Em Cirurgia Ortognática

Luis Eduardo Charles Pagotto, DDS, MSc; Thiago de Santana Santos, DDS, MSc, PhD; Sara Juliana de Abreu de Vasconcellos, DDS, MSc; Joanes Silva Santos, DDS; Paulo Ricardo Saquete Martins-Filho, DDS, MSc, PhD

Jornal of Cranio-Maxillo-Facial Surgery

Vol. 45, Issue 10, p1607-1613

Published online: June 30, 2017

Impact Factor: 1.583

DOI: http://dx.doi.org/10.1016/j.jcms.2017.06.011

Abstract

Purpose: The purpose of this study is to perform a systematic review and meta-analysis on complications after orthognathic surgery comparing piezosurgery with conventional osteotomy.

Methods: We conducted this study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a systematic search to identify randomized (RCTs) and non-randomized controlled trials (nRCTs) from PubMed, Scopus, Science Direct, Lilacs, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar and OpenThesis that compared piezoelectric osteotomy and conventional osteotomy in patients submitted to orthognathic surgery with regard to operative time, intraoperative blood loss, postoperative swelling, pain, and neurosensitivity. We used mean difference (MD) and risk difference (RD) with 95% confidence interval to pool individual results of continuous and dichotomous outcome data, respectively.

Results: Eight (3 RCTs and 5 nRCTs) studies were selected. No difference was observed in operative time between piezosurgery and conventional osteotomies. We found a decrease of intraoperative blood loss by using piezosurgery (MD -128 mL; P < 0.001). Our meta-analysis also yielded a pooled difference in severe blood loss of 35% (P = 0.008) favoring piezosurgery. We pooled individual results of studies evaluating the neurosensitivy based on clinical neurosensory testing. Our meta-analysis showed a pooled difference in severe nerve disturbance of 21% (P < 0.0001) favoring piezosurgery over conventional osteotomy. The test for subgroup differences (I2 = 26.6%) indicated that follow-up time may have an impact on neurosensory disturbance. We found differences between piezosurgery and conventional osteotomy at 3 months (RD 28%; P < 0.001) and 6 months (RD 15%; P = 0.001) after surgery. Due to a lack of sufficient studies, meta-analysis for pain and swelling was not performed.

Conclusion: Our meta-analysis suggests that piezosurgery has favorable effects on complications associated with orthognathic surgery, including a reduction in intraoperative blood loss and severe nerve disturbance.

Keywords: orthognathic surgery, piezosurgery, mandibular osteotomy.

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