Dr J J Sanders FRCA Anaesthetic SPR Dr A Diba FRCA Anaesthetic Consultant
Queen Victoria Hospital,
East Grintead, Sussex, England.
Orthognathic surgery is a well established method of correcting dento-facial
deformity with operations on either the upper or lower jaws alone or more
commonly a combination of procedures on both. However, the relationship of the
mandibular condyle to the glenoid fossa is known to change in patients between
the conscious and the relaxed supine position during anaesthesia.
The correct position of the condyle is essential when applying fixation to sagittal split osteotomies. It is the difference between the conscious and relaxed positions that is thought to account for occlusal inaccuracies in the postoperative period. In an attempt to overcome this difficulty much has been written and several condylar positioning devices devised. These have never gained widespread popularity as they are generally difficult and time consuming to use. We suggest that the most accurate condylar positioning devise is the patient themselves. With the advent of modern anaesthetic drugs with ultra short recovery profiles and reliable delivery systems it is relatively straightforward to rouse a patient in order to check occlusion peroperatively.
We report a series of ten patients and describe the anaesthetic technique employed, which was a combination of propofol TCI and remifentanil infusion. Concentrations and infusion rates are recorded intraoperatively for both drugs. There has been no incidence of adverse recall. In all patients, where the peroperative occlusal check indicated a correct planned position, there has been no occlusal discrepancy postoperatively.