Orthognathic surgery in patients with systemic diseases.

PURPOSE: To review the experience with orthognathic surgery in patients with systemic diseases, syndromic conditions or an oncological history at a tertiary center. METHODS: All patients who had undergone orthognathic surgery and all patients who were considered for orthognathic surgery between January 2013 and August 2020 at a tertiary center were retrospectively reviewed. Patients with cleft lip/palate and orthognathic patients requiring craniofacial surgery or reconstructive surgery were excluded. Patients with an underlying disorder were identified and divided into 3 categories: systemic disease, syndromic condition, or oncological disease treated with chemotherapy and/or radiation therapy of the head and neck. Data on intraoperative and postoperative complications until 3 months after surgery were collected for the patients who had undergone surgery. If orthognathic surgery was contraindicated, the reason was extracted from the patient's medical record. RESULTS: Eighty out of 1049 orthognathic patients had an underlying disorder (7.6%), including 50 patients with at least one systemic disease, 25 patients with a syndromic condition, and 5 patients with an oncological disease. A complication was encountered in respectively 5 (10%), 9 (36%), and 0 (0%) patients. Three out of 1134 patients who consulted the multidisciplinary orthognathic-orthodontic consultation had a contraindication for orthognathic surgery because of an underlying disease (0.3%). CONCLUSION: Based on our findings, intraoperative and short-term postoperative complications in patients with an underlying disorder are not frequent. Contraindications for orthognathic surgery because of a medical condition are very rare.

Non-neoplastic salivary gland diseases in children: a 10-year review at a tertiary center.

OBJECTIVES: Non-neoplastic salivary gland diseases are rare in children. This paper aims to present the spectrum of encountered non-neoplastic salivary gland diseases at a tertiary center by describing the demographics, clinical characteristics, and outcomes in this patient population. METHODS: A review of electronic medical records was performed from 2010 until 2020. Relevant data were retrieved and charted according to the type of salivary gland disease. A comparison between diseases was made for demographics, presenting symptoms, treatment, and outcomes. RESULTS: Fifty patients with 11 different non-neoplastic salivary gland diseases were identified. Sialolithiasis was the most prevalent condition (12/50), with 83% localized in the submandibular gland. In contrast to gender, age, and symptoms, the location of pathology was significantly associated with the diagnosis (p < 0.001). In patients with sialolithiasis, a hybrid procedure (combined endoscopy and lithotomy) resulted in 100% resolution of symptoms. For (plunging) ranula, marsupialisation had a relative risk of recurrence of 9.6 compared to (partial) extirpation of the sublingual gland. CONCLUSIONS: Children with salivary gland diseases present with overlapping symptoms, making clinical diagnosis challenging. The present study may aid physicians and specialists in diagnosing the most prevalent conditions in children. Although no gold standards exist for their treatment, hybrid procedures (sialolithiasis) and subglingual gland extirpation (ranula) showed superior results over alternatives.

Maxillofacial and oral surgery in patients with thrombophilia: safe territory for the oral surgeon? A single-center retrospective study.

OBJECTIVE: The aim of this study was to analyze patients with thrombophilia who underwent oral and/or maxillofacial surgery at our center. STUDY DESIGN: We performed a retrospective analysis of patients with hereditary or acquired thrombophilia who had undergone oral/maxillofacial surgery between January 1, 2000 and December 31, 2019. Data regarding demographic and patient characteristics, surgical treatment modalities, antithrombotic therapies, and complications were analyzed. RESULTS: A total of 76 eligible patients (26 male, 50 female) were included in this study, with a mean follow-up period of 3.8 months (range, 0-51 months). The mean age at time of surgery was 44.7 ± 19.4 years. Seven different hereditary and acquired thrombophilia were identified: factor V Leiden (n = 31; 40.8%), prothrombin G20210A mutation (n = 5; 6.6%), protein C deficiency (n = 4; 5.3%), protein S deficiency (n = 11; 14.5%), antiphospholipid syndrome (n = 10; 13.2%), hyperhomocysteinemia (n = 8; 10.5%), and elevated factor VIII (n = 2; 2.6%). Complications occurred in 9 patients (11.8%) and included postoperative infections (n = 6; 7.9%) and postoperative bleeding (n = 3; 3.9%). CONCLUSION: Our data suggest that oral and/or maxillofacial surgery in patients with a confirmed diagnosis of thrombophilia is not associated with a burden of thrombosis or high complication rates. Furthermore, we formulated a guideline for preoperative antithrombotic therapy for patients with thrombophilia undergoing oral and/or maxillofacial surgery.