# Surgical Complications of Orthognathic Surgery
## 4 Discussion  
Orthognathic surgery, like any surgical procedure, is not exempt from potential complications either during surgery or postoperatively. As orthognathic procedures are elective surgery in young, healthy patients any complication is important and significant [13]. The severest complication found in this study was a major hemorrhage. Bleeding is recognized as a possibly fatal complication with a surgical prevalence of 0.2-2.2% [3; 4; 5; 8; 14; 15]. Hemorrhage sources vary and include maxillary artery and vein, pterygoid artery-venous \begin{table}
\begin{tabular}{c c c c c} \hline \hline  & **Cl I** & **CL II** & **CL III** & **Total** \\ \hline
**Sev./Mod. Complications** & 2 & 3 & 5 & **10** \\ \hline
**Bad Split** & 0 & 2 & 0 & **2** \\ \hline
**Condyl Sag** & 1 & 1 & 0 & **2** \\ \hline
**Temp. Nerve Injury** & 3 & 4 & 11 & **18** \\ \hline
**Late infection** & 0 & 0 & 1 & **1** \\ \hline
**Hardware Issues** & 1 & 6 & 9 & **16** \\ \hline
**TMJ Disorders** & 0 & 0 & 0 & **0** \\ \hline
**Dental Injuries** & 1 & 0 & 5 & **6** \\ \hline
**Simple Hemorrhage** & 1 & 0 & 0 & **1** \\ \hline
**Total Complications** & 9 & 16 & 31 & **56** \\ \hline
**Total Patients w/complications** & 6 & 13 & 26 & **45** \\ \hline
**Total Patients** & **12** & **21** & **70** & **103** \\ \hline
**Probability of complication per patient** & 50.0\% & 61.9\% & 37.1\% & \\ \hline
**Odds Ratio of complication per patient** & 1.69 & 2.75 & 1 & \\ \hline
**99\% Confidence Interval** & 1.38, 2.06 & 2.26, 3.35 & \(p=0.022\) & \\ \hline \hline \end{tabular}
\end{table} 
Table 4: Complications by type of surgery stacked to bi-max and one-jaw surgery. \begin{table}
\begin{tabular}{c c c c c} \hline \hline  & **Bi-Maxillary Surgery** & **One Jaw Surgery** & **Total** &
\begin{tabular}{c} **Rate Ratio of** \\ **Complication per** \\ **Type of Surgery** \\ \end{tabular} \\ \hline
**Sev./Mod. Complications** & 7 & 3 & **10** & 0.89 \\ \hline
**Bad Split** & 0 & 2 & **2** & 0 \\ \hline
**Condyl Sag** & 1 & 1 & **2** & 0.38 \\ \hline
**Temp. Nerve Injury** & 13 & 5 & **18** & 0.99 \\ \hline
**Late infection** & 1 & 0 & **1** & N/A \\ \hline
**Hardware Issues** & 14 & 2 & **16** & 2.67 \\ \hline
**TMJ Disorders** & 0 & 0 & **0** & N/A \\ \hline
**Dental Injuries** & 3 & 3 & **6** & 0.38 \\ \hline
**Simple Hemorrhage** & 1 & 0 & **1** & N/A \\ \hline
**Total Complications** & **40** & **16** & **56** & \\ \hline
**Total Patients w/complications** & 33 & 12 & **45** & \\ \hline
**Total Patients** & 72 & 31 & **103** & \\ \hline
**Probability of complication per patient** & 45.8\% & 38.7\% & \\ \hline
**Odds Ratio of complication per patient** & 1.34 & 1 & \(p=0.019\) \\ \hline
**99\% Confidence Interval** & 1.05, 1.69 & \\ \hline \hline \end{tabular}
\end{table} 
Table 5: Complications by initial skeletal diagnosis. plexus, inferior alveolar or retromandibular artery or vein, palatine artery, or facial artery. Severe arterial bleeding may require blood transfusion [16; 17; 18]. Consistent with the literature, we had two hemorrhage episodes which occurred in two patients during the postoperative period (1.9%), one of them requiring surgical intervention to embolize with coils the internal maxillary artery the other was treated with local pressure on one of the branches of the facial artery and local application of tranexamic acid. One of the relatively moderate complications identified in this study is permanent nerve injury. Generally, permanent damage due to the injury of the alveolar nerve occurs with a prevalence of 0.8-9.6% [8; 14; 19; 20; 21]. IAN lesions are the most common with a risk of section, traction, or compression during osteotomy, splitting, or fixation of the mandible. Another nerve that may be injured is the Infra-Orbital Nerve (ION) in maxillary osteectomies. In this study, the prevalence of permanent nerve injury was 2.9%, similar to other reports [21; 22]. We did not perform any nerve repair as no obvious nerve transection was identified or noted intraoperatively.