Orthognathic surgery treatment injuries reported to the Danish Patient Compensation Association: A 25-year retrospective observational study.

Abstract Aim of study The aim of this study was to describe and classify indemnity claims of treatment injuries in orthognathic surgery received by the Danish Patient Compensation Association (DPCA) during a 25-year time span from 1993 – 2018 in order to illustrate the wide scope of treatment injuries, patient’s complaints, suffering, and compensation. Material and methods All indemnity claims associated with orthognathic surgery were reviewed accessing the DPCA database including osteotomies performed in association with orthodontic treatment only, thus excluding access osteotomies for tumor surgery, osseodistraction cases, etc. Results A total of 237 indemnity claims were received for injury associated with orthognathic surgery, including anesthesia. One-hundred sixteen claims (49 %) were approved and patients accordingly compensated with a total of 23.2 million, average 200.000 Danish kroner per patient. In US dollars, 3.5 million, and 30 thousand, respectively. Most claims (45.5 %) were associated with neurological issues, neurosensory disturbances of all kinds including pain and loss of neural function. Others were associated with airway, breathing and circulation (2.1 %), temporomandibular joint issues (8.9 %), jaw malposition (9.3 %), malocclusion (11.0 %), facial issues (6.8 %), dental issues (10.5 %), and miscellaneous (5.9 %), as sole complaint or in concert. Data from the Danish Health Data Authority allowed a calculation of the indemnity claims rate covering the time frame 2005 – 2008 being indeed very low, 1.8 % out of 10,955 orthognathic surgeries. Conclusions Treatment injuries do occur to the misfortune of patients and surgeons alike. The low rate of indemnity claims indicates an underreporting when compared to known rates of complications. It is the surgeon’s responsibility that potential benefits of surgery outweigh the risk of complications, be they treatment errors or known shortcomings of procedures. Established criteria for admission to orthognathic surgery would be advisable and most probably reduce the number patients operated on marginal indication and treatment injuries in this group.