The purpose of this study is to evaluate the incidence, risk factors and postoperative nausea and vomiting (PONV) in patients who underwent orthognathic surgery.
The subjects were 139 patients aged 17-52 years (47 males and 92 females) who underwent orthognathic surgery in the Hokkaido University Hospital from January 2001 to December 2003. Ninety-four Sagittal splitting ramus osteotomy (SSRO), 34 Le Fort I osteotomy and SSRO (Le Fort I+SSRO), and 11 surgically assisted rapid palatal expansion (SARPE) were performed. Anesthesia was maintained with sevoflurane and nitrous oxide in oxygen. There were no cases of maxillomandibular fixation. The factors investigated included age, gender, type of surgery, amount of bleeding, operation time, anesthesia time, anesthesia induction drugs, fentanyl dose and incidence of PONV. A statistical study was performed using logistic regression analysis to confirm the statistical significance among age, gender, amount of bleeding, operation time, anesthesia time, difference of anesthesia induction drugs, fentanyl dose, and incidence of PONV. A Chi-square test for independence was used to confirm the statistical significance between the type of surgery and incidence of PONV. Differences were considered significant for a P<.05.
Nausea was observed in 44.6% females and 17.1% males. The incidence of nausea was significantly higher in females. A significantly higher amount of vomiting was observed in 23.5% of Le Fort I+SSRO compared with 7.4% of SSRO and 9.1% of SARPE. Statistically significant differences for vomiting were also noted in the operation time and anesthesia time.

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Idiopathic scoliosis is a well-known orthopedic disease in childhood and the onset and progress are observed during adolescence. It is speculated that the progress of idiopathic scoliosis affects the maxillofacial growth and the function of the temporomandibular joint because the craniofacial skeletal is located on the top of the spinal column. Another reason may be that asymmetric craniofacial growth changes the head posture and/or spinal column. In this study, we examined the association of scoliosis with jaw deformity and temporomandibular joint disorders.
The subjects were 44 patients who underwent orthognathic surgery for treatment of a jaw deformity at Hiroshima University Hospital. We measured the Cobb angle, an indicator of scoliosis, and the curve of the spinal column in vertebrae thoracicae on the chest radiograph. Moreover, the lateral shift of points A and B, cant of the occlusal plane and ANB angle were measured on the postero-anterior (PA) plane and lateral cephalograms. Association between the curve of the spinal column and maxillofacial morphology was examined by correlation analysis. The degree of scoliosis was examined in association with the pathological status of temporomandibular joint.
The prevalence of subjects diagnosed with scoliosis was 22.7%. Among the scoliosis patients, 70% were female. In all subjects with a jaw deformity, a significantly positive correlation was not found between the following variables and the Cobb angle: ANB angle, lateral shift of points A and B, cant of the occlusal plane. Moreover, no significant association between the curve of spinal column in the vertebrae thoracicae and previous variables was revealed. In addition, there was no relationship between the degree of the scoliosis and progress of the temporomandibular joint disorder.
These findings suggested that the progress of scoliosis exerts no substantial influence on the growth of the maxillofacial skeleton and the progress of temporomandibular joint disorders.

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Clinical path (path) is generally applied to acute surgical cases. Therefore, orthognathic surgery is proper for using the path. Thus, we introduced the path for sagittal split ramus osteotomy (SSRO) in 2003. This time, we examined 75 path cases from 2003 to 2007 and 56 cases that did not use the path from 2000 to 2002 in order to evaluate the effect of the path.
As a result, we could cut 1 day of the hospitalization period with management by the path. There were no differences with regard to surgical time, amount of bleeding and incidence of complications during and after surgery. We prepared no autologous blood transfusions. Infection after surgery did not occur in the path cases, even though we reduced the antimicrobial. Few abnormal remarks were found regarding the blood tests carried out 7 days after surgery.
Once the path is introduced, it is necessary to check and reform it periodically. According to this survey, it was suggested that we could shorten the hospitalization period a few more days. We did not have to change the method of surgery or prepare autologous blood transfusions at all. It will be possible to reduce a few more days of the administration period for antimicrobial to prevent infection.

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In this case report, we present a surgical orthodontic treatment performed for an aged female. The patient was a 62-year-old female with chief complaints concerning occlusal disharmony, dyslalia, and aesthetic disturbance. As a result of various analysis, the patient was diagnosed with mandibular prognathism accompanied by deep bite and reversed occlusion. Due to the venerability of the patient, she presented numerous risks. The patient was treated with Le Fort I osteotomy, sagittal split ramus osteotomy and genioplasty. To acquire and to maintain a stable postoperative occlusion, close cooperation with the prothodontist was carried out. Postoperatively, the patient's chief complaints were improved and she demonstrated satisfactory progress after one year. The results of this case report indicate that treatment of a jaw deformity with surgical orthodontic procedures is effective for the improvement of occlusal disorders as well as aesthetic problems. If there are no general health problems, this treatment may be applied irrespective of the patient's age.

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Interceptive orthodontic treatment is important to prevent malocclusion. This treatment is performed to minimize maxillo-facial deformation and malocclusion by removing their causes from primary dentition in an early stage of the mixed dentition period.
This case was mandibular protrusion in the growth period with left deviation of the mandibular bone. Although interceptive orthodontic treatment was performed, facial asymmetry became marked with adolescent growth. As a result, surgical orthodontic treatment was performed upon reaching adulthood.
The orthognathic surgery consisted of intraoral vertical ramus osteotomy (IVRO) on the deviated side and sagittal splitting ramus osteotomy (SSRO) on the non-deviated side. Although good results were obtained, we evaluated the effects of interceptive orthodontic treatment during the growth period.
This case suggests: 1) To prevent mandibular asymmetry, early treatment from the primary dentition period should be regarded as an option; 2) a chin cap should be used in consideration of the possibility of adverse effects; and 3) evaluation of muscle functions is important to facilitate the normal growth and development of the mandible.

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