Orthognathic surgery is a widely recognized procedure for treating patients with jaw deformities, and the number of such patients who have underlying diseases or have an implantable cardioverter defibrillator (ICD) has been increasing. We report treatment management for orthognathic surgery in two patients with jaw deformities who had ICDs and indicate important points that require attention when treating patients with jaw deformities who have ICDs.
One patient was a 51-year-old male with mandibular prognathism who had received an ICD for Brugada syndrome. He experienced proper ICD function against ventricular fibrillation (VF) and began taking quinidine hydrochloride after that event. We decided that surgery under general anesthesia would be possible without deterioration of cardiac function and we started treatment. After preoperative orthodontic treatment, Le Fort 1 osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) were performed. Preoperative examination showed no abnormalities except for a coved ST-segment elevation in the V1 lead and saddleback ST-segment elevation in the V3 lead. He continued taking quinidine hydrochloride during his hospital stay. The use of the ICD was discontinued and a defibrillator patch was applied to the chest during surgery, and there was no arrhythmia requiring defibrillation. The ICD was reset after surgery and no surgical ICD procedure was carried out during his hospital stay.
The other patient was a 38-year-old male with mandibular prognathism who had an ICD for idiopathic VF. He experienced proper ICD function against VF probably caused by vasospastic angina and began taking benidipine hydrochloride after that event. We decided that surgery under general anesthesia would be possible without deterioration of cardiac function and we started treatment. Presurgical orthodontic treatment was followed by Le Fort 1 osteotomy and BSSRO. He had no abnormalities on preoperative examination and continued taking benidipine hydrochloride during his hospital stay. The use of the ICD was discontinued and a defibrillator patch was applied to the chest. Nicorandil was administered continuously to prevent coronary artery spasms during the surgery, and there was no arrhythmia requiring defibrillation. The ICD was reset after surgery and no surgical ICD procedure was carried out during his hospital stay.
We conclude that in the treatment of jaw deformities in patients who have ICDs, 1) planning of the treatment according to the cardiac function of each patient, 2) device management (prevention of malfunction), and 3) prevention of life-threatening arrhythmias caused by the disease state are important.