Risks associated with bimax

[Deleted member 18582]

Complications associated with orthognathic surgery

While most patients undergo orthognathic surgery for aesthetic purposes, aesthetic improvements are most often followed by postoperative functional complications. Therefore, patients must carefully decide whether their purpose of undergoing orthognathic ...

www.ncbi.nlm.nih.gov

This is the latest article that summarizes the rate of complications from orthognathic surgery that I have noticed often serves as a reference for the risks of undergoing bimax. It is from 2017. It calculates percentages for complications based on previous articles published on the same topic in an attempt to arrive at a summary of the risks.

I've noticed this study has some limitations. I just wanted to bring them up so we can arrive at a better clarity as to the risks of doing this surgery today.

The source materials they use have some issues, some for which the author is at fault and others not:

• The article itself was published in 2017, so the study itself was probably written in 2015-2016. This means it has now been at least 8 years since they worked on it. Advancements made to reduce rate of complications in the last 8 years are therefore not accounted for.
• Most of the data from previous articles that figure into their calculations come from examples as old as 1990. Most of the cases seem to be from the 90s or early 20s. Surely in the last 30 years there have been advancements to reduce risk of complications. It was, I might add, during this period that djs was much more common as a purely aesthetic procedure. This was before insurance in the U.S.A. at least began cracking down on sleep apnea patients who would get DJS covered by insurance to treat sleep apnea. Now, they generally requiring people to demonstrate they cannot withstand CPAP first. A little administrative barrier that wouldn't stop those seriously interested in the surgery, but would reduce the amount of purely aesthetic cases being done (which are likely those with the highest risk of complications)
• Data is taken from all over the globe with different standards of medical training and research in each country
• It does not account for differences in age. The demographic here is mostly young healthy men. This is the demographic I would suspect is least likely to experience complications from this surgery and surgeries in general.

In short, when anyone discusses risks keep in mind it is probably lower for you than the numbers often circulated.

 

[Deleted member 26824]

dnr, tldr?

 

[hansmoleman]

To me the major bullshit alert is when surgeons always refer to the literature for risk. I’m like, shut up and tell me YOUR numbers. How many bimaxes have you performed and what are the outcomes?

 

[Deleted member 18582]

Yea, plenty of advancements. Custom plates, piezo, cutting guides... Which are used by only a handful of surgeons, far as I'm aware. So the average might not be the best metric to look at

Even when it comes to something like rotations--

it's something every surgeon knows how to do, they learn it in school, but know thats is unstable and greater chance of risks. its just that there are surgeons that

• just don't do it at all as a matter of principle, and are never asked to since majority of jaw surgeries are just linear advancements
• ones who generally don't bring it up, but might do it if a patient insists
• ones do them all the time and regularly propose them to patients

even if there was a figure on the % of rotations that have complications, you wouldn't be able to differentiate the risk between surgeons in group 2 and group 3, since the latter of course has more experience doing it

 

[hansmoleman]

Is there any reliable number on how custom guides/plates decrease risk?

 

[Deleted member 18582]

Is there any reliable number on how custom guides/plates decrease risk?

It at least says something about titanium plates:

"Ahn et al.3 reported that postoperative complications such as open bite, infections, TMD, and relapse can occur following orthognathic surgery. In an analysis of complication rates by the type of materials used in bone-fracture fixation, the rate of complications was 8.6% when titanium plates were used, and 18.3% when resorbable plates were used."

titanium plates are the norm, but I would expect for custom made titanium plates that users here often get would have yet a smaller risk of relapse since they are of course expressly designed to maintain the particular movements the patient had undergone. They don't discuss that in this article though and I wouldn't be able to say anything about other kinds of risks

 

[WannaBeA6]

my only fear are the hearing related ones, the rest seems okay

 

[DelonLover1999]

good shit

It should be noted though that this article is referring to all types of orthognathic surgery. So in the respiratory section, for example, it includes things like airway obstruction, which is only possible to happen if you undergo a mandibular setback.