Can Patients with Low Bone Density Undergo Orthognathic Surgery? - Orthopedics

More Info

---

Patients with low bone density, such as those diagnosed with osteoporosis or osteopenia, can indeed undergo orthognathic surgery, including procedures like maxillary and mandibular advancement surgery (MMA). However, there are several important considerations and potential risks that both the patient and the surgical team should be aware of.

Bone Healing and Density Concerns:
Low bone density can affect the healing process after surgery. The primary concern is that the fixation devices, such as plates and screws used during the surgery, may not achieve optimal stability due to the compromised quality of the bone. This could lead to complications such as non-union (failure of the bone to heal properly) or malunion (healing in an incorrect position). In patients with low bone density, there is a higher risk that the screws may loosen or fail to hold the bone segments together effectively.

To mitigate these risks, surgeons may take several approaches:
1. Preoperative Assessment: A thorough evaluation of the patient's bone density and overall health is crucial. This may include imaging studies like DEXA scans to assess bone mineral density.

2. Bone Augmentation Techniques: In some cases, surgeons may consider using bone grafts or bone substitutes to enhance the quality of the bone at the surgical site. This can provide additional support for the fixation devices and improve the chances of successful healing.

3. Use of Advanced Fixation Devices: Surgeons may opt for specialized plates and screws designed to provide better stability in low-density bone. These devices can help reduce the risk of loosening and improve the overall success of the surgery.

Postoperative Care and Monitoring:
Patients with low bone density may require closer monitoring during the postoperative period. This includes regular follow-ups to assess the healing process and ensure that there are no complications. Patients may also be advised to engage in specific rehabilitation exercises to promote bone health and recovery.

Nutritional and Lifestyle Considerations:
In addition to surgical interventions, patients should focus on optimizing their bone health through nutrition and lifestyle changes. This includes:
- Calcium and Vitamin D Supplementation: Ensuring adequate intake of calcium and vitamin D is essential for bone health. Patients should discuss with their healthcare provider the appropriate dosages and forms of supplementation.

- Regular Weight-Bearing Exercise: Engaging in weight-bearing exercises can help improve bone density and overall strength. Patients should consult with a physical therapist or a healthcare provider to develop a safe and effective exercise plan.

- Avoiding Risk Factors: Patients should be encouraged to avoid smoking and excessive alcohol consumption, as these can negatively impact bone health.

Conclusion:
In summary, while patients with low bone density can undergo orthognathic surgery, careful planning and consideration of the potential risks are essential. A multidisciplinary approach involving oral and maxillofacial surgeons, orthodontists, and possibly endocrinologists or nutritionists can help optimize outcomes. Patients should be proactive in managing their bone health and discussing any concerns with their surgical team to ensure a successful surgical experience and recovery.