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J.-W. Choi, J. Y. LeeThe Surgery-First Orthognathic Approachhttps://doi.org/10.1007/978-981-15-7541-9_4
4. Postoperative Care of Patients Undergoing the Surgery-First Approach and Postoperative Orthodontics Involving Temporary Anchorage Devices
Mandibular surgeryPostop careSSROIVROTADsMini-screwMini-implantDental compensationFixationPhysical therapy
4.1 Postoperative Care of Patients Undergoing the Surgery-First Approach
Comparison of specific aspects of sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) [8]
SSRO |
IVRO |
|
---|---|---|
Osteotomy |
Posteroanterior sagittal split |
Lateromedial cut |
Open procedure |
Blind procedure |
|
Along IANV |
Rear to IANV |
|
Frequent exposure of IANV |
No exposure to IANV |
|
Bone healing |
Contact on marrow to marrow |
Contact on cortex to cortex |
Bone fixation |
Rigid internal fixation |
No fixation |
Condylar head |
Original position |
New equilibrated position |
Postop MMF |
None or shorter period |
Required (for 7–10 days) |
Prognosis |
Weakly dependent on PT |
Strongly dependent on PT |
-
1.
Postoperative care differences between SSRO and IVRO
SSRO and IVRO have different areas for resecting bone segments and different muscles attached to each bone segment. In addition, as mentioned in the table above, because the mechanism of bone healing of segments is different, the postoperative fixation method is different, which leads to differences in the postoperative care. The following is a summary of the differences in the post-operative care method for each technique, and even in the case of surgery-first approach, the same principles and procedures are accompanied for post-operative care for each technique.
-
Short-term intermaxillary fixation
-
Early distal segment stability
-
Requires fixation (plate, screws)
-
Requires a second surgery
-
-
Inferior alveolar neurovascular bundle
-
Possible proximal segment displacement
-
Sagging, torque (relapse), temporomandibular joint problems
-
-
Date of procedure to bone healing is about 6–8 weeks
-
1–2 weeks of care by the surgeon
-
3–8 weeks of care by the orthodontist
-
Depends on the mandibular position during the bone healing period