title: Transoral Fixation of Bicortical Screws Is Safe and Feasible for Lower Jaw Osteotomies.
abstract: OBJECTIVE
  Transoral placement of bicortical screws is a rigid fixation method in orthognathic surgery that is used less often than transbuccal placement. The aim of this study was to examine the postoperative outcome of transoral bicortical screw insertion during orthognathic surgery and to compare it with the more common transbuccal fixation technique.
  
  
  METHODS
  A retrospective cohort study was conducted. Clinical files of orthognathic surgery patients operated on from January 2010 through December 2012 were reviewed. Screw insertion approach (transoral vs transbuccal) was examined as a predictive variable for postoperative complications (hardware removal and infection). Type of surgery, fibrin sealant, preoperative third molar removal, and patient age and gender were analyzed as potential risk factors. Descriptive and bivariate statistics and regression analyses were performed.
  
  
  RESULTS
  Of the 606 patients whose cases were reviewed, 509 patients (185 men; mean age, 26.3 ± 11.1 yr) met the inclusion criteria. Most presented with a Class II malocclusion (84.5%). A transbuccal approach was used in 27.5% of cases, leading to a screw-related infection of 6.3%. Patients treated with a transoral technique (72.5%) had fewer infections (3.5%), but this was not statistically relevant. Screw removal was indicated in 3.3% of patients. Screw placement using the transoral and transbuccal approaches was performed in 3.0 and 4.2% of patients, respectively. Infection and screw removal rates did not differ significantly between fixation techniques (P = .16 and P = .49, respectively).
  
  
  CONCLUSIONS
  The present findings showed an overall low rate of screw removal and infection secondary to bicortical screw insertion during orthognathic surgery. The postoperative outcome was similar for the transoral and transbuccal approaches.
authors.affiliation: Resident, Division of Maxillofacial Surgery, Department of Surgery, GH St John, Bruges-Ostend, Belgium. Electronic address: bart_falter@hotmail.com.
authors.forename: Bart
authors.initials: B
authors.lastname: Falter
authors.affiliation: Department Head, Division of Maxillofacial Surgery, Department of Surgery, GH St John, Bruges-Ostend, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Abeloos
authors.affiliation: Staff Member, Division of Maxillofacial Surgery, Department of Surgery, GH St John, Bruges-Ostend, Belgium.
authors.forename: Calix
authors.initials: C
authors.lastname: De Clercq
authors.affiliation: Staff Member, Division of Maxillofacial Surgery, Department of Surgery, GH St John, Bruges-Ostend, Belgium.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Neyt
authors.affiliation: Staff Member, Division of Maxillofacial Surgery, Department of Surgery, GH St John, Bruges-Ostend, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lamoral
authors.affiliation: Professor, Division of Maxillofacial Surgery, Department of Surgery, GH St John, Bruges-Ostend, Belgium.
authors.forename: Gwen R J
authors.initials: GR
authors.lastname: Swennen
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D020878:Device Removal / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008312:Malocclusion, Angle Class II / Q000601:surgery*; D008313:Malocclusion, Angle Class III / Q000601:surgery*; D063168:Mandibular Osteotomy / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D059229:Osteotomy, Sagittal Split Ramus / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult