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An Evaluation of the Changes in Maxillary Pulpal Blood Flow Associated with Orthognathic Surgery

Division of Dental Health & Development, University of Wales College of Medicine, Heath Park, Cardiff CF4 4XY, U.K.

M. L. Jones, B.D.S., M.SC., PH.D., D.ORTH. F.D.S.

Division of Dental Health & Development, University of Wales College of Medicine, Heath Park, Cardiff CF4 4XY, U.K.

M. Hill, B.D.S., M.D.SC., M.SC., F.D.S.

Division of Oral Surgery, Oral Medicine & Pathology, University of Wales College of Medicine, Cardiff CF4 4XY, U.K.

A.W. Sugar, B.CH.D., F.D.S.

MaxilloFacial Unit, Morriston Hospital, Swansea SA6 6NL, U.K.

Professor Malcolm L. Jones, Division of Dental Health & Development, Dental School, University of Wales College of Medecine, Heath Park, Cardiff CF64 3NY, U.K. E-mail: JonesML{at}cf.ac.uk

The objective of this study was to evaluate the use of the Laser Döppler Flowmeter (LDF) in the measurement of pulpal blood flow following orthognathic surgery and to conduct an initial sudy of the effects of a Le Fort I osteotomy on the pulpal blood flow of the maxillary central incisors. The design consisted of a preliminary prospective controlled consecutive clinical trial undertaken at the Orthodontic Clinic, University Dental Hospital NHS Trust, Wales, 1994.

The study group consisted of 15 consecutive patients who were to receive a standard advancement Le Fort I osteotomy. Seven patients who were to undergo a mandibular advancement only acted as a control. A further 20 separate patients participated in a study for the assessment of measurement error. The blood flow in relative perfusion units v. time, was measured using a Laser Döppler Flowmeter.

Measurement error for flowmeter recordings with hand-held application and custom-made splint support showed no consistent difference or significant random variation between the two methods for holding the probe against the teeth (pooled S.D. of reproducibility 1/1=1.91/1.39 for custom splint location as opposed to 0.96/1.07 for hand-held/fixed bracket location).

For the surgical patients under investigation no significant differences for maxillary pulpal blood flow were found in the control group (mandibular osteotomy) over time. However, in the maxillary osteotomy patients there was a tendency for an initial rise in the maxillary perfusion post-surgery as measured at the central incisor pulps, followed by an overall reduction at 6 months. As an example, the mean value for the upper right central showed a significant increase of blood flow during the immediate post-operative period (P<0.05, but at 6 months after surgery demonstrated a statistically significant overall reduction in comparison with the presurgical reading (P<0.001).

The laser Döppler flowmeter is not an easy instrument to use in the clinical assessment of pulpal blood flow. However, it would appear from these longitudinal series of readings, taken over a 6-month period on 15 patients, that the maxillary perfusion recorded at the central incisor pulps may be permanently affected in many Le Fort I osteotomy patients. For patients that already have prejudiced blood supply this could lead to devitalization and discoloration of incisors. It is not known if this effect on the perfusion of the pulp continues beyond 6 months post-surgery.

Key words: Döppler Flowmeter, Le Fort I, Maxillary Osteotomy, Pulpal Blood Flow, Pulpal Perfusion