OHI-S Orthognathic Surgery

Diagnosis and Management of Complications and Errors

4 Lessons | 2 Hours 11 Minutes | Joel Ferri & Eren Pera

Develop a structured approach to recognizing, preventing, and managing errors in orthognathic surgery with OHI-S Orthognathic Surgery: Diagnosis and Management of Complications and Errors.

Presented by Joel Ferri and Eren Pera, this focused clinical program examines complications across the complete orthognathic treatment pathway:

• Diagnosis
• Orthodontic preparation
• Surgical planning
• Surgical execution
• Functional assessment
• Aesthetic assessment
• Postoperative stability
• Relapse
• Complication management

Rather than concentrating only on operative technique, the course investigates why orthognathic treatment can fail or relapse and how errors may arise from diagnostic, orthodontic, surgical, functional, and interdisciplinary factors.

The program covers:

• Dentofacial deformity diagnosis
• Maxillary and mandibular planning
• Sagittal discrepancies
• Vertical discrepancies
• Transverse discrepancies
• Orthodontic compensation
• Orthodontic decompensation
• Surgeon–orthodontist coordination
• New orthognathic techniques
• Relapse mechanisms
• Swallowing dysfunction
• Mouth breathing
• Residual maxillary growth
• Mandibular condylar changes
• Myopathy and muscle typology
• Vascular complications
• Dental complications
• Nerve injuries
• Unfavorable fractures and bad splits
• Infection
• Pseudoarthrosis
• Dentoalveolar necrosis
• TMJ disorders

The central clinical framework is:

Diagnose Correctly → Plan Interdisciplinarily → Execute Safely → Recognize Complications Early → Identify the Cause of Relapse → Manage the Underlying Problem

Course Details

• Course: Orthognathic Surgery: Diagnosis and Management of Complications and Errors
• Provider: OHI-S
• Faculty: Joel Ferri, Eren Pera
• Lessons: 4
• Official Duration: 2 Hours 11 Minutes
• Language: English
• Official OHI-S CE: 2 CE Credits
• Primary Specialty: Oral & Maxillofacial Surgery
• Secondary Specialty: Orthodontics
• Main Focus: Orthognathic Surgery Complications, Errors & Relapse
• Clinical Level: Advanced

Course Overview

Successful orthognathic surgery depends on much more than technically performing an osteotomy.

Treatment begins long before surgery.

A patient may experience an unsatisfactory outcome because of problems involving:

• Initial diagnosis
• Skeletal analysis
• Dental compensation
• Orthodontic preparation
• Surgical movement selection
• Vertical control
• Transverse planning
• Condylar position
• Functional disorders
• Postoperative healing

This course analyzes these potential failure points systematically.

A useful treatment pathway is:

Diagnosis → Orthodontic Preparation → Surgical Plan → Surgery → Functional Recovery → Stability Evaluation

At every stage, clinicians should ask:

What Can Go Wrong Here—and How Can It Be Prevented?

Diagnosis Comes Before Surgery

Orthognathic surgery should address a correctly diagnosed dentofacial deformity.

The clinician must distinguish among:

• Skeletal discrepancies
• Dental compensations
• Functional adaptations
• Soft-tissue concerns
• TMJ-related factors

Incorrect diagnosis may produce an incorrect surgical objective even when the procedure itself is technically well executed.

Three-Dimensional Treatment Planning

Orthognathic planning should evaluate the patient in:

Sagittal Dimension

• Maxillary position
• Mandibular position
• Class II / Class III relationships
• Incisor relationships

Vertical Dimension

• Facial height
• Open bite
• Deep bite
• Maxillary vertical excess or deficiency
• Occlusal-plane relationships

Transverse Dimension

• Maxillary width
• Mandibular width
• Dental compensation
• Facial and occlusal asymmetry

Planning errors in any dimension can affect:

• Occlusion
• Function
• Facial aesthetics
• Stability

LESSON 1

Avoiding Pitfalls in Orthognathic Surgery: Common Errors in Maxillary and Mandibular Procedures

Instructor: Eren Pera
Duration: 12 Minutes

The first lesson establishes the diagnostic and treatment-planning framework.

Topics include:

• Diagnostic errors in dentofacial deformities
• Maxillary surgery planning pitfalls
• Mandibular surgery planning pitfalls
• Orthodontic–surgical treatment planning
• Compensation and decompensation errors
• Sagittal planning mistakes
• Vertical planning errors
• Transverse discrepancies
• Technical pitfalls
• Interdisciplinary workflow problems
• Communication gaps
• Functional stability
• Aesthetic outcomes
• Complication prevention
• Relapse prevention

Diagnostic Errors

One of the most important principles of the course is:

A technically successful operation cannot compensate for an incorrect diagnosis.

Treatment planning should establish:

• Nature of the dentofacial deformity
• Skeletal contribution
• Dental contribution
• Functional contribution
• Soft-tissue objectives

before defining surgical movements.

Maxillary & Mandibular Planning

Surgical planning should consider how movement of one jaw affects:

• Occlusion
• Facial proportions
• Airway relationships
• Soft tissue
• Opposing jaw
• TMJ and condylar position

The maxilla and mandible should therefore be considered within one integrated craniofacial system.

Orthodontic–Surgical Coordination

Orthodontics and surgery are not independent phases.

A strong interdisciplinary pathway is:

Orthodontic Diagnosis → Decompensation → Surgical Planning → Orthognathic Surgery → Finishing Orthodontics

Poor coordination can result in:

• Incorrect dental position
• Compromised surgical movement
• Residual malocclusion
• Unstable outcomes

Compensation and Decompensation

Patients with skeletal discrepancies may develop dental compensation.

Before surgery, orthodontic treatment may need to remove that compensation so the true skeletal discrepancy becomes visible.

Errors may occur when teeth are:

• Under-decompensated
• Over-decompensated
• Positioned inconsistently with the surgical objective

The orthodontic plan must therefore be based on the intended final skeletal correction.

Sagittal Planning Errors

Sagittal mistakes can involve incorrect assessment of:

• Maxillary protrusion or retrusion
• Mandibular protrusion or retrusion
• Dental compensation
• Incisor position

The consequence may be an incomplete or excessive correction of the patient’s profile and occlusion.

Vertical Planning Errors

Vertical planning affects:

• Incisor show
• Smile
• Facial height
• Occlusal plane
• Mandibular autorotation

Small planning changes may have substantial facial effects.

Transverse Errors

Transverse discrepancies may remain hidden if diagnosis concentrates only on sagittal cephalometric relationships.

Potential issues include:

• Maxillary deficiency
• Asymmetry
• Dental compensation
• Crossbite

These must be recognized before final surgical planning.

Interdisciplinary Communication

Poor communication between surgeon and orthodontist can introduce avoidable errors.

Both clinicians should understand:

• Final skeletal objective
• Required decompensation
• Planned surgical movement
• Postoperative orthodontic goals

The treatment should be planned as a single process rather than two separate specialties working independently.

LESSON 2

New Techniques in Orthognathic Surgery: Advances in Precision and Predictability

Instructor: Eren Pera
Duration: 16 Minutes

The second lesson reviews contemporary developments in orthognathic surgery.

Topics include:

• Emerging surgical techniques
• New orthognathic concepts
• Rationale behind newer approaches
• Accuracy
• Stability
• Predictability
• Indications
• Limitations
• Multidisciplinary integration
• Complication reduction
• Evidence-based decision-making

Modern Orthognathic Surgery

Modern treatment has increasingly incorporated:

• Improved diagnostic workflows
• More structured treatment planning
• Digital technologies
• Multidisciplinary collaboration

However, newer technology does not eliminate the need for accurate diagnosis and surgical judgment.

Precision vs. Predictability

These terms should be distinguished.

Precision

Refers to accurately executing the intended plan.

Predictability

Refers more broadly to the consistency of the clinical outcome.

A procedure may be performed precisely but still fail to produce the expected result if:

• Diagnosis was incorrect
• Planning was inadequate
• Biological factors were underestimated

Indications and Limitations

The course emphasizes evaluating both the potential advantages and limitations of contemporary techniques.

The appropriate question is not:

“What Is the Newest Technique?”

but:

“Which Technique Is Appropriate for This Patient and Treatment Objective?”

Evidence-Based Decision-Making

New surgical concepts should be evaluated according to:

• Indication
• Clinical evidence
• Patient anatomy
• Stability
• Risk
• Surgical experience

rather than novelty alone.

LESSON 3

Etiology of Relapse in Orthognathic Surgery

Instructor: Joel Ferri
Duration: 40 Minutes

The third lesson focuses on understanding why orthognathic results relapse.

Topics include:

• Persistent dysfunctions
• Abnormal swallowing
• Mouth breathing
• Residual maxillary growth
• Mandibular condylar reshaping
• Myopathy
• Muscle typology
• Early identification of relapse mechanisms
• Prevention of permanent damage

Orthognathic Relapse

Relapse should not always be interpreted simply as:

“The Bone Moved Back.”

The true mechanism may involve:

• Persistent muscular function
• Growth
• Condylar changes
• Occlusal relationships
• Skeletal adaptation
• Uncorrected functional disorders

Understanding the cause is critical before selecting a corrective strategy.

Persistent Dysfunction

The official course specifically highlights persistent dysfunctions such as:

• Abnormal swallowing
• Mouth breathing

If the underlying functional driver remains after surgery, it may continue to influence the dentofacial system.

This emphasizes:

Treat the Cause, Not Only the Skeletal Result

Swallowing Dysfunction

Abnormal swallowing patterns can influence:

• Tongue posture
• Dental relationships
• Muscular forces

Persistent dysfunction may therefore need to be incorporated into multidisciplinary assessment.

Mouth Breathing

Mouth breathing may coexist with:

• Airway-related problems
• Altered oral posture
• Functional adaptation

Its relevance should be evaluated according to the individual patient rather than assumed to be the cause of every relapse.

Residual Maxillary Growth

Growth-related changes can affect long-term stability.

The course discusses the impact of:

Residual Maxillary Growth

on postoperative outcomes.

This reinforces the importance of understanding:

• Patient age
• Growth status
• Deformity pattern

before treatment.

Condylar Reshaping

Changes involving the mandibular condyle can alter:

• Mandibular position
• Occlusion
• Facial symmetry
• Long-term surgical stability

The course discusses unfavorable condylar reshaping as a potential mechanism contributing to relapse.

Myopathy & Muscle Typology

Constitutional muscular factors may influence postoperative adaptation.

The curriculum includes:

• Myopathy
• Muscle typology

as potential contributors to treatment stability.

Early Detection

Relapse management should emphasize:

Recognition Before Severe Secondary Deformity Develops

Early evaluation may allow clinicians to identify:

• Occlusal changes
• Functional abnormalities
• TMJ problems
• Skeletal changes

before they become more difficult to manage.

LESSON 4

Mistakes and Complications in Orthognathic Surgery

Instructor: Joel Ferri
Duration: 1 Hour 1 Minute

The final lesson provides the most comprehensive overview of surgical complications.

Topics include:

• Functional considerations
• Diagnostic errors
• Orthodontic treatment errors
• Surgical planning errors
• Aesthetic planning errors
• Surgical safety
• Risk factors
• Vascular complications
• Dental complications
• Nerve-related complications
• Unfavorable fractures
• Bad splits
• Postoperative infection
• Pseudoarthrosis
• Dentoalveolar necrosis
• TMJ disorders
• Complication prevention
• Early recognition
• Management

Functional Considerations

Orthognathic treatment should not focus exclusively on facial appearance.

Planning may also involve:

• Mastication
• Occlusion
• TMJ function
• Muscle function
• Swallowing
• Airway-related functional considerations

Aesthetic improvement should be integrated with functional goals.

Aesthetic Planning Errors

Orthognathic surgery directly changes facial proportions.

Planning should consider:

• Profile
• Facial height
• Lip support
• Chin projection
• Smile
• Facial symmetry

An ideal occlusal result does not automatically guarantee an ideal facial result.

Vascular Complications

Orthognathic surgery is performed in anatomically vascular regions.

The course includes vascular complications as a major safety topic.

Recognition and management of intraoperative and postoperative bleeding require formal surgical training and appropriate emergency preparedness.

Dental Complications

Potential dental complications may occur in association with:

• Osteotomies
• Segmental procedures
• Surgical manipulation

The course emphasizes prevention and recognition rather than viewing dental complications as isolated technical events.

Nerve-Related Complications

Neurosensory problems are important considerations in orthognathic surgery.

Clinicians should understand the relationship between:

• Surgical anatomy
• Osteotomy design
• Nerve position
• Postoperative neurological symptoms

Unfavorable Fractures & Bad Splits

A bad split is an important intraoperative complication, especially within mandibular osteotomy procedures.

The course reviews:

• Recognition
• Risk considerations
• Management principles

These events require experienced surgical decision-making.

Postoperative Infection

Postoperative infection may compromise:

• Healing
• Fixation
• Bone
• Soft tissues
• Final stability

Prevention and early management are therefore essential components of surgical care.

Pseudoarthrosis

Pseudoarthrosis represents failure to achieve normal bony union between surgical segments.

It can affect:

• Stability
• Occlusion
• Function

and may require further evaluation or intervention.

Dentoalveolar Necrosis

The program also includes dentoalveolar necrosis, an important but potentially serious complication involving compromised vascular supply to dentoalveolar segments.

This emphasizes the importance of:

• Surgical anatomy
• Tissue preservation
• Vascular considerations

Temporomandibular Joint Disorders

TMJ-related problems can influence:

• Diagnosis
• Treatment planning
• Postoperative function
• Stability

The relationship between orthognathic surgery and TMJ conditions must therefore be evaluated at the individual-patient level.

Prevention Before Management

One of the strongest lessons of the course is that complication management begins before surgery.

A useful prevention model is:

Accurate Diagnosis

↓

Appropriate Orthodontic Preparation

↓

Correct Surgical Plan

↓

Recognition of Risk Factors

↓

Careful Execution

↓

Early Detection

↓

Appropriate Management

Orthodontist–Surgeon Collaboration

Orthognathic surgery requires one of the closest collaborations in dentistry.

Orthodontist

Responsible for key components including:

• Dental alignment
• Decompensation
• Arch coordination
• Surgical preparation
• Postoperative finishing

Oral & Maxillofacial Surgeon

Responsible for:

• Skeletal diagnosis
• Surgical planning
• Operative treatment
• Surgical risk management

The best outcomes depend on a shared final objective.

Compensation vs. Decompensation

A patient may appear to have a less severe skeletal discrepancy because the teeth have compensated.

Before surgery, those compensations may need correction.

A simplified example is:

Skeletal Deformity + Dental Compensation

↓

Orthodontic Decompensation

↓

True Skeletal Discrepancy Revealed

↓

Surgical Correction

Incorrect sequencing can compromise final:

• Occlusion
• Facial profile
• Stability

Orthognathic Surgery & TMJ

TMJ evaluation should form part of the diagnostic process when clinically relevant.

Potential considerations include:

• Pain
• Dysfunction
• Condylar morphology
• Range of motion
• Existing joint disease

The presence of TMD does not automatically determine one universal orthognathic strategy.

Relapse Prevention

Long-term stability requires more than rigid fixation.

Factors influencing stability may include:

• Growth
• Muscle function
• Swallowing
• Breathing patterns
• Condylar adaptation
• Orthodontic finishing
• Retention
• Original deformity

The course therefore approaches relapse as a multifactorial problem.

Major Topics Covered

• Orthognathic Surgery
• Orthognathic Surgery Complications
• Orthognathic Surgery Errors
• Dentofacial Deformities
• Maxillary Surgery
• Mandibular Surgery
• Orthodontic Surgical Planning
• Orthodontic Decompensation
• Dental Compensation
• Sagittal Discrepancies
• Vertical Discrepancies
• Transverse Discrepancies
• Orthognathic Relapse
• Swallowing Dysfunction
• Mouth Breathing
• Residual Maxillary Growth
• Mandibular Condyle
• TMJ Disorders
• Myopathy
• Vascular Complications
• Nerve Injury
• Bad Split
• Unfavorable Fracture
• Postoperative Infection
• Pseudoarthrosis
• Dentoalveolar Necrosis
• Surgical Risk Management
• Oral and Maxillofacial Surgery
• Surgical Orthodontics

Who Should Take This Course?

The strongest target audience includes:

• Oral and Maxillofacial Surgeons
• Orthognathic Surgeons
• Oral & Maxillofacial Surgery Residents
• Orthodontists
• Orthodontic Residents involved in surgical cases

The program is particularly useful for clinicians participating in:

Orthodontic–Surgical Management of Dentofacial Deformities

The strongest primary audience is:

Oral and Maxillofacial Surgeons

with Orthodontists as the essential interdisciplinary secondary audience.

Is This an Orthodontics Course?

Orthodontics is a major component because the course covers:

• Compensation
• Decompensation
• Surgical orthodontic planning
• Interdisciplinary coordination
• Orthodontic errors

However, the overall course is officially categorized within:

Oral and Maxillofacial Surgery

and much of Lesson 4 addresses operative complications.

Therefore, the product should be positioned primarily as:

Orthognathic / Oral & Maxillofacial Surgery

with Orthodontics as a major secondary specialty.

Why This Course Is Useful

The strongest value is the integration of several failure domains within one course.

Diagnostic Errors

• Dentofacial diagnosis
• Sagittal / vertical / transverse discrepancies

Orthodontic Errors

• Compensation
• Decompensation
• Coordination

Surgical Planning Errors

• Maxillary movement
• Mandibular movement
• Aesthetic planning

Surgical Complications

• Vascular
• Dental
• Neurologic
• Bad splits
• Infection
• Necrosis

Relapse

• Dysfunction
• Growth
• Condylar changes
• Muscle factors

The complete framework is:

Prevent → Recognize → Understand the Cause → Manage → Improve Long-Term Stability

Important Surgical Training Notice

Orthognathic surgery is an advanced surgical discipline.

Recorded education can improve understanding of:

• Diagnosis
• Treatment planning
• Complication recognition
• Relapse mechanisms
• Interdisciplinary coordination

but it does not substitute for:

• Formal Oral & Maxillofacial Surgery training
• Operative residency training
• Supervised surgical experience
• Advanced airway and emergency management
• Appropriate institutional credentialing

Management of complications such as vascular injury, bad splits, infection, pseudoarthrosis, necrosis, or nerve injury requires appropriately trained surgical teams.

Original OHI-S CE Information

The current official OHI-S course page lists:

2 CE Credits

for the complete:

4-Lesson / 2h 11min

course.

Official CE eligibility applies to participants who complete the applicable requirements through OHI-S.

An independently distributed MedicalAmboss recording package should not automatically be advertised as including:

• OHI-S CE Credits
• OHI-S Certificate

unless official participation and credit eligibility are included.

Product Summary

• Product: Orthognathic Surgery: Diagnosis and Management of Complications and Errors
• Provider: OHI-S
• Faculty: Joel Ferri & Eren Pera
• Lessons: 4
• Official Duration: 2h 11min
• Language: English
• Current Official OHI-S CE: 2 Credits
• Primary Specialty: Oral & Maxillofacial Surgery
• Secondary Specialty: Orthodontics
• Main Focus: Errors, Complications, Relapse & Prevention

4. Short Description

OHI-S Orthognathic Surgery: Diagnosis and Management of Complications and Errors is an advanced 4-lesson, 2h 11min clinical course presented by Joel Ferri and Eren Pera.

The program covers diagnostic errors in dentofacial deformities, maxillary and mandibular treatment-planning pitfalls, orthodontic compensation and decompensation, sagittal/vertical/transverse planning, modern orthognathic techniques, relapse caused by persistent dysfunction and growth-related factors, condylar changes, vascular and nerve complications, bad splits, infection, pseudoarthrosis, dentoalveolar necrosis, and TMJ disorders.

Topics

Lesson 1. Avoiding Pitfalls in Orthognathic Surgery: Common Errors in Maxillary and Mandibular Procedures

• Diagnostic errors in dentofacial deformities

• Treatment planning pitfalls in maxillary and mandibular surgery

• Orthodontic–surgical planning principles

• Errors in orthodontic compensation and decompensation

• Sagittal discrepancies: planning mistakes

• Vertical dimension errors in surgical planning

• Transverse discrepancies and miscalculations

• Surgical and technical pitfalls

• Workflow and interdisciplinary coordination issues

• Communication gaps between orthodontist and surgeon

• Factors affecting functional stability

• Factors influencing aesthetic outcomes

• Prevention of complications and relapse

• Systematic approach to predictable treatment outcomes

• Clinical strategies for improving surgical predictability

Lesson 2. New Techniques in Orthognathic Surgery: Advances in Precision and Predictability

• Emerging techniques in modern orthognathic surgery

• Rationale behind new surgical concepts

• Impact on accuracy, stability, and predictability

• Indications and limitations of contemporary techniques

• Integration into multidisciplinary workflows

• Strategies to improve outcomes and minimize complications

• Evidence-based decision-making in clinical practice

Lesson 3. Etiology of Relapse in Orthognathic Surgery

• Relapse due to persistent dysfunctions: swallowing abnormalities and mouth breathing

• Residual maxillary growth and its impact

• Unfavorable mandibular condyle reshaping

• Constitutional abnormalities: myopathy and muscle typology

• Importance of early detection and management to prevent permanent damage

Lesson 4. Mistakes and Complications in Orthognathic Surgery

• Functional considerations in orthognathic surgery

• Diagnostic errors

• Errors in orthodontic treatment

• Errors in surgical planning

• Errors in aesthetic considerations

• Overview of surgical safety and risk factors

• Vascular complications

• Dental complications

• Nerve-related complications

• Unfavorable fractures and bad splits

• Postoperative infections

• Pseudoarthrosis

• Dentoalveolar necrosis

• Temporomandibular joint (TMJ) disorders

• Other potential complications

• Importance of prevention, early detection, and proper management