Effect of Redon-type Drains on Postoperative Edema Following Mandibular Orthognathic Surgery: a Randomized, Controlled Superiority Trial With Two Parallel Arms (DPO - OM)
Orthognathic surgery involves the maxillary and/or mandibular skeletal bases; it entails maxillary and/or mandibular osteotomies (such as sagittal split osteotomies of the mandibular rami) aimed at restoring normal maxillomandibular skeletal and dento-occlusal relationships in patients with maxillomandibular dysmorphosis. These deformities give rise to morphological, aesthetic, and functional abnormalities that can be severe (e.g., respiratory issues, temporomandibular joint pain). Postoperative edema is inevitable following orthognathic surgery; it can be significant, causing pain and discomfort while delaying patient recovery and hospital discharge. The use of Redon-type drains for mandibular osteotomies is not a standard practice across surgical teams due to a lack of consensus. The only available data come from studies with methodologies that do not allow for a definitive conclusion regarding the superiority of using-or not using-postoperative Redon drains (Lee et al. 2020), and no clinical trials have investigated this issue. This project aims to evaluate the impact of Redon-type drainage in mandibular osteotomies (sagittal split osteotomies of the mandibular rami), whether or not combined with genioplasty (osteotomy of the mental symphysis). We hypothesize that drainage using Redon-type drains for 6 hours in the immediate postoperative period following mandibular osteotomies significantly reduces postoperative edema.
The primary objective of this clinical trial is to demonstrate the superiority-in terms of reducing postoperative edema at day 2-of placing Redon-type drains for 6 hours immediately following sagittal split osteotomy of the mandibular rami (in addition to standard postoperative care) compared to standard postoperative care alone, without a drainage device.
Hypothesis: Demonstrating that the use of Redon-type drains following orthognathic surgery osteotomies reduces postoperative edema, pain, and discomfort would provide a rational basis for this practice and support its routine implementation. The expected benefits are twofold, impacting both patients and public health. For patients, the anticipated benefits include reduced postoperative discomfort and pain, faster recovery, and shorter hospital stays, with the future prospect of outpatient care.
Tutkimuksen yleiskatsaus
Tila
Interventio / Hoito
Opintotyyppi
Ilmoittautuminen (Arvioitu)
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Opiskeluyhteys
- Nimi: Anne MORICE, DR
- Puhelinnumero: 0247476680
- Sähköposti: a.morice@chu-tours.fr
Opiskelupaikat
-
-
-
Angers, Ranska
- Chu Angers
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Nantes, Ranska
- Chu Nantes
-
-
Osallistumiskriteerit
Kelpoisuusvaatimukset
Opintokelpoiset iät
Hyväksyy terveitä vapaaehtoisia
Sukupuolet, jotka voivat opiskella
Kuvaus
Inclusion criteria:
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Patients aged 15 years or older
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Undergoing mandibular osteotomies, with or without genioplasty, with or without wisdom tooth extraction (maxillary and/or mandibular)
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Informed consent obtained from the adult patient, or from the holder(s) of parental authority if the patient is a minor*
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Enrolled in a French social security program
- When both holders of parental authority cannot give joint consent, the consent of a single legal representative may be obtained in situations provided for by regulations or duly justified and documented in the source file.
Exclusion Criteria:
- History of maxillomandibular bone surgery
- Coagulation disorder
- Thrombophilia
- Patients on anticoagulants or antiplatelet agents
- Patients with a constitutional bone disorder
- Patients with a syndromic craniofacial malformation
- Absolute or relative contraindications to treatment with corticosteroids
- Pregnant (urine test) or breastfeeding women
- Patients under legal guardianship, conservatorship, or judicial protection
- Contraindications to the procedure
- Patients who have taken corticosteroids or NSAIDs on the day before the procedure (D-1).
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Ennaltaehkäisy
- Jako: Satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseet ja interventiot
Osallistujaryhmä / Arm |
Interventio / Hoito |
|---|---|
|
Kokeellinen: experimental arm
with drains placed at the end of the procedure, in addition to standard postoperative care. These will be Redon drains with an outlet that is either intraoral or transcutaneous in the cervical region, depending on the participating center's practices (intraoral transmucosal in the Tours and Angers centers or transcutaneous in the Nantes center); these drains will be removed 6 hours after placement Translated with DeepL.com (free version) |
in which drains are placed at the end of the procedure, in addition to standard postoperative care. |
|
Active Comparator: control arm
which consists of not placing any drainage device immediately after surgery, with standard postoperative care identical to that of the experimental group. |
not placing any drainage device immediately after surgery, with standard postoperative care identical |
Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Postoperative swelling
Aikaikkuna: Cervicofacial linear measurement will be collected 48 hours after the randomization (day 2) and at month 3. As the facial skeletal anatomy will be modified by the surgical procedure, month 3 will be considered as the baseline measurement.
|
The primary outcome will be the post operative facial swelling 48 hours after the end of the surgical procedure (randomization will be at this timepoint) measured with cervicofacial linear measurements |
Cervicofacial linear measurement will be collected 48 hours after the randomization (day 2) and at month 3. As the facial skeletal anatomy will be modified by the surgical procedure, month 3 will be considered as the baseline measurement.
|
Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Postoperative swelling
Aikaikkuna: Cervicofacial linear measurement will be collected at 6 hours after randomization, 24 hours after randomization (day 1) and at day 7
|
Postoperative swelling at other time points than for the primary outcome, measured with cervico facial linear measurements |
Cervicofacial linear measurement will be collected at 6 hours after randomization, 24 hours after randomization (day 1) and at day 7
|
|
Postoperative swelling
Aikaikkuna: It will be collected 24 hours after randomization (day 1) , at day 2, at day 7 and at month 3
|
Postoperative swelling using 3D photogrammetry instead of cervicofacial linear measurements |
It will be collected 24 hours after randomization (day 1) , at day 2, at day 7 and at month 3
|
|
Pain intensity
Aikaikkuna: Pain will be collected 6 hours after randomization, at day 1 (24 hours after randomization), at day 2 and at day 7
|
Pain will be measured using a visual analog scale where 0 corresponds to no pain and 10 to unbearable pain |
Pain will be collected 6 hours after randomization, at day 1 (24 hours after randomization), at day 2 and at day 7
|
|
Aesthetic discomfort
Aikaikkuna: It will be collected 6 hours after randomization, at day 1 (24 hours after randomization), at day 2 and at day 7
|
Aesthetic discomfort will be measured using a visual analog scale with 0 indicating no discomfort and 10 corresponding to an extremely uncomfortable feeling |
It will be collected 6 hours after randomization, at day 1 (24 hours after randomization), at day 2 and at day 7
|
|
Breathing discomfort
Aikaikkuna: It will be collected 6 hours after randomization, at day 1 (24 hours after randomization), at day 2 and at day 7
|
Breathing discomfort will be measured using a visual analog scale where 0 corresponds to no discomfort and 10 to extremely bothersome |
It will be collected 6 hours after randomization, at day 1 (24 hours after randomization), at day 2 and at day 7
|
|
Swallowing discomfort
Aikaikkuna: It will be collected 6 hours after randomization, at day 1 (24 hours after randomization), at day 2 and at day 7
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Swallowing discomfort will be measured using a visual analog scale where 0 corresponds to no discomfort and 10 to extremely bothersome |
It will be collected 6 hours after randomization, at day 1 (24 hours after randomization), at day 2 and at day 7
|
|
Pain during redon drain removal
Aikaikkuna: It will be collected 6 hours after randomization, at time to redon removal.
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Pain during redon drain removal will be collected for participants of the experimental group after redon drain removal |
It will be collected 6 hours after randomization, at time to redon removal.
|
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The daily bed rest in hours
Aikaikkuna: It will be collected at day 1 and at day 2 (how long the participant stay in his bed in the last 24 hours) as well as at day 7 (how long the participants stay in his bed each day of the last 4 days).
|
It corresponds to how long, in hours, the participant stays in his bed each day. |
It will be collected at day 1 and at day 2 (how long the participant stay in his bed in the last 24 hours) as well as at day 7 (how long the participants stay in his bed each day of the last 4 days).
|
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The general well-being
Aikaikkuna: It will be collected at day 7 and at month 3
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General well-being will be assessed using the GHQ-28 self-assessment questionnaire. The GHQ-28 is a questionnaire with 28 items and with scores ranging from 0 - indicating no deterioration in well-being - to 84 - indicating a significant deterioration in well-being. |
It will be collected at day 7 and at month 3
|
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The length of hospital stay
Aikaikkuna: a maximum of 90 days
|
It corresponds to the lenght of the hospital stay, in days (a maximum of 90 days) |
a maximum of 90 days
|
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Postoperative adverse events
Aikaikkuna: Throughout the three-month follow-up period, whenever an adverse event occurs
|
Postoperative adverse events correspond to hematoma, pre-thoracic hematoma spread, and infection |
Throughout the three-month follow-up period, whenever an adverse event occurs
|
Yhteistyökumppanit ja tutkijat
Sponsori
Tutkijat
- Opintojohtaja: Anne MORICE, Dr, University Hospital, Tours
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Arvioitu)
Ensisijainen valmistuminen (Arvioitu)
Opintojen valmistuminen (Arvioitu)
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
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