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What I Orthognathic surgery – what I wish I’d known Lucy Davenport-Jones. BOC 2021. Episode 135. September 29th 2021

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Hosted by
Farooq Ahmed

 

Join me for Lucy’s lecture looking at 3 aspects of orthognathic surgery; 3D planning,  body dysmorphia and obstructive sleep apnoea.

 

 

Digital workflow

o   CBCT

o   Scanned models

o   Digital surgical planning

o   Surgical cuts planned

o   Customised plates

o   Re-assess planned Vs delivered changes

 

Video assessment

o   Soft tissues in animation

o   incisal show, rest, smiling

 

CBCT assessment

o   Can assess maxilla relative to cranial base – not possible with plan views

o   Detailed assessment of maxillary cant

o   Apex of roots visible

o   Cuts can be planned away from roots

o   ID nerve position and plan around them

o   Cutting guides

o   Screw holes for guide and plates

o   Bone depth measured and appropriate screw selected

 

Post operative assessment

o   End CBCT superimpose plates and planned position

 

Advantages

o   Diagnosis – especially asymmetry

o   Planning

o   Execution – more controlled surgery

o   Stability – of union due to predictable bone thickness

o   Safety – nerve

o   Teaching

o   Communication

o   Post op analysis

 

Shared decision making

o   NICE guidelines on SDM

o   Involvement in surgical planning for patients

 

 

Disadvantages of 3D planning

 

o   Cost – 2-3k per patient

o   Soft tissue analysis unpredictable

o   Airway analysis unpredictable

o   60 minutes additional time per case in planning

o   Plates not adaptable

 

Lucy – what has she learned

o   Change maxillary impaction points

 

Airway consideration

o   Effects of mandibular set back

o   Sleep study

o   Mandibular advancement splint

o   Repeat sleep study

o   Plan bimaxillary advancement

o   Mallampati – visual assessment, most OSA patients grade 4 – due to base of tongue

o   Caution of large maxillary set back

 

 

Body dysmorphia BDD

o   Believe they look abnormal or are deformed when they are not

o   Likely dissatisfied with treatment outcomes

o   1.7-2.4% in population, greater in those seeking treatments

o   Effect of Covid, worsening of BDD  Quittkat 2020

o   Zoom dysmorphia – people living in isolation with greater awareness of appearance

o   Patients working from home = seeking more treatment

o   Symptoms of BDD worsened with working from home

o   Screening of BDD for orthognathia surgery

o   BDD screening questionnaire

o   Preoccupation, level of distress, impaired social function

o   Lucy has learned

o   Difficult conversation

o   Beware of multiple surgeries

o   Don’t offer less evasive treatment, will still remain dissatisfied

 

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