Yu-Ray Chen(abstract1)

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The Present and Future of Orthognathic Surgery – Chang Gung Craniofacial Center

Yu-Ray Chen, Li Shia Ng
Chang Gung Craniofacial Center, Taipei, Taiwan

“Wherever the art of Medicine is loved, there is also a love of Humanity”- Hippocrates

In Chang Gung Memorial Hospital, the treatment of patients have gone beyond the science of treating disease, but evolved into the art of improving patient’s experience.

In the constantly evolving field of medical practice, we need continuous refinement of patient care. The recent focus is on quality improvement, not only in terms of medical care, but with a huge emphasis on patient’s satisfaction.

If an aesthetic outcome is the patient’s final destination, the journey through our center should be a smooth one for all our patients. To achieve this, we want to ensure that every patient, who undergo surgery at our center, has a pleasant experience.

Patient’s Involvement
Even before the operation, patient’s involvement and mental preparation is important.

We will go through the indication and surgical procedure with each patient and understand their expectation in order to personalize surgical plan. Realistic expectation is necessary to
counsel patients on what is achievable via surgery.

To improve patient’s understanding of the entire surgical process and prevent the undesirable circumstance of “fearing the unknown”, we encourage patients to access the internet, which
has abundant information on the experience of other orthognathic patients. Each patient’s experience is different and the thoughts and feelings shared by various patients are invaluable,
beyond what can be explained by the surgeons.

Evidence-based Practice
As new information regarding medical practices, surgical techniques and patient care becomes available, we review these information on a regular basis in order to provide best-practice healthcare for our patients. In addition, we also perform prospective studies at our center to add to the existing information.

Surgical Excellence
Other than being one of the earliest centers to practice surgery-first orthognathic surgery, we regularly review our results to ensure the quality of our surgery.

To improve the stability of bone movement during orthognathic surgery and prevent relapse, bone grafts are placed to increase bony contact. These are obtained from adjacent intra-oral
sites to reduce donor site morbidity.

Currently, we also perform concurrent third molar teeth extraction to reduce the need for another dental procedure prior to surgery. This has not increased the rate of unexpected fractures or complications during surgery.

Genioplasty can be carried out simultaneously to improve aesthetic outcome. Functionally, nasal obstruction from septal deviation and inferior turbinate hypertrophy can be corrected during orthognathic surgery due to good exposure of the nasal cavity. Progress in Anesthesia Anesthesia is an integral component of our surgery.

Hypotensive anesthesia is maintained during surgery to reduce bleeding and improve the surgical field. Nerve blocks are performed for better control of the blood pressure intra-operatively. After reviewing various literatures, medications administered while patients are under general anesthesia can reduce the rate of post-operative nausea and vomiting.
Post-operative Experience The post-operative course is aimed at providing the highest level of comfort for patients, whether in terms of pain control, or the reduction of side effects from anesthetic medications. With the peri-operative administration of Dexamethasone and non-steroidal anti-inflammatory drugs, there has been a major reduction in post-operative swelling.

As patients are well immediately after the operation, the length of hospitalization is reduced. Nurses are trained to advise patients on oral hygiene and diet after the operation. During their stay, patients will have the opportunity for hands-on practice on self-care before they are discharged. This will improve their confidence in post-operative management at home.

Integrated Care
In Chang Gung Craniofacial Centre, there is a close working relationship with the orthodontists, who provide pre-operative surgical planning with 3D simulation. They are also involved in post-operative orthodontic care to produce the most stable and aesthetically pleasing occlusion for patients.

Traditionally, patients are subjected to pre-operative orthodontic treatment for decompensation of dentition before surgery. With the practice of surgery-first orthognathic surgery, the discomfort from extended periods of orthodontic treatment is reduced. In most patients, post-operative orthodontic treatment is completed in six to eighteen months. In time to come, we hope to subject patients to minimal post-operative orthodontics to achieve functional occlusion, in order to reduce overall treatment duration.

Looking to the Future
To be a centre of medical excellence, we believe that medical practice cannot stagnate. We strive to provide holistic healthcare, which encompasses both the physical and mental well-being of patients. Ultimately, the aim is to produce a happy patient, who is confident of a positive outcome at our centre.

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