Obstructive airway compromise in the early postoperative period after orthognathic surgery

Between January 1, 1989 and April 30, 2012, approximately 2164 consecutive patients were treated with orthognathic surgery at the St. John's Hospital, Genk, Belgium. They all underwent a mandibular, maxillary, or bimaxillary osteotomy, performed by one of the 3 resident maxillofacial surgeons at the St. John's hospital in Genk. The purpose of the review was to investigate the incidence of major airway difficulties occurring postoperatively because of surgically related causes. It seemed that obstructive airway compromise was the only reason for urgent intervention to protect or to restore the airway. In total, 3 urgent unanticipated life-saving reintubations were attempted. One was successful, and the other was changed into an urgent tracheostomy. No deaths occurred in this patient series after orthognathic surgery. Osseous genioplasties, as stand-alone surgery or in combination with other simultaneous orthognathic procedures, do care the risk for a life-threatening respiratory distress because of a hematoma of the floor of the mouth, when performed with an oscillating saw or a surgical drill. If so, this probably will happen within the first 4 postoperative hours according to the experience in our series. This risk can be avoided by using a piezosurgical unit to perform the osseous genioplasty.