Complication Prevention and Care After Bimaxillary Osteotomies

Postoperative complications can be divided into immediate complications during the termination of the anesthesia and the first 3 h thereafter, as well as complications that can occur in the first 12–24 h after the end of the operation, when the patient is usually on the normal ward or at home. The most serious complications affect the functions of the lungs, heart, and all forms of weaning disorders, in which the patient becomes a danger to himself/herself. The overall complication rate is reported to be 4%, with some studies in the literature reporting an overall complication rate of 6–9%. Complications related to the respiratory system include airway obstruction, hypoventilation, tachypnea, tracheal swelling, bronchospasm, aspiration, and rarely spontaneous atelectasis or even a pneumothorax. Repositioning of the lower jaw can lead to a narrowing of the posterior airway. Especially in class III patients, the preoperative assessment of the airway space requires attention. Checklists will help to avoid complications. Immediate and indirect complications of Le Fort I and II osteotomies include vascular complications (hemorrhage, arteriovenous fistula), aseptic necrosis, maxillary sinusitis, sensory deficits, nasal septal deviations, changes in the position of the nose, loss of tooth vitality/sensitivity, undesirable—bad fractures toward the base of the skull and in the pterygoid region, ophthalmologic complications, maxillary mal-positioning, bony nonunion, maxillary instability, and relapse.