Complete Reoperation in Orthognathic Surgery.

[BACKGROUND] Complete reoperation is defined as undergoing reoperative/repeated jaw osteotomies, in a patient who previously underwent orthognathic surgery. The purpose of this study is to (1) describe jaw positions at three time-points (before primary and before and after reoperative surgery), (2) investigate factors necessitating reoperation, and (3) outline the technical challenges.

[METHODS] Repeated orthognathic surgery cases >1-year out were included. Demographic, radiologic, and perioperative data were compiled. Repeated osteotomies (Le-Fort and/or bilateral split sagittal osteotomy, with or without genioplasty), were compared to their respective primary procedures. Statistical analysis was performed using t tests and z-scores.

[RESULTS] Fifteen patients were included (28.1 years; 71 percent female). Reoperative/repeated surgery was most often needed to address iatrogenic bony malposition and asymmetry. Relapse was a less common indication. Time between reoperative and primary surgery was 14 months. Sagittal discrepancies (p = 0.029) were the most frequent reason for primary orthognathic surgery (e.g., mandibular hypoplasia (p = 0.023). Reoperative/repeated orthognathic was performed for asymmetry (p = 0.014). Repeated procedures used more 3-dimensional planning (p < 0.001), required all three osteotomies (p = 0.034), had longer operative times (p = 0.078), and all required hardware removal (p < 0.001). Anatomical outcomes were good with 100% patient satisfaction at long-term follow-up.

[CONCLUSIONS] Reoperative/repeated orthognathic surgery is challenging and underreported in the literature. Whereas primary orthognathic typically addressed sagittal discrepancies, reoperative/repeated osteotomies were needed to correct iatrogenic bone malposition and asymmetries. Challenges include: re-planning, scar burden, need to remove integrated hardware, and repeated osteotomy/fixation. Despite these difficulties, outcomes and patient acceptance were good.

[CLINICAL QUESTION/LEVEL OF EVIDENCE] Therapeutic, IV.