Comparison of Orthognathic Surgery Outcomes Between Patients With and Without Underlying High-Risk Conditions: A Multidisciplinary Team-Based Approach and Practical Guidelines

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  Figure 1. Flowchart for inclusion of orthognathic surgery (OGS)-treated patients with (high-risk patients) and without (regular-risk) underlying high-risk conditions.

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  Figure 2. Multidisciplinary orthognathic surgery team-based approach. For patients without underlying high-risk conditions (regular-risk group), preoperative assessment (general and surgically focused history, physical examinations, and recommendations based on the American Society of Anesthesiologists Physical Status (ASA-PS) scores) conducted by the surgical and anesthetic teams are typically sufficient. For patients receiving diagnosed or presumed underlying high-risk conditions (high-risk group), specialty-specific consultations are required. Based on an accurate diagnosis (including complementary tests), patients may have their orthognathic surgery programmed or a preoperative optimization may be required before surgery. Condition-specific guidelines with practical recommendation for perioperative care are provided by the medical specialist team.

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  Figure 3. Multistep orthognathic surgery journey from the initial preoperative multidisciplinary-based consultation to reintegration into society after correction of facial deformity and malocclusion. Patient provided written consent for the use of his image.

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  Figure 4. Case of a 16-year-old girl with Sturge Weber syndrome with a left face vascular malformation. The involvement of skeletal and soft tissues was extensive. She had received several sclerosing agent injections and laser treatments to reduce the vascular lesions. She experienced an episode of prolonged bleeding after a tooth extraction. Her facial deformity was characterized by left facial overgrowth and malocclusion with anterior open bite. Computed tomography angiography showed localized hypervascularity but no intracranial vascular malformation. Three-dimensional simulation was performed for surgical planning. She received Le Fort I, bilateral sagittal split of the ramus, genioplasty, and reduction of the left zygoma and buccal fat pad. Intraoperative blood oozing was noted, but was under control. Postoperative intermaxillary immobilization was not required, and the course was uneventful. One year later, she received the second stage of soft tissue reduction. The patient and her parents were satisfied with the treatment. (MMC: maxillomandibular complex). Patient provided written consent for the use of her image.

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  Figure 5. Case of an 18-year-old woman with a facial deformity characterized by a long face, mandibular protrusion, and chin deviation. She had a history of operation for biliary atresia during infancy, and liver cirrhosis and esophageal varices during adulthood. Her underlying conditions were adequately controlled. She underwent orthognathic surgery with Le Fort I, Wassmund osteotomy, bilateral sagittal split of the ramus, and genioplasty, with no postoperative intermaxillary immobilization. Her postoperative course was uneventful, and the results on occlusion and facial appearance were satisfactory. At follow-up 3 years after surgery, she appeared satisfied and reported psychosocial improvement. Patient provided written consent for the use of her image.