背景:正颌手术可导致鼻窦改变,包括鼻窦炎,归因于LeFortI截骨术中上颌窦的暴露。此外,作为一个基于医院的程序,在这种环境中普遍存在的细菌存在潜在的并发症风险。这项研究评估了正颌手术前后上颌窦炎的发生以及鼻腔中多药耐药细菌的存在。
方法:10例牙颌面畸形患者行LeFortI截骨术。使用SNOT-22问卷进行临床评估,术前和术后3-6个月收集鼻腔样本,以量化总嗜温细菌并检测金黄色葡萄球菌,鲍曼不动杆菌,和肺炎克雷伯菌.术前和术后进行锥形束计算机断层扫描(CBCT),并使用Lund-Mackay系统评估结果。本研究由PUCRS研究伦理委员会注册并批准(编号:4.683.066)。
结果:对SNOT-22的评估显示,有5例患者症状有所改善,而两个仍然在相同的解释范围内。一名患者出现术后上颌窦炎,SNOT-22或CBCT评估时未检测到。CBCT显示三名患者的鼻窦状况恶化,其中两人的鼻腔细菌总数显著增加。Brodsky量表用于评估腭扁桃体肥大,60%的受试者患有1级扁桃体,20%为2级,20%为3级。没有病人有4级扁桃体,这将表明超过75%的阻塞。两名患者的鼻腔中有金黄色葡萄球菌和肺炎克雷伯菌。值得注意的是,肺炎克雷伯菌,耐多药,甚至在手术前就存在于患者的鼻腔中,但这并没有导致上颌窦炎,可能是由于患者的年轻和健康状况。
结论:大多数患者在正颌手术后,上颌窦炎的体征和症状以及生活质量均有改善。然而,一些患者可能仍然携带耐多药细菌,即使他们没有症状。因此,全面的术前评估对于避免难以治疗的术后并发症至关重要.
BACKGROUND: Orthognathic surgery can lead to sinus alterations, including sinusitis, attributed to the exposure of maxillary sinuses during Le Fort I osteotomy. Furthermore, being a hospital-based procedure, there is potential risk of complications arising from bacteria prevalent in such environments. This study evaluated maxillary sinusitis occurrence and the presence of multidrug-resistant bacteria in the nasal cavity before and after orthognathic surgery.
METHODS: Ten patients with dentofacial deformities underwent Le Fort I osteotomy. Clinical evaluations using SNOT-22 questionnaire were performed, and nasal cavity samples were collected pre-surgery and 3-6 months post-surgery to quantify total mesophilic bacteria and detect Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae. Cone Beam Computed Tomography (CBCT) was performed pre- and post-operatively, and the results were evaluated using the Lund-Mackay system. This study was registered and approved by the Research Ethics Committee of PUCRS (No. 4.683.066).
RESULTS: The evaluation of SNOT-22 revealed that five patients showed an improvement in symptoms, while two remained in the same range of interpretation. One patient developed post-operative maxillary sinusitis, which was not detected at the time of evaluation by SNOT-22 or CBCT. CBCT showed a worsening sinus condition in three patients, two of whom had a significant increase in total bacteria count in their nasal cavities. The Brodsky scale was used to assess hypertrophy in palatine tonsils, where 60% of the subjects had grade 1 tonsils, 20% had grade 2 and 20% had grade 3. None of the patients had grade 4 tonsils, which would indicate more than 75% obstruction. Two patients harboured S. aureus and K. pneumoniae in their nasal cavities. Notably, K. pneumoniae, which was multidrug-resistant, was present in the nasal cavity of patients even before surgery, but this did not result in maxillary sinusitis, likely due to the patients\' young and healthy condition.
CONCLUSIONS: There was an improvement in signs and symptoms of maxillary sinusitis and quality of life in most patients after orthognathic surgery. However, some patients may still harbour multidrug-resistant bacteria, even if they are asymptomatic. Therefore, a thorough pre-operative assessment is essential to avoid difficult-to-treat post-operative complications.