## 4 Discussion  
TMJ Disorders. Temporomandibular joint disorders are the most frequent complications following orthognathic surgery, with a prevalence in the literature of 13.64% [6; 7; 12; 13; 14]. They are joint noise, pain, and condylar reabsorption [15; 16]. For patients presenting with temporomandibular disorders prior to orthognathic surgery, a unanimous consensus on the influence of orthognathic surgery on TMJ dysfunction has not been reached yet [6]. As reported by the study by [PERSON] et al., the osteotomy of LeFort I does not seem to be associated with direct trauma to the ATM or to the masticatory muscles, so there are only minimal effects on the TMJ dysfunction [17]. The results of our study reported a general prevalence of post-operative TMDs and TMJ disorders of 24.14% (i.e., fourteen patients out of fifty-eight). The prevailing disorder was joint noise, followed by bilateral pain. The patients were mostly men (57.15%) with an initial diagnosis of [PERSON]'s third-class malocclusion (71.42%). Among the four patients out of fifty-eight (6.90%) with TMJ disorders prior to surgery, only two had them solved. Therefore, patients who presented temporomandibular disorders before orthognathic surgery or with the above risk factors, a careful evaluation of the patient by the clinician must be carried out before planning any surgical correction. In this regard, the systematic review by [PERSON] et al. suggests, on the basis of the available literature, methods that can help clinicians meet these challenges [14]. These methods are as follows: (1) correct intraoperative diagnosis; (2) specific condylar positioning technique; and (3) awakening the patient to a state of sedation to examine the passive and active movements of the jaw to create the correct occlusal relationship. Paraesthesia and Hypoesthesia. The total prevalence of paresthesia was 22.41%, while that of hypoesthesia was 12.07%. The review of the literature by [PERSON] et al. suggested a prevalence of 50% while that of [PERSON] reported a value even higher than 50% [6; 14]. In our study, paraesthesia cases resolved spontaneously in seven patients. Of the cases of hypoesthesia, five resolved spontaneously within the first year after the operation. Our data concerning nerve lesions seemed to be different from those reported in the most recent reviews [18; 19; 20]. The reason might be related to the use of piezoelectric instrumentation. The available evidence suggests that piezoelectric surgery has favorable effects on complications associated with orthognathic surgery [11; 21]. Asymmetries. We recorded eight cases of patients who perceived their own face as slightly asymmetric (13.79%), and this asymmetry was detected on average four years after  
Figure 7: Thoracic Rx performed after the placement of the intercostal drainage (Pleurevac). surgery. Patients undergoing orthognathic surgery usually expressed a positive judgment about the aesthetics of their face following combined orthodontic and surgical therapy [22]. Nasal base enlargement. Orthognathic surgery has an influence on the overlying soft tissues of the translated osseous maxillomandibular complex. The most common secondary change in the nasolabial region is the enlargement of the nasal base, particularly on the wingspan and the nasal volume [23; 24; 25]. In our study, however, no cases of nasal wing enlargement were observed. For this reason, we recommend the use of piezoelectric devices, and in particular, we suggest Mt1-10 as the surgical tip. Piezoelectric surgery has been crucial to reduce tissue complications. Septal Deviation. Additionally, the deviation of the nasal septum is possible following osteotomy of LeFort I, which provides procedures for the repositioning of the bone segment [6]. In the present study, however, no cases of deviation of the nasal septum were observed. Nasal Obstruction.