Orthognathic Surgery


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Orthognathic Surgery

  1. 1. Orthognathic Surgery
  2. 2. ORTHOGNATHIC SURGERYO rthognathic surgery refers to thesurgical repositioning of the maxilla, Orthognathic Surgerymandible, and the dentoalveolar seg-ments to achieve facial and occlusalbalance. One or more segments of thejaw(s) can be simultaneously reposi-tioned to treat various types of maloc-clusions and jaw deformities. Preoperative diagnosis and plan-ning for patients with jaw asymmetriesand deformities includes a photo-graphic analysis and a completeorthognathic work-up involvingcephalometric and panorex radi-ographs, dental impressions, and mod- Nineteen year old female with Postoperative result after com-els. This is done by the maxillary hypoplasia, malocclu- bined maxillary/mandibularPedodontist/Orthodontist in coordi- sion and facial disharmony. procedures to correct occlusionnation with the craniofacial surgeon. and improve facial balance.All findings are analyzed and pre-sur-gical model surgery performed toascertain the feasibility of varioustreatment options. Additionally, com-puter analysis is done pre-surgicallyby the craniofacial surgeon to simulatesurgical results, thereby facilitatingproper planning of the case. Computeranalysis provides the craniofacial teamwith visual information and numericaldata that is a compilation of manytime-consuming calculations such asthose used in various cephalometricanalyses (Steiner, Ricketts, or Jarabak-Bjork). Twenty year old male with Postoperative result after Usually, pre-surgical orthodontics prognathic mandible. mandibular set back.are necessary to straighten the teethand align the arches so that a stable revise minor occlusal discrepancies. Orthognathicocclusion can be obtained post-opera- surgery is often delayed until after all of the permanenttively, while orthodontics following teeth have erupted unless medical conditions necessi-surgery are frequently required to tate that the surgery be performed earlier. In adult ©1997 Erlanger Health System Tennessee Craniofacial Center 1(800) 418-3223
  3. 3. patients, orthognathic surgery can be Orthognathic Surgerycombined with soft tissue contouringto improve the aesthetic results. Maxillary advancement is a type oforthognathic surgery that may be nec-essary to improve the facial contourand normalize dental occlusion whenthere is a relative deficiency of themidface region. This is done by surgi-cally moving the maxilla with sophisti-cated bone mobilization techniquesand fixing it securely into place. Formost patients, the use of screws andminiplates have replaced wiring of thebone and teeth required to hold thejaw stable. Inlay bone grafts can be uti- A young woman with a prog- Postoperative result after maxil-lized for space maintenance and nathic mandible and hypoplastic lary advancement and mandibu- maxilla. lar set back.secured with screw and plate fixation,while onlay bone grafting is used toaugment the bony skeleton andimprove facial soft tissue contour. Depending on the soft tissue pro-file of the face or the severity of anocclusal discrepancy, problems withthe lower face may require surgery onthe mandible. This can be done in con-junction with or separate from maxil-lary surgery. The mandible can beadvanced, set back, tilted or augment-ed with bone grafts. A combination ofthese procedures may be necessary.Pre-operative planning is crucial to thesuccess of the procedure and evaluatesthe surgical and orthodontic options. Twenty year old woman with Postoperative result afterThe surgeon chooses the type of microgenia. orthognathic surgery and chinmandibular surgery based on his expe- advancement showing improve-rience, evaluation of the photographic ment in lower facial profile.and cephalometric analysis, andmodel surgery. Following any signifi- limited or no IMF. However, if interosseous wiring iscant surgical movement of the used, IMF is maintained for approximately six weeks.mandible, fixation may be accom- Nutritionally balanced, blenderized diets are importantplished with miniplates and screws or for proper healing in the patient in IMF.with a combination of interosseouswires and intermaxillary fixation The chin is an important component of the facial(IMF). Rigid fixation (screws and profile as well as the aesthetic balance. The position andplates) has the advantage of needing projection of the chin should be evaluated in patients©1997 Erlanger Health System Tennessee Craniofacial Center 1(800) 418-3223
  4. 4. Orthognathic Surgeryconsidering orthognathic andfacial soft tissue contouring proce-dures. Photographic and cephalo-metric analysis help determine theamount of change necessary toobtain a well balanced face. Thechin can be augmented with suchalloplastic materials as silicone,polyethylene or hydroxyapatite.However, most craniofacial sur-geons prefer a sliding horizontalosteotomy genioplasty. This pro-cedure tends to give a more natur-al contour to the chin and avoidsthe risk of extrusion that goes Seventeen year old patient with Postoperative result afteralong with alloplastic implants. micrognathia (hypoplastic lower jaw). mandibular advancement. Orthognathic Surgery Nineteen year old girl with ectodermal dysplasia. She has a hypoplastic maxilla and an enlarged mandible. Postoperative result after maxillary advancement, chin reduction and orthodontic treatment. ©1997 Erlanger Health System Tennessee Craniofacial Center 1(800) 418-3223