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Tytuł pozycji:

Orthognathic Hardware Complications in the Era of Patient-Specific Implants.

Tytuł:
Orthognathic Hardware Complications in the Era of Patient-Specific Implants.
Autorzy:
Kalmar CL; From the Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia.
Humphries LS; From the Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia.
Zimmerman CE; From the Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia.
Vu GH; From the Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia.
Swanson JW; From the Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia.
Bartlett SP; From the Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia.
Taylor JA; From the Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia.
Źródło:
Plastic and reconstructive surgery [Plast Reconstr Surg] 2020 Nov; Vol. 146 (5), pp. 609e-621e.
Typ publikacji:
Journal Article
Język:
English
Imprint Name(s):
Publication: : Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Baltimore : Williams & Wilkins,
MeSH Terms:
Bone Plates/*adverse effects
Genioplasty/*adverse effects
Osteotomy, Le Fort/*adverse effects
Osteotomy, Sagittal Split Ramus/*adverse effects
Postoperative Complications/*epidemiology
Stomatognathic System Abnormalities/*surgery
Adolescent ; Cleft Lip ; Comorbidity ; Female ; Genioplasty/instrumentation ; Humans ; Male ; Osteotomy, Le Fort/instrumentation ; Osteotomy, Sagittal Split Ramus/instrumentation ; Patient-Specific Modeling ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Prosthesis Design/adverse effects ; Reoperation/statistics & numerical data ; Retrospective Studies ; Risk Factors ; Stomatognathic System Abnormalities/epidemiology ; Treatment Outcome ; Young Adult
References:
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Entry Date(s):
Date Created: 20200823 Date Completed: 20201215 Latest Revision: 20210106
Update Code:
20240105
DOI:
10.1097/PRS.0000000000007250
PMID:
32826735
Czasopismo naukowe
Background: Patients undergoing orthognathic skeletal correction present with a variety of comorbidities that may affect surgical outcomes. The purpose of this study was to determine how patient risk factors and operative technique contribute to complication rates after orthognathic surgery in the era of patient-specific implants.
Methods: Retrospective cohort analysis was conducted of pediatric patients undergoing Le Fort I osteotomy, bilateral sagittal split osteotomy, and/or genioplasty from 2014 to 2018. Patient risk factors, operative characteristics, and postoperative outcomes were gathered and compared with appropriate statistics.
Results: Ninety-four patients met inclusion criteria, with an overall 1-year complication rate of 11.7 percent (11 of 94). Patient-specific mandibular plates are significantly associated with infection (p = 0.009; OR, 8.8), occurrence of any complication (p = 0.003; OR, 8.3), readmission (p < 0.001; OR, 11.1), and reoperation (p < 0.001; OR, 11.4). In patients with syndromes or history of cleft lip/palate, patient-specific mandibular plates are associated with infection (p = 0.006; OR, 10.3), readmission (p < 0.001; OR, 21.6), and reoperation (p < 0.001; OR, 22.9). In multivariate regression controlling for age, sex, syndrome status, and orofacial cleft history, use of patient-specific mandibular plates was associated with infection (p = 0.017; adjusted OR, 12.5), any complication (p = 0.007; adjusted OR, 11.8), readmission (p = 0.001; adjusted OR, 17.9), and reoperation (p = 0.001; adjusted OR, 18.9).
Conclusions: In the era of patient-specific orthognathic surgery, syndromic status and use of patient-specific mandibular plates are associated with increased infection, readmission, and reoperation because of hardware-related complications. The authors' data support increased caution and counseling with use of patient-specific mandibular implants in patients with syndromic status, history of orofacial cleft, and history of previous maxillomandibular surgery given increased risk of hardware-related complications.
Clinical Question/level of Evidence: Therapeutic, III.

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