title: Correction of Symptomatic Chronic Nasal Airway Obstruction in Conjunction With Bimaxillary Orthognathic Surgery: Does It Complicate Recovery and Is It Effective?
abstract: OBJECTIVE
  The purpose of this study was to assess the safety and efficacy of intranasal procedures carried out simultaneously with bimaxillary orthognathic surgery.
  
  
  METHODS
  The authors executed a retrospective cohort study derived from patients treated by a single surgeon at 1 institution from 2004 through 2013 with a minimum follow-up of 1 year (range, 1 to 10 yr). An index study group consisting of a consecutive series of patients with symptomatic chronic obstructive nasal breathing (CONB) and a bimaxillary developmental dentofacial deformity (DFD) also involving the chin were identified. They underwent a minimum of: Le Fort I osteotomy, bilateral sagittal ramus osteotomies, septoplasty, inferior turbinate reduction (ITR), and osseous genioplasty. Study variables included age at operation, gender, pattern of presenting DFD, presence of obstructive sleep apnea, segmentation of the maxilla, and airway management. The primary outcome variable studied was residual CONB.
  
  
  RESULTS
  During the study period, 262 patients met the inclusion criteria. Their age at operation averaged 25 years (range, 13 to 63 yr) and 134 were female (51%). The major patterns of presenting DFD included long face (29%) and maxillary deficiency (25%). No patients required nasal packing, reintubation, tracheostomy, or blood transfusion. In 6 of the 262 patients (2%), the intranasal procedures did not resolve nasal breathing difficulties. In these patients, procedures recommended included synechiae release (n = 3), revision septoplasty (n = 3), and further ITR (n = 4). An association between age at time of surgery and non-segmental Le Fort I osteotomy with the occurrence of residual nasal obstruction was confirmed.
  
  
  CONCLUSIONS
  When completing septoplasty and ITR through a Le Fort I, airway management need not be altered from standard protocol. The management of CONB in conjunction with orthognathic surgery is highly effective, with few complications. Non-segmental Le Fort I in patients at least 40 years of age is more likely to be associated with residual CONB, but the incidence remains low.
authors.affiliation: Director, Posnick Center for Facial Plastic Surgery, Chevy Chase, MD; Clinical Professor of Surgery and Pediatrics, Georgetown University, Washington, DC; Clinical Professor of Orthodontics, University of Maryland, School of Dentistry, Baltimore, MD; Adjunct Professor, Department of Oral and Maxillofacial Surgery, Howard University College of Dentistry, Washington, DC. Electronic address: jposnick@drposnick.com.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Posnick
authors.affiliation: Chief Resident, Department of Oral and Maxillofacial Surgery, Howard University Hospital, Washington, DC.
authors.forename: Elbert
authors.initials: E
authors.lastname: Choi
authors.affiliation: Fellow, Posnick Center for Facial Plastic Surgery, Chevy Chase, MD.
authors.forename: Anayo
authors.initials: A
authors.lastname: Adachie
authors.affiliation: Associate Professor of Surgery, Division of Otolaryngology, George Washington University, Washington, DC.
authors.forename: Thomas
authors.initials: T
authors.lastname: Troost
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D058109:Airway Management / Q000379:methods; D015331:Cohort Studies; D063169:Dentofacial Deformities / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D063172:Genioplasty / Q000379:methods; D006801:Humans; D008297:Male; D008437:Maxilla / Q000002:abnormalities / Q000601:surgery; D008875:Middle Aged; D015508:Nasal Obstruction / Q000601:surgery*; D009300:Nasal Septum / Q000601:surgery; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D019340:Osteotomy, Le Fort / Q000379:methods; D059229:Osteotomy, Sagittal Split Ramus / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods; D020181:Sleep Apnea, Obstructive / Q000601:surgery; D000267:Tissue Adhesions / Q000601:surgery; D016896:Treatment Outcome; D014420:Turbinates / Q000601:surgery; D055815:Young Adult