Predictability of occlusion in orthognathic surgery is a constant challenge. The location of the mandibular condyle might differ between normal muscle tone while awake and relaxation under general anesthesia leading to a difference in planned and real position of the condylar segment in orthognathic osteotomies. In neurosurgery the temporary reduction of general anesthesia to conscious sedation is a well established method for intraoperative control of various sensory and motoric functions.
From 2005 we used conscious sedation for intraoperative control of occlusion in orthognathic surgery. We operated 13 patients with Sagittal Spilt Osteotomy using miniplate fixation, 11 patients with Le Fort I Osteotomy and 26 patients with both (Bimaxillary Osteotomy). Before wound closure anesthesia was reduced to conscious sedation. The patient was asked to move the mandible in all directions. Occlusion was checked and – if incorrect – anesthesia was deepened and correction of the miniplate fixation was performed followed by another reduction of anesthesia.
47 of 50 patients moved their mandible according to our instructions. 3 patients did not comply. 38 patients showed the planned occlusion. 6 patients had a malocclusion undergoing further correction. 3 patients had a malocclusion without further correction for various reasons. Postoperative occlusion was correct in 43 patients (+3 patients without compliance). 4 patients required elastic treatment for 3 weeks for minor discrepancies. No patient remembered the wake up procedure.
We conclude that intraoperative temporary reduction of general anesthesia to conscious sedation is an easy adjunct to the predictability of the outcome of orthognathic surgery.
Conflict of interest: None declared.