Perioperative complications in corrective facial orthopedic surgery: a 5-year retrospective study

Frequency and severity of complications have a profound impact on referral patterns for facial orthopedic surgery. Therefore, a retrospective study was undertaken to determine the incidence of such problems in a large series of patients, with the intent to use these data to make possible changes in the perioperative protocol used in our clinic.

The files of all patients operated on between 1992 and 1996 were studied. These comprised 1,108 patients with 1,872 osteotomy procedures. The following parameters were descriptively analyzed: airway obstruction, hemorrhage, hematoma, infection, neurosensory disturbances, unfavorable fractures, malposition of condyles and nasal septum, and vascularization problems.

The most frequent complication was impairment of trigeminal nerve function. In 31.5% of the mandibular base osteotomies, 43.6% of the combined mandibular base and chin osteotomies, and 13% of the chin osteotomies, lip sensibility was decreased immediately postoperatively. After 1 year, this number was reduced to approximately 5%. The function of 17 lingual nerves and 45 infraorbital nerves was temporarily impaired. A wound infection was next in frequency. Fifty-three infections (mandible-to-maxilla ratio, 2.5:1) were treated with drainage under local anesthesia and antibiotic therapy. Loss of part or all of an osteotomized segment did not occur. Other complications were rare and/or temporary.

The most frequent complication was impairment of inferior alveolar nerve function. Life-threatening complications were not encountered. The frequency of infections (<5%) requires further consideration regarding ways to reduce the incidence.