General anesthesia in orthognathic surgeries: does it affect horizontal jaw relations? 2013

Masoud Yaghmaei, and Masoud Ejlali, and Sekieneh Nikzad, and Ashraf Sayyedi, and Shahrouz Shafaeifard, and Fereydoun Pourdanesh
Professor, Department of Oral and Maxillofacial Surgery, Dental Research Center, Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

OBJECTIVE The aim of this study was to evaluate the influence of general anesthesia on centric jaw relation (CR) records of orthognathic surgical patients in different postural positions. METHODS Fifty patients undergoing orthognathic surgery at Taleghani Hospital (Tehran, Iran) in 2008 were prospectively studied. CR records were obtained in conscious patients in 2 different positions (upright and supine) 1 day before surgery and in the supine position under general anesthesia. The impressions were made and the corresponding casts were mounted on a semiadjustable articulator. Differences were measured to the nearest 0.10 mm using a caliper. Paired t test and a general linear regression model were used for statistical analysis. RESULTS Fifty patients (27 women and 23 men; mean age, 22.5 ± 3.5 yr) were enrolled. Angle Class I (group I), Class II (group II), and Class III (group III) malocclusions were detected in 16% (n = 8), 54% (n = 27), and 30% (n = 15) of patients, respectively. Although mean changes were smaller than 2 mm, statistically significant differences were found by paired t test in all Angle classification groups. No significant differences were found between the supine and conscious and the supine and unconscious patient positions in groups I and III (P > .05). However, in group II, this difference was statistically significant (P = .001). Regarding the impact of anesthesia on CR records of patients with different Angle classes, this study showed a significant effect, particularly in group II. Assessment of the outcome of interest (difference between the supine and conscious and the upright and conscious positions) versus position after adjustment for Angle class using a general linear regression model showed that the difference was significant only for Angle class (β = +0.29; t = 3.05; P = .003). CONCLUSIONS General anesthesia may not adversely affect the mandibular condylar position in orthognathic patients in a supine position compared with a supine and conscious position. However, among all study groups, group II showed more significant changes in CR records under general anesthesia. Oral and maxillofacial surgeons should be well aware of such changes in these particular positions and avoid possible mismanagement and potential complications.

UI MeSH Term Description Entries
D007574 Jaw Relation Record A registration of any positional relationship of the mandible in reference to the maxillae. These records may be any of the many vertical, horizontal, or orientation relations. (Jablonski, Illustrated Dictionary of Dentistry) Axiography,Bite Registration,Sirognathography,Record, Jaw Relation,Records, Jaw Relation,Bite Registrations,Jaw Relation Records,Registration, Bite,Registrations, Bite
D008297 Male Males
D008311 Malocclusion, Angle Class I Malocclusion in which the mandible and maxilla are anteroposteriorly normal as reflected by the relationship of the first permanent molar (i.e., in neutroclusion), but in which individual teeth are abnormally related to each other. Angle Class I,Class I, Angle
D008312 Malocclusion, Angle Class II Malocclusion in which the mandible is posterior to the maxilla as reflected by the relationship of the first permanent molar (distoclusion). Angle Class II,Angle Class II, Division 1,Angle Class II, Division 2,Class II Malocclusion, Division 1,Class II Malocclusion, Division 2,Malocclusion, Angle Class II, Division 1,Malocclusion, Angle Class II, Division 2,Class II, Angle
D008313 Malocclusion, Angle Class III Malocclusion in which the mandible is anterior to the maxilla as reflected by the first relationship of the first permanent molar (mesioclusion). Angle Class III,Habsburg Jaw,Hapsburg Jaw,Prognathism, Mandibular,Underbite
D008335 Mandibular Condyle The posterior process on the ramus of the mandible composed of two parts: a superior part, the articular portion, and an inferior part, the condylar neck. Condyle, Mandibular,Condyles, Mandibular,Mandibular Condyles
D011187 Posture The position or physical attitude of the body. Postures
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D003243 Consciousness Sense of awareness of self and of the environment. Consciousnesses
D003725 Dental Articulators Mechanical devices that simulate the temporomandibular joints and jaws to which maxillary and mandibular casts are attached. The entire assembly attempts to reproduce the movements of the mandible and the various tooth-to-tooth relationships that accompany those movements. Articulators,Articulator, Dental,Articulators, Dental,Dental Articulator,Articulator

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