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Research Article| Volume 50, ISSUE 2, e17-e21, March 2012

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Consent for orthognathic surgery: a UK perspective

      Abstract

      Obtaining consent to undertake orthognathic surgery is a legal requirement that starts at the initial visit when treatment is being considered and continues until the operation itself. The process includes discussion of the benefits, risks, and potential complications of the proposed procedure, and any alternative (including doing nothing), but there is no consensus about how much information should be disclosed. Guidance is provided on the basis of case law, which is itself evolving. The purpose of this study was to look at the current practice of obtaining consent for orthognathic surgery by oral and maxillofacial surgeons in the UK to act as a benchmark and potentially to stimulate further debate. We also review common and serious complications that might be included in the process.

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      References

      1. General Medical Council. Consent: patients and doctors making decisions together; 2008. Available from URL: http://www.gmc-uk.org.

      2. Sidaway v Board of Governors of Bethlem Royal and the Maudsley Hospital [1985] 2 WLR 480.

      3. Bolam v Friern Hospital Management Committee [1957] 1 WLR 582.

      4. Chester v Afshar [2004] UKHL 41 Pt 2.

        • Brons S.
        • Becking A.G.
        • Tuinzing D.B.
        Value of informed consent in surgical orthodontics.
        J Oral Maxillofac Surg. 2009; 67: 1021-1025
        • Gasparini G.
        • Boniello R.
        • Moro A.
        • Di Nardo F.
        • Pelo S.
        Orthognathic surgery: a new pre-operative informed consent model.
        J Craniofac Surg. 2009; 20: 90-92
        • Layton S.
        • Korsen J.
        Informed consent in oral and maxillofacial surgery: a study of the value of written warnings.
        Br J Oral Maxillofac Surg. 1994; 32: 34-36
        • Brosnam T.
        • Perry M.
        Informed consent in adult patients: can we achieve a gold standard?.
        Br J Oral Maxillofac Surg. 2009; 47: 186-190
        • Van Sickels J.E.
        Prevention and management of complications of orthognathic surgery.
        in: Miloro M. Peterson's principles of oral & maxillofacial surgery. 2nd ed. BC Decker, Ontario2004: 1247-1266
        • Richardson D.
        Avoiding surgical complications in orthognathic surgery.
        in: Ward-Booth P. Schendel S. Hausaman J. Maxillofacial surgery. 2nd ed. Churchill Livingston, London2006: 1259-1274
        • Van de Perre J.P.
        • Stoelinga P.J.
        • Blijdorp P.A.
        • Brouns J.J.
        • Hoppenreijs T.J.
        Perioperative morbidity in maxillofacial orthopaedic surgery: a retrospective study.
        J Craniomaxillofac Surg. 1996; 24: 263-270
        • Kramer F.J.
        • Baethge C.
        • Swennen G.
        • Teltzrow T.
        • Schulze A.
        • Berten J.
        • et al.
        Intra- and perioperative complications of the Le Fort I osteotomy: a prospective evaluation of 1000 patients.
        J Craniofac Surg. 2004; 15: 971-977
        • Teltzrow T.
        • Kramer F.
        • Schulze A.
        • Baethge
        • Brachvogel P.
        Perioperative complications following sagittal split osteotomy of the mandible.
        J Craniomaxillofac Surg. 2005; 33: 307-313
        • Lanigan D.T.
        • Hey J.H.
        • West R.A.
        Major vascular complications of orthognathic surgery: false aneurysms and arteriovenous fistulas following orthognathic surgery.
        J Oral Maxillofac Surg. 1991; 49: 571-577
        • Chow L.K.
        • Singh B.
        • Chiu W.K.
        • Samman N.
        Prevalence of postoperative complications after orthognathic surgery: a 15-year review.
        J Oral Maxillofac Surg. 2007; 65: 984-992
        • Kuhlefelt M.
        • Laine P.
        • Suominen-Taipale L.
        • Ingman T.
        • Lindqvist C.
        • Thorén H.
        Risk factors contributing to symptomatic miniplate removal: a retrospective study of 153 bilateral sagittal split osteotomy patients.
        Int J Oral Maxillofac Surg. 2010; 39: 430-435
        • Panula K.
        • Finne K.
        • Oikarinen K.
        Incidence of complications and problems related to orthognathic surgery: a review of 655 patients.
        J Oral Maxillofac Surg. 2001; 59: 1128-1136
        • Espeland L.
        • Høgevold H.E.
        • Stenvik A.
        A 3-year patient centred follow-up of 516 consecutively treated orthognathic surgery patients.
        Eur J Orthodont. 2008; 30: 24-30
        • de Mol van Otterloo J.J.
        • Tuinzing D.B.
        • Greebe R.B.
        • van der Kwast W.A.
        Intra- and early postoperative complications of the Le Fort I osteotomy. A retrospective study on 410 cases.
        J Craniomaxillofac Surg. 1991; 19: 217-222
        • Jacks S.C.
        • Zuniga J.R.
        • Turvey T.A.
        • Schalit C.
        A retrospective analysis of lingual nerve sensory change after mandibular sagittal split osteotomy.
        J Oral Maxillofac Surg. 1998; 56: 700-704
        • De Vries K.
        • Devriese P.P.
        • Hovinga J.
        • van den Akker H.P.
        Facial palsy after sagittal split osteotomies. A survey of 1747 sagittal split osteotomies.
        J Craniomaxillofac Surg. 1993; 21: 50-53
        • Lanigan D.T.
        • Hey J.H.
        • West R.A.
        Aseptic necrosis following maxillary osteotomies: report of 36 cases.
        J Oral Maxillofac Surg. 1990; 48: 504-509
        • Precious D.S.
        Removal of third molars with sagittal split osteotomies: the case for.
        J Oral Maxillofac Surg. 2004; 62: 1144-1146
        • Proffit W.R.
        • Turvay T.A.
        • Phillips C.
        The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: an update and extension.
        Head Face Med. 2007; 3: 21
        • Dolce C.
        • Hatch J.P.
        • Van Sickels J.E.
        • Rugh J.D.
        Rigid versus wire fixation for mandibular advancement: skeletal and dental changes after 5 years.
        Am J Orthod Dentofacial Orthop. 2002; 121: 610-619
        • O’Ryan F.
        • Schendel S.
        Nasal anatomy and maxillary surgery. II. Unfavorable nasolobial esthetics following the Le Fort I osteotomy.
        Int J Adult Orthodon Orthognath Surg. 1989; 4: 75-84
        • Panula K.
        • Somppi M.
        • Finne K.
        • Oikarinen K.
        Effects of orthognathic surgery on temporomandibular joint dysfunction: a controlled prospective 4-year follow up study.
        Int J Oral Maxillofac Surg. 2000; 29: 183-187
        • Hoppenreijs T.J.
        • Freihofer H.P.
        • Stoelinga P.J.
        • Tuinzing D.B.
        • van’t Hof M.A.
        Condylar remodelling and resorption after Le Fort I and bimaxillary osteotomies in patients with anterior open bite. A clinical and radiological study.
        Int J Oral Maxillofac Surg. 1998; 27: 81-91
        • Bouwman J.P.
        • Kerstens H.C.
        • Tuinzing D.B.
        Condylar resorption in orthognathic surgery. The role of intermaxillary fixation.
        Oral Surg Oral Med Oral Pathol. 1994; 78: 138-141
        • Hoppenrijs T.J.
        • Stoelinga P.J.
        • Grace K.L.
        • Robben C.M.
        Long-term evaluation of patients with progressive condylar resorption following orthognathic surgery.
        Int J Oral Maxillofac Surg. 1999; 28: 411-418
        • Cunningham S.J.
        • Moles D.C.
        A national review of mandibular orthognathic surgery activity in the National Health Service in England over a nine year period: part 2–patient factors.
        Br J Oral Maxillofac Surg. 2009; 47: 274-278