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Orthognathic Surgery: A Comparison of Academic Vs. Private Practice
Poster Session bridge region. The miniplates from the brand Neoortho had the lowest resistance during mechanical tests but maintained its rigidity when subjected to manipulation, as did the brand Engimplan. References: 1. Langford RJ, Frame JW. Surface analysis of titanium maxillofacial plates and screws retrieved from patients. Int J Oral Maxillofac Surg. 2002;31:511–518. 2. Ellis III E, Graham J. Use of a 2.0-mm Locking Plate/Screw System for mandibular fracture surgery. J Oral Maxillofac Surg. 2002; 60:642-645.
POSTER 24 Orthognathic Surgery: A Comparison of Academic Vs. Private Practice D. A. Denson: UAB, P. D. Waite, H. Digumarthi, J. E. Everts Medical studies have shown that academic medical centers (AMCs) have higher costs of treatment compared with private practice or nonteaching entities (PP), and have also consistently treated a higher number of patients with comorbidities with good outcomes. Patient acuity contributes to the higher cost at these centers.1 Orthognathic surgery has revolutionized the field of OMFS, and improvements in treatment with higher success rates has allowed surgeons to migrate to community hospitals from tertiary centers to perform these procedures.2 This study evaluates patients in academic vs. private practice by diagnosis, ASA level, surgical complexity, indications for surgery, and medical morbidities. Orthognathic patients’ records at UAB AMC department of OMFS from the years 2004-2010 were compared to records of a local OMFS PP group from years 2007-2011. Surgical procedures included Le fort, BSSO, genioplasty, and combinations of these. Charts were scrutinized for age, sex, past medical history, ASA classification, dentofacial deformity, and indications for surgical procedures. A total of 1,331 patients were operated on by the two groups. This gave a sample size of 333 patients from the UAB AMC and 560 patients for the PP group. A chart review by an experienced clinician was used to gather data. 4 specific comorbidities were analyzed (DM, HTN, OSA, CAD) as well as ASA classification. Indications for procedures were evaluated including post-traumatic deformity correction, TMJ issues, OSA, cleft palate, and dentofacial deformities. The pearson chi-square test was applied to the majority of the comparisons. The fisher’s exact test was also used in select cases, both with a p value <0.05 denoting significance. Results showed that the average age of patients encountered in both groups was similar, with AMC having an average age of 29 and PP at 27. There was a much larger proportion of female patients treated in PP setting (M/F ratio for AMC is 1.06/1, in PP it was 1/1.6) There was a statistical significance in all 3 co-morbidities, with the AMC AAOMS 2015
having a higher percentage in all 3. There was a marked difference in percentage of ASA levels observed for each group, with AMC having a statistically significant higher ASA class 2 and 3 patients compared to PP. There was a statistically significant difference in percentage of procedures performed for TMJ related issues, OSA, post-traumatic deformities, and cleft palate patients, with the higher percentage being performed at AMC. Average time of procedure and length of stay was higher in AMC than PP. This comparative demographic study suggests that OMFS AMCs tend to treat orthognathic surgical patients with higher numbers of comorbidities and systemic illnesses. This correlates with previous medical and surgical specialty studies1. It also indicates that OMFS AMCs treat a higher percentage of patients with concurrent medical abnormalities than only patients with dentofacial abnormalities. References: 1. Lisa I. Iezzoni et. al. Illness Severity and Costs of Admissions at Teaching and Nonteaching Hospitals. JAMA, 1990; 264(11):1426-1431. 2. Carter J, Mohammad A. Accelerated Orthognathic Surgery and Increased Orthodontic Efficiency—A Paradigm Shift: A Special Series Part I Building Nonhospital-Based Platforms for Ambulatory Orthognathic Surgery: Facility, Anesthesia, and Price Considerations. Journal of Oral and Maxillofacial Surgery, 2009;67(10): 2054-2063.
POSTER 25 Role of Virtual Surgical Planning in Increased Predictability of Orthognathic Surgery F. A. Quereshy, D. A. Baur, N. Levintov: Case Western Reserve University, School of Dental Medicine, M. A. Altay M. Bazina Success of orthognathic surgery depends not only on the technical aspects of the operation but to a larger extent on the formulation of a precise surgical plan, consistency and capability of achieving predictable, stable results. Traditionally, 2-dimensional cephalometry has been utilized for the planning and postoperative evaluation of orthognathic surgery. However, there are several limitations that are associated with traditional 2-dimensional cephalometry such as inability to measure many important parameters on plain cephalograms, and inability to measure post surgical surface volume difference of maxillofacial reconstruction. This study conducted a retrospective evaluation of treatment outcomes by comparing single-jaw and doublejaw orthognathic surgery using superimpositioning of CT scans. Three dimensional (3D) imaging based planning systems enable the surgeon to establish necessary osteotomy planes preoperatively. The virtual surgical approach allows the clinician to assess different surgical scenarios. Of practical importance is the assessment of postsurgical e-63
POSTER 24 Orthognathic Surgery: A Comparison of Academic Vs. Private Practice D. A. Denson: UAB, P. D. Waite, H. Digumarthi, J. E. Everts Medical studies have shown that academic medical centers (AMCs) have higher costs of treatment compared with private practice or nonteaching entities (PP), and have also consistently treated a higher number of patients with comorbidities with good outcomes. Patient acuity contributes to the higher cost at these centers.1 Orthognathic surgery has revolutionized the field of OMFS, and improvements in treatment with higher success rates has allowed surgeons to migrate to community hospitals from tertiary centers to perform these procedures.2 This study evaluates patients in academic vs. private practice by diagnosis, ASA level, surgical complexity, indications for surgery, and medical morbidities. Orthognathic patients’ records at UAB AMC department of OMFS from the years 2004-2010 were compared to records of a local OMFS PP group from years 2007-2011. Surgical procedures included Le fort, BSSO, genioplasty, and combinations of these. Charts were scrutinized for age, sex, past medical history, ASA classification, dentofacial deformity, and indications for surgical procedures. A total of 1,331 patients were operated on by the two groups. This gave a sample size of 333 patients from the UAB AMC and 560 patients for the PP group. A chart review by an experienced clinician was used to gather data. 4 specific comorbidities were analyzed (DM, HTN, OSA, CAD) as well as ASA classification. Indications for procedures were evaluated including post-traumatic deformity correction, TMJ issues, OSA, cleft palate, and dentofacial deformities. The pearson chi-square test was applied to the majority of the comparisons. The fisher’s exact test was also used in select cases, both with a p value <0.05 denoting significance. Results showed that the average age of patients encountered in both groups was similar, with AMC having an average age of 29 and PP at 27. There was a much larger proportion of female patients treated in PP setting (M/F ratio for AMC is 1.06/1, in PP it was 1/1.6) There was a statistical significance in all 3 co-morbidities, with the AMC AAOMS 2015
having a higher percentage in all 3. There was a marked difference in percentage of ASA levels observed for each group, with AMC having a statistically significant higher ASA class 2 and 3 patients compared to PP. There was a statistically significant difference in percentage of procedures performed for TMJ related issues, OSA, post-traumatic deformities, and cleft palate patients, with the higher percentage being performed at AMC. Average time of procedure and length of stay was higher in AMC than PP. This comparative demographic study suggests that OMFS AMCs tend to treat orthognathic surgical patients with higher numbers of comorbidities and systemic illnesses. This correlates with previous medical and surgical specialty studies1. It also indicates that OMFS AMCs treat a higher percentage of patients with concurrent medical abnormalities than only patients with dentofacial abnormalities. References: 1. Lisa I. Iezzoni et. al. Illness Severity and Costs of Admissions at Teaching and Nonteaching Hospitals. JAMA, 1990; 264(11):1426-1431. 2. Carter J, Mohammad A. Accelerated Orthognathic Surgery and Increased Orthodontic Efficiency—A Paradigm Shift: A Special Series Part I Building Nonhospital-Based Platforms for Ambulatory Orthognathic Surgery: Facility, Anesthesia, and Price Considerations. Journal of Oral and Maxillofacial Surgery, 2009;67(10): 2054-2063.
POSTER 25 Role of Virtual Surgical Planning in Increased Predictability of Orthognathic Surgery F. A. Quereshy, D. A. Baur, N. Levintov: Case Western Reserve University, School of Dental Medicine, M. A. Altay M. Bazina Success of orthognathic surgery depends not only on the technical aspects of the operation but to a larger extent on the formulation of a precise surgical plan, consistency and capability of achieving predictable, stable results. Traditionally, 2-dimensional cephalometry has been utilized for the planning and postoperative evaluation of orthognathic surgery. However, there are several limitations that are associated with traditional 2-dimensional cephalometry such as inability to measure many important parameters on plain cephalograms, and inability to measure post surgical surface volume difference of maxillofacial reconstruction. This study conducted a retrospective evaluation of treatment outcomes by comparing single-jaw and doublejaw orthognathic surgery using superimpositioning of CT scans. Three dimensional (3D) imaging based planning systems enable the surgeon to establish necessary osteotomy planes preoperatively. The virtual surgical approach allows the clinician to assess different surgical scenarios. Of practical importance is the assessment of postsurgical e-63