Background: Despite clinical advances in orthognathic ...



Orthognathic Surgery: is there a future?

Andrea Moreira Gonzalez, MD, James E Zins, MD

Introduction: Orthognathic surgery has evolved from an infrequently performed extraoral procedure to a commonly performed intraoral procedure with a high degree of predictability over the last years (1,2). Technical advances, such as rigid fixation techniques, new bone graft harvesting techniques, and new bone substitutes, have further enhanced surgical success (1-4). Despite significant improvement in technique and technology, we previously reported a perceived regional decrease in orthognathic cases in Ohio (3). It is suggested this may be true throughout the country. In an attempt to document this possible decrease in incidence of orthognathic surgery and to detail the possible reasons, a survey was sent to plastic surgeons in the American Society of Maxillofacial Surgery (ASMS) and oral surgeons in the American Association of Oral & Maxillofacial Surgeons (AAOMS) practicing in US. The purpose of the study was to assess the number of orthognathic surgical procedures performed over the 5-year period.

Method: This study was approved by Cleveland Clinic Institutional Research Board Committee. Lists of plastic surgeons in the ASMS and oral surgeons in the AAOMS practicing in the US were obtained from their databases. A total of 3273 active professionals (482 plastic surgeons and 2791 oral surgeons) were surveyed. The survey was an anonymous, two-page questionnaire with the responses designed so that participant could either circle answers or circle yes or no. The survey documented an increase, a decrease, or no change in the number of orthognathic operations performed by each respondent over the previous 5 years (from 1999 to 2003), and secondarily to query the respondents as to why such an increase or decrease had occurred. Orthognathic procedures were defined as those surgical procedures used to address malocclusion and/or dentofacial deformities of the maxilla and mandible. Current and previous levels of reimbursement for single-jaw or double-jaw surgery were asked, and whether insurance coverage or other reasons were the respondents’ presumed cause for reduction or increase. If reimbursement was the issue, questions were related to how much reimbursement would need to increase before the respondent would actually seek out these cases. Statistical analysis was performed using descriptive statistics initially; for quantitative variable the mean, median and standard deviation were calculated. Comparisons of categorical measures were performed using Chi-Square tests, while ordinal measures were compared using Wilcoxon Rank Sum test. To compare whether the trend in surgeries differed by surgeon type, a repeated measure ANOVA model was used. A significance level of 0.05 was used for all tests.

Results: 3273 surveys were mailed, 883 were returned (response rate = 28%). Those surveyed had mean experience of 19.8 years. Both the mean and median number of surgeries decreased every year. The median number of surgeries in 2003 was 43% of the median surgery total in 1999. There was a significant decreasing trend in the number of surgeries performed from 1999 to 2003 (p ................
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