surgery, Durham, CT
Introduction: Double jaw and genioplasty procedures involve complex movements of the facial bones to improve aesthetics and function. Traditionally these procedures are performed in a hospital setting with extended overnight stays. This study investigates feasibility and outcomes of performing complex multi-jaw surgery in an outpatient setting.
Methods: A retrospective analysis on orthognathic surgery cases involving at minimum the maxilla, mandible, and chin together (triple jaw cases), as well as additional concurrent procedures, performed by a single surgeon at the same outpatient Ambulatory Surgical Center (ASC), over a 1.5 year period. Demographics, details of surgical procedures, anesthesia, length of procedure, length of recovery period in the facility, post-operative course, hospital transfers, admissions, or emergency visits, and outcomes were all assessed.
Results: 140 patients were identified. Nearly equal numbers of males/females, average age of 30.9, were treated. All underwent triple jaw surgery-plus (Lefort -1, BSSO, Genioplasty, plus at least 2 other ancillary procedures). Average operative time was 194.5 minutes, and mean recovery room duration was 123.3 minutes. All patients were discharged home the same day. No patient required hospital transfers or admissions, and no emergency admissions were required postoperatively. Postoperative antiemetics were administered, although only one patient vomited. No patients experienced airway complications postoperatively. Infection rate was 1.4% and there was 0% incidence of hardware complications, exposure or breakage. Patient satisfaction rates were >99%.
Conclusions: Complex combined double jaw, genioplasty plus combined procedures, can be safely performed in an outpatient ambulatory setting with an experienced high-volume surgeon. ASC orthognathic surgery offers a promising alternative to conventional hospital-based care with overnight admissions. This series suggests that efficiency, recovery, outcomes, reduced nausea and infection, and patient satisfaction may be optimized in the ASC setting.
Table 1. Patient Demographics and Surgical Characteristics (n = 140)
| Variable | Value |
| Sex (Male : Female) | 71 : 69 |
| Age (years) | 30.9 ± 10.5 |
| Type of Jaw Surgery | Triple Jaw Surgery (100%) (n = 140) |
| Ancillary Procedures | |
| - Fat Grafting | 100% (n = 140) |
| - Bone Grafting | 100% (n = 140) |
| - TMJ Procedure | 20% (n = 28) |
| - Submental Liposuction | 32.1% (n = 45) |
| - Facial Implants | 14.3% (n = 20) |
| - Buccal Fat Removal | 4.3% (n = 6) |
| 3D Planning Used | 100% (n = 140) |
| Average Operative Time | 194.5 minutes |
| Discharged Same Day | 100% (n = 140) |
| Required Hospital Admission from ASC | 0% (n = 0) |
| Postoperative Vomiting | 0.7% (n = 1) |
| Infection Rate | 1.4% (n = 2) |
| Hardware Exposure or Failure | 0% (n = 0) |
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