D. Bram Tuinzing

Preoperative antibiotic prophylaxis in orthognathic surgery: a randomized, double-blind, and placebo-controlled clinical study.

PURPOSE This study evaluated the need for antibiotic prophylaxis in orthognathic surgery. PATIENTS AND METHODS Fifty-four patients (age range, 18 to 40 years) underwent bimaxillary orthognatic surgery. After randomization, a placebo (n = 19), 2,200 mg amoxicillin-clavulanic acid (n = 18), or 1,500 mg cefuroxime (n = 17) was administered in a double-blind fashion. During the first month, the postoperative course was observed according to the clinical parameters of infection, total leukocyte count and erythrocyte sedimentation rate (ESR). RESULTS Fifteen of 54 patients developed a wound infection. Of these, 10 had received a placebo; 3, cefuroxime; and 2, amoxicillin-clavulanic acid. CONCLUSIONS There was a statistically significant (P<.004) increased risk of having an infectious complication after bimaxillary orthognathic surgery without antibiotic prophylaxis. No significant difference in the incidence of infectious complications was found between the 2 medications.

Facial corrections in male to female transsexuals: A preliminary report on 16 patients

PURPOSE The need for facial corrective surgery to facilitate passing as a member of the other sex occurs in a relatively low percentage of male-to-female transsexuals. The aim of this study was to explore criteria and techniques for facial corrections in male-to-female transsexuals because little is known on objective measures for meaningful facial alterations in the female direction. PATIENTS AND METHODS In the period 1992 to 1994, 16 male-to-female transsexual patients were eligible for bony facial corrections. Several techniques were used to feminize the masculine appearance: mandibular angle reduction, genioplasty, bimaxillary osteotomy, and zygoma onlay and zygoma sandwich osteotomies. RESULTS Subjectively good results were obtained. Improvement in quality of life was not objectively assessed. CONCLUSIONS Facial corrective surgery seems to be promising in selected cases of male-to-female transsexualism. Further research is recommended on quantification of the differences in male and female faces for optimal indications and design of this type of surgery. The psychosocial aspects of the facial surgery and long-term stability of the surgical result also need to be further investigated.

Management of posttraumatic malocclusion caused by condylar process fractures

PURPOSE The aim of the study was to evaluate the results of orthognathic surgery in cases with posttraumatic malocclusion as a long-term complication of condylar process fractures. PATIENTS AND METHODS A retrospective study on 21 patients with posttraumatic malocclusions attributable to condylar process fractures was performed. In group I, 15 patients were treated for asymmetric malocclusion with unilateral or bilateral mandibular ramus osteotomies. In group II, six patients were treated for anterior open bit with either a Le Fort I osteotomy (n=5) or a bilateral ramus osteotomy (n=1). All patients had clinical and radiographic follow-up for at least 1 year. RESULTS Stable dental and cephalometric results were obtained in all patients except the one in group II who was treated with bilateral sagittal split osteotomies. In two cases, both in the asymmetric group, minor occlusal interferences had to be treated by equilibration in the early postoperative period. CONCLUSIONS Orthognathic surgery is a predictable and stable method for the treatment of posttraumatic malocclusion due to condylar process fractures. Maxillary orthognathic surgery is successful in correcting symmetric anterior open bites due to bilateral condylar process fractures. Because posttraumatic malocclusion is a rare complication after closed treatment of condylar process fractures, and it can be treated satisfactorily using orthognathic surgery, routine open reduction and fixation of condylar process fractures is not indicated to prevent posttraumatic malocclusion.