Prognostic factors for maxillary sinus mucosal thickening following Le Fort I osteotomy: a retrospective analysis

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Abstract

Background

Le Fort I osteotomy is one of the surgical procedures now routinely and safely performed. It is possible to move the maxilla in three dimensions, but it is necessary to separate the bones around the maxillary sinus. Therefore, with surgery, maxillary sinus mucosal thickening occurs. By knowing the changes in the sinus mucosa after surgery and the factors affecting it, it is possible to better predict the outcomes of surgery and contribute to safer surgery. In this study, thickening of maxillary sinus mucosa before and after surgery in Le Fort I osteotomy was evaluated using multidetector-row computed tomography (MDCT) images, and the changes in mucosal thickening and the related factors were examined.

Methods

Using MDCT images, the maxillary sinus mucosa of 125 patients who had undergone Le Fort I osteotomy was retrospectively evaluated before surgery, 1 month after surgery, and 1 year after surgery. On the MDCT images, the maxillary sinus was judged as mucosal thickening and classified into three grades according to the proportion occupying the maxillary sinus. In the evaluation of factors related to mucosal thickening, the following eight factors were examined: sex, age, diagnosis, operating time, amount of postoperative bleeding, with/without bone graft, with/without multisegmental osteotomy, and with/without macrolide therapy after surgery.

Results

The mean age at the time of surgery was 25.6 ± 8 years. Of all 125 patients, 66 had bilateral thickening, 19 had unilateral thickening, and 40 had no thickening. Factors that were significantly related to mucosal thickening were the operative time for the maxilla, bone grafts, and macrolide therapy after surgery.

Conclusions

Operative time for the maxilla, bone grafts, and macrolide therapy after surgery were found to be related to mucosal thickening. In addition, MDCT scanning 1 month after surgery was considered to be appropriate for evaluation of maxillary sinus mucosal thickening.

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Most cited references 18

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Incidence of complications and problems related to orthognathic surgery: a review of 655 patients.

K Panula, K Finne, K Oikarinen (2001)

This retrospective report evaluates the incidence of pre-, intra-, and postoperative complications of orthognathic surgery and their significance to the patient. The clinical records and radiographs of 655 patients operated on in Vaasa Central Hospital, Finland during a 13-year period between 1983 and 1996 were examined. The total number of operations was 689. All notes referring to problems or complications from the orthodontic phase to the varying postoperative follow-up times were gathered and analyzed. The most common complication was a neurosensory deficit in the region innervated by the inferior alveolar nerve; mild in 32% of patients (183 of 574 patients with an osteotomy in the mandible) and disturbing in 3% of patients (18/574). The most serious complication was severe intraoperative bleeding in 1 patient necessitating major blood transfusions and later embolization of the internal maxillary artery. There were no fatal complications. The incidence of other problems was low, and there were very few patient complaints. Despite the great variety of severe complications reported in the literature, their frequency seems to be extremely low, and orthognathic surgery treatment can be considered to be a safe procedure. Copyright 2001 American Association of Oral and Maxillofacial Surgeons

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Macrolide antibiotics as immunomodulatory medications: proposed mechanisms of action.

Masaharu Shinkai, Bruce Rubin, Markus O. Henke (2008)

Macrolide antibiotics administered in sub-antimicrobial doses improve pulmonary function and decrease exacerbation frequency for persons with diffuse panbronchiolitis or cystic fibrosis. Data also suggest a beneficial effect of macrolide antibiotics in the treatment of steroid dependent asthma. Many potential immunomodulatory effects of macrolide antibiotics have been reported including the ability to down-regulate prolonged inflammation, decreasing airway mucus secretion, inhibiting bacterial biofilm, decreasing the production of reactive oxygen species, inhibiting neutrophil activation and mobilization, accelerating neutrophil apoptosis, and blocking the activation of nuclear transcription factors. Macrolides initially decrease, then increase, and have finally a sustained suppression of cytokine secretions from normal human bronchial epithelial cells through inhibition and activation of extracellular signal-regulated kinases (ERK) and then reversibly retard cell proliferation probably through ERK. Consistent with this, macrolide antibiotics possibly reduce mucin production as well as neutrophil migration by interfering with ERK signal transduction.

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Incidence of complications and problems related to orthognathic surgery.

Sun Park, Byeong Gwan Kim (2007)

This retrospective report evaluates the incidence of intra- and postoperative complications of orthognathic surgery and their relevance. The clinical records and radiographs of 301 patients who underwent surgery at Chosun University Dental Hospital, Korea, over an 8-year period between 1998 and 2005 were examined. The most common complication was a neurosensory deficit in the region innervated by the inferior alveolar nerve. The most serious complication was severe intraoperative bleeding. No complication was fatal. Despite the great variety of severe complications reported, their frequency seems to be extremely low. Orthognathic surgery appears to be a safe procedure.

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Author and article information

Contributors

Masashi Iwamoto:

ORCID: http://orcid.org/0000-0003-0201-920X

iwamotomasashi@tdc.ac.jp

Miki Watanabe: watanabemiki@tdc.ac.jp

Masae Yamamoto: yamamotomasae@tdc.ac.jp

Masato Narita: narimasa@tdc.ac.jp

Takashi Kamio: kamio@tdc.ac.jp

Takashi Takaki: ttakaki@tdc.ac.jp

Takahiko Shibahara: sibahara@tdc.ac.jp

Akira Katakura: katakura@tdc.ac.jp

Journal

Journal ID (nlm-ta): Maxillofac Plast Reconstr Surg

Journal ID (iso-abbrev): Maxillofac Plast Reconstr Surg

Title: Maxillofacial Plastic and Reconstructive Surgery

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 2288-8101

ISSN (Electronic): 2288-8586

Publication date (Electronic): 11 March 2019

Publication date PMC-release: 11 March 2019

Publication date Collection: December 2019

Volume: 41

Issue: 1

Electronic Location Identifier: 12

Affiliations

[1 ]GRID grid.265070.6, Department of Oral Pathobiological Science and Surgery, , Tokyo Dental College, ; 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061 Japan

[2 ]GRID grid.265070.6, Department of Oral and Maxillofacial Surgery, , Tokyo Dental College, ; 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061 Japan

Author information

Masashi Iwamoto http://orcid.org/0000-0003-0201-920X

Article

Publisher ID: 195

DOI: 10.1186/s40902-019-0195-3

PMC ID: 6409288

PubMed ID: 30915318

SO-VID: 65a5c944-001c-4c1e-a950-5043b7abf625

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 25 January 2019

Date accepted : 19 February 2019

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Keywords: le fort i osteotomy,maxillary sinus mucosal thickening,orthognathic surgery,prognostic factors

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Keywords: le fort i osteotomy, maxillary sinus mucosal thickening, orthognathic surgery, prognostic factors

Prognostic factors for maxillary sinus mucosal thickening following Le Fort I osteotomy: a retrospective analysis

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Core Readings in Statistical Mediation Analysis

Most cited references 18

Incidence of complications and problems related to orthognathic surgery: a review of 655 patients.

Macrolide antibiotics as immunomodulatory medications: proposed mechanisms of action.

Incidence of complications and problems related to orthognathic surgery.

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