## 4 Discussion
Nasal obstruction is also a possible complication of orthognathic interventions and may depend on the swelling and mucosal congestion around the distal opening of the nasolacrimal duct or the anatomic placement of the medial face structure [26; 27; 28]. In our study, we found only one case of nasal obstruction after surgery, corresponding to a prevalence of 1.72% that was solved thanks to medical therapy. Dental Discromies and Pulpal Necrosis. The main risk factor for dental element lesion during orthognathic surgery is the alteration or interruption of the pulp blood flow, in particular at the osteotomy cutting zones [6; 29; 30]. [PERSON] et al. reported on how osteotomic cutting should be performed at least 5 mm from the apices of the teeth [31]. According to [PERSON], osteotomic cuts closer to this size should be avoided as this could lead to the devitalization of those teeth, as also confirmed by [PERSON] and [PERSON] [32]. When, however, a repositioning of the maxilla greater than 6 mm is necessary, this margin of 5 mm is not always feasible due to the position of the infraorbital foramen. In our study, we had one case of dyschromia and necrosis in four dental elements. Occlusion and Masticatory Efficiency. Occlusal forces are usually improved in all patients six months after surgery [33]. In our study, four patients reported mild dissatisfaction with their masticatory efficiency. Gingival Recessions. Gingival recession is a possible complication mainly related to the osteotomy cutting area. [PERSON] et al. had a prevalence of 0.8% [34]. In our study, the recession prevalence was 1.72%, that is, only one patient in fifty-eight presented recession on a single tooth. Pre-operative width of the keratinized tissue did not appear to be the critical factor in the development of the recession. The risk of recession appears to increase with mandibular advancement procedures and appears to occur in sites where both the keratinized gingiva and the underlying bone are thin [35]. Periodontal Problems. Possible periodontal problems are represented by an increased probing depth and bone loss with a prevalence of 0.2% [34]. In our study, the prevalence of periodontal problems was 1.72%, with only one patient reporting dental mobility following surgery. In order to minimize periodontal and dental damage, it seems therefore necessary to avoid damaging the dental structure next to osteotomy cutting lines [36]. Dysgeusia. The alteration of taste is a possible complication, both at the lingual and the palatal level, with sensory changes at the lingual level in 19.4% of the subjects; in the present study, only one case of dysgeusia (1.72%) was reported in the left hemipide of a patient; this spontaneously solved within the first postoperative year [37]. Nausea and/or Vomiting Nausea and vomiting are postoperative complications that may occur after general anesthesia [6]. In our study, only two cases were recorded, for a prevalence of 3.45%. Postoperative pain can be effectively controlled with non-steroidal anti-inflammatory drugs such as NSAIDs or COX-2 inhibitors [38]. Alterations of Crying. Nasolacrimal duct obstruction and tear reflex loss are two rare consequences after bimascellar orthognathic surgery [39; 40]. In our study, there were no cases of tear change or complications related to visual acuity and/or to extraocular structures. Hearing Problems. The alteration of the auditory valvular function and auditory problems have been cited as between 6.82% and 7% [6; 14]. In our study, there was only one case of bilateral post-surgical tinnitus, which still occurred sporadically at the time of seven-year follow-up. Delay Healing. Risk factors for delayed recovery appear to be smoking, the presence of third molars, and diabetes [14]. Additionally, synthesis media position can be a contributing factor to the greater incidence of healing delay [14; 41]. In our study, we reported two cases of subjects with delayed surgical wound healing (prevalence of 3.45%),which was solved with antibiotic therapy.