Care of Patients Undergoing the Surgery-First Approach and Postoperative Orthodontics Involving Temporary Anchorage Devices

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© Springer Nature Singapore Pte Ltd. 2021

J.-W. Choi, J. Y. LeeThe Surgery-First Orthognathic Approachdoi.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

Jong-Woo Choi1   and Jang Yeol Lee2  
(1)

Department of Plastic Surgery, Asan Medical Center, Seoul, Korea (Republic of)
(2)

SmileAgain Orthodontic Center, Seoul, Korea (Republic of)
 
 
Jong-Woo Choi (Corresponding author)
 
Jang Yeol Lee
Keywords

Mandibular surgeryPostop careSSROIVROTADsMini-screwMini-implantDental compensationFixationPhysical therapy

4.1 Postoperative Care of Patients Undergoing the Surgery-First Approach

History of Orthognathic Surgery
Since the introduction of the first mandibular surgery involving Blair’s ostectomy, in 1907 [1], two mandibular surgery methods, introduced in the 1950s, have been used (Fig. 4.1). The first is intraoral vertical ramus osteotomy (IVRO) and the second is sagittal split ramus osteotomy (SSRO) [2, 3].

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Fig. 4.1

Two major methods for mandibular setback surgery; sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO)

Currently, both procedures are widely used; each has different features, advantages, and disadvantages. The following is a comparison of specific aspects of sagittal split ramus osteotomy and intraoral vertical ramus osteotomy (Table 4.1).

Table 4.1

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

IANV inferior alveolar neurovascular bundle, PT physiotherapy, MMF maxillomandibular fixation, SSRO sagittal split ramus osteotomy, IVRO transoral vertical ramus osteotomy

  1. 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.

SSRO
  • 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

Mar 5, 2021 | Posted by in Orthodontics | Comments Off on Care of Patients Undergoing the Surgery-First Approach and Postoperative Orthodontics Involving Temporary Anchorage Devices
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