Psychological Issues and the Obese or Formerly Obese Patient

Symposia Overweight patients will have a compromised airway and the establishment of an emergent airway can be severely compromised. A neck circumference of greater than 17 inches is also associated with a high rate of obstructive sleep apnea. Respiratory function will be further compromised in a supine position, consistent with a restrictive lung disease. Other co-morbid diseases in the obese patient can lead to poor outcomes. The potential for diabetes mellitus along with a decreased lower esophageal sphincter tone can lead to aspiration during sedation and anesthesia. In conclusion, although obesity is not a specific contraindication for an office anesthetic the surgeon needs to expect a patient that is not as healthy as they may seem. Expectations of decreased respiratory and cardiac function may further compromise the patient and treatment of the moderate to severely obese patient should warrant modifications to the usual anesthetic and surgical treatment plan. References Chacon GE, Viehweg TL, Ganzberg SI: Management of the obese patient undergoing office based oral and maxillofacial surgery procedures. J Oral Maxillofac Surg 62:88-93; 2004 Marciani RD, French TM, James LE: Effect of obesity on postoperative complications in dentoalveolar surgery. J Oral Maxillofac Surg 62 (1):34-38, 2004

Psychological Issues and the Obese or Formerly Obese Patient Steve I. Ganzberg, SB, DMD, MS, Columbus, OH Obesity is associated with significant psychiatric comorbidity. Twenty to 60% of patients presenting for bariatric surgery suffer from Axis I psychiatric disorders with mood disorders including major depressive disorder and dysthymia predominating. Anxiety disorders, including generalized anxiety and social phobia are diagnosed in up to 50% of reports. Additionally, up to 72% of patients have been diagnosed with a personality disorder. It is not clear if all of these disorders predate severe obesity, begin concurrently or are a result of obesity. Interestingly, most psychiatric and personality disorders are not reliably predictive of weight loss following surgery. They are more predictive of overall well-being and quality of life measures following surgery. The oral and maxillofacial surgeon, as all other physicians and dentists, sees an increasing number of obese patients. Certainly, surgical and sedative alterations are needed for these patients. However, it is important for the surgeon to understand their personal preconceived ideas regarding obesity, many of which may be false, in order to effectively communicate with the patient not only regarding upcoming surgery, but also as a means to help the patient’s overall health through appropriate weight loss discussion and referral.

SYMPOSIUM ON SEGMENTAL ORTHOGNATHIC SURGERY Wednesday, October 10, 2007, 9:45 am–11:45 am

Techniques on Dentoalveolar Distraction Ostegenesis: Accelerated Surgical Orthodontics Scott L. Bolding, DDS, Springdale, AR Traditional surgical orthodontic therapy utilizes cell mediated orthodontic tooth movement to align teeth within the alveolar processes prior to orthognathic procedures. Orthognathic procedures are used to align the skeletal structures of the face and orient the alveolar arches so that the teeth are positioned in proper molar and cuspid relationships. Treatment planning relies heavily on clinical assessment of facial defects and cephalometric analysis to determine these discrepancies. Once these discrepancies have been identified, appropriate skeletal movements are completed by the surgeon with procedures such as the sagital split osteotomy and Le Fort osteotomy. While these procedures have experienced very favorable outcomes, there are many cases in which the facial deficit is not truly a skeletal problem, but is an alveolar bone discrepancy. The alveolar bone discrepancy may be either an intra-alveolar arch defect that does not allow 4

enough room for the dentition, or it may be an alveolarskeletal defect that does not align the alveolus properly with its associated skeletal structures. Dentoalveolar discrepancies are difficult to treat with cellular mediated orthodontic tooth movement alone. Arch deformities usually require the orthodontist to prolong orthodontic treatment time to obtain proper tooth alignment. Many times this requires the extraction of multiple teeth or the positioning of the teeth outside the confines of their underlying bone. Traditional surgical procedures that have been used to correct arch width discrepancies are: surgically assisted rapid palatal expansion and the mandibular midline distraction. While these surgical procedures have provided favorable results, they do not assist in the anterior-posterior discrepancies or vertical discrepancies. Many of the anterior-posterior dentoalveolar discrepancies are treated with orthognathic surgical procedures even though the underlying skeletal foundation is in a relatively normal position. One example of this, is mandibular advancement in patients with mandibular alveolar deficiency. Often this can necessitate AAOMS • 2007