I want a piece of information about orthognathic surgery

[Periskir]

Hello!! I'm new here and i would like to know if some orthognathic surgeries can be done with a combination of IV sedation and local/regional anesthesia instead of general anesthesia and i also want to be informed about the latest methods of surgery(eg.piezoelectric orthognathic surgery)

Thanks in advance!!

[snapdresser]

Those are questions you'd have to ask a specialist. To my knowledge, piezoelectric osteotomy is only being done in clinical research situations. Some university hospitals may be willing to do it, but I don't know which ones. Consider looking up the authors of some research papers on it and contacting their university departments. I don't know of any surgeons that offer piezoelectric orthognathic surgery or IV/local anesthesia for the procedure. Good luck and please let us know what you find out!

[Periskir]

Thanks You think an operation under IV sedation is possible today? I mean 15 years ago it would be considered impossible.

[snapdresser]

"Possible", sure. I highly doubt anyone does it, though. But that doesn't mean you should end your investigation here! If you find out otherwise, please let us know! I'm sure other people would be interested as well.

[Periskir]

What's the main difference between "normal" jaw surgery and piezosurgery? Ans the rasults depends on the piezotome machine/apparatus?

[snapdresser]

There is less damage done to the soft tissues, supposedly, with the piezoelectric osteotomy. That can results in decreased healing time, less pain, etc. I'm not sure of any effects regarding the movement of the nerves in the jaw, whether it makes them easier or harder to deal with, etc. From this and your other post on stem cells and stuff, it seems like you're very interested in procedures that are still in the research phase. Is there a real need for that? Is there some reason that your body is particularly adverse to the "normal" LeFort I-III/BSSO procedures? The "normal" LeFort I-III and BSSO have been done by surgeons thousands of times, the methods have been well-vetted, and the side effects are well known. Is there a reason you NEED something besides the tried-and-true procedures?

[Periskir]

I just want to shorten the healing time as much as possible.

[snapdresser]

Be tough!!! I can't imagine anybody would do stem cell injections for this procedure and the healing time probably won't be much reduced by piezoelectric osteotomy alone. The osteogenesis still has to occur and that takes time. Just be brave, buckle down, and it'll be over before you know it!

[Periskir]

You know i have mild retrognathism and my self-esteem has been affected. . and so i'm looking for the best outcome.

[snapdresser]

The outcome is going to be the same regardless of piezoelectric osteotomy and stem cell injections. And chances are, that outcome is going to be great! Just find a qualified surgeon you trust and you should be fine!

[sirwired]

I don't see how you'd avoid full anesthesia. IV sedation is used when something really unpleasant needs to be done, AND all the appropriate nerves can be dulled with injections of local anesthetic. This is simply not the case with orthognathic surgery. Not all the "upstream" nerve trunks are easily accessible. I think they'd also like to be able to operate without worrying about your airway, which means nasal intubation. I don't think you get intubated with IV sedation.

If you are worried about General Anesthesia: When I had my LeFort I done, I was entered into a clinical trial to use a specific anesthesia protocol designed to reduce post-operative nausea and vomiting (which is a special problem with orthognathic surgeries, due to swallowed blood and all the insult to the soft tissues of your mouth.) It worked for me personally (not even a touch of nausea) and the trial appeared to be a success. You might want to see if the anesthesia dept. for your surgery would be willing to use it; it doesn't involve anything exotic, just a specific set of common drugs and techniques.

https://clinicaltrials.gov/ct2/show/NCT01592708
https://aaoms.confex.com/aaoms/am1310/w ... r3444.html

[Periskir]

And what was the outcome of your surgery?

[sirwired]

It turned out just fine. Due to thin cortical bone (something that can't really be predicted ahead of time) I was in a splint longer than hoped (six weeks!) so the no-chew diet got monotonous. But the final result was fine. My cross-bite was corrected, my gum recession halted, and everything appears stable now.

[Periskir]

How did you participate in a clinical trial? And how these improve everyday medicine? I've seen numerous clinical trial papers but very few of them are used in everyday medicine yet.

[sirwired]

My surgery was done at UNC, who was sponsoring the trial. The full anesthesia protocol is in that clinicaltrials web page, so any anesthesiologist could use it if they felt that it was a good idea.