COMPLICATIONS OF
ORTHOGNATHIC
SURGERY

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INDIAN DENTAL ACADEMY
Leader in continuing dental education

www.indiandentalacademy.com

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CONTENTS
• INTRODUCTION
• VASCULAR COMPLICATION
• ASEPTIC NECROSIS
• DELAYED UNION OF BONE FRAGMENTS
• NON-UNION OF BONE F...
•DENTAL AND PERIODONTAL INJURY
•FISTULAS
• NASAL COMPLICATIONS
•MAXILLARY SURGERY COMPLICATION
•MANDIBULAR SURGERY
COMPLIC...
• ORTHODONTIC COMPLICATIONS
• OTHER COMPLICATION

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INTRODUCTION

•
•
•

Orthognathic surgery is one of the
fast developing branch in oral and
maxillo-facial surgery.
It is p...
• Typical,facial alteration by surgery
•

enhances physical appearance,
thereby increases the confidence.
Increase in the ...
ANATOMY
•MAXILLA CONSIST OF :
A body
4 processes-zygomatic
-Palatine
-Frontal
-Alveolar
lateral surface of maxilla:Anterio...
infra orbital foramen exist, above foramen
Orbital plate of maxilla,laterally malar surface
attaches to zygomatic bone,med...
Mandible
•Forms major part of lower 1/3 of face and
contributes significantly to facial aesthetics
•Mandible consist of
ho...
Which extends anteriorly till mental foramen
And upward to the coronoid process
•The ramus of mandible exhibits anteriorly...
VASCULAR SUPPLY
ARTERIAL SUPPLY
1.External carotid artery
2.Facial artery
3.Lingual artery
4.Maxillary artery
5.Superficia...
NERVE SUPPLY
1.Motor nerve is Facial nerve
its 5 branches are –Temporal
Zygomatic
Buccal
Mandibular
Cervical
2.Sensory ner...
Vascular complication
•HEMORRHAGE
MAXILLA - Acute injury Turvey and
Fonseca proposed that most likely vessels
at risk of i...
~Delayed hemorrhage can occur as early
as night of surgery of maxillary lefort-I to as
late as 9 days post-operatively
~Du...
Mandibular vascular injury
~Internal carotid artery injury can occur
during sagittal split osteotomy
~Injury to internal m...
ASEPTIC NECROSIS
~Major loss of hard and soft tissue can
occur due to compressed blood supply
~flattening of dental papill...
NON UNION,DELAYED UNION
OF BONE
MAXILLA
due to local or systemic factor
compromised because of previous
surgery,as in clef...
MANDIBLE
Avascular necrosis,insufficient bone contact
and instability of bone fragment

Any para-functional movement of ja...
DENTAL AND PERIODONTAL
INJURIES
~related to poor planning and
technical errors during surgery
~common problems are cut tee...
Periodontal bone
loss And gingival
recession

www.indiandentalacademy.com
FISTULAS
~Oronasal and
oroantral region
~injury from
saw,osteotome,
rotary instrument
~while attempting to
stretch midpala...
NERVE INJURY
A.Sensory nerve
MAXILLA

Parasthesia of teeth and
mucosa is more common.
~usually sensation comes to normal w...
MANDIBLE
~Injury to inferior alveolar nerve
can occur during sagittal split
osteotomy
~Injury to lingual nerve can also
oc...
B.Motor nerve
~injury to facial nerve is more common with
Extra oral approach than intra oral approach
~facial nerve injur...
Extension of distal fragment beyond
proximal segment
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NASAL AND SINUS COMPLICATION
A.Alteration in nasal form and septum

~repositioning of maxilla requires
manipulation of nas...
~Maxillary septum is disarticulated from
entire maxilla during lefort,anterior
maxillary surgery special attention
should ...
~as nasal valve is the smallest cross
section of nose alteration in this area
can cause nasal breathing problems
C.ALAR BA...
D.SINUS INFECTION
~due to inadequate drainage and open fistula
~infection associated with alloplastic implant
~retention o...
MODEL SURGERY
~it is done immediately before orthognathic
Surgery
~it is important to use a face bow transfer to
mount the...
www.indiandentalacademy.com
OCCUSAL SPLINT
~it is placed immediately after orthognathic
surgery in positioning the teeth in proper
occlusion for stabi...
MODIFICATION OF SPLINT
~reduction of depth of occlusal index to
remove interferences
~patient must able to do lateral excu...
MAXILLARY SURGERY
COMPLICATIONS
A.LE-FORT I OSTEOTOMY
B.ANTERIOR SUB-APICAL
OSTEOTOMY
C.POSTERIOR SUB-APICAL
OSTEOTOMY

ww...
A.LE FORT-I OSTEOTOMY
~HEMMORHAGE

Injury to internal
carotid artery

Internal jugular vein

www.indiandentalacademy.com
~INJURY TO PALATE
intra operatively rowe disimpaction forceps
are used to disimpact maxilla,beak of forcep
injure palate

...
~HEMATOMA
laceration to descending palatine artery
during down fracture lefort I

~DELAYED HEMMORHAGE
~NON UNION,DELAYED U...
B.ANTERIOR SUB APICAL
OSTEOTOMY
~periodontal defects
In between teeth and
loss of blood supply
to teeth adjacent to
osteot...
C.POSTERIOR SUB APICAL
OSTEOTOMY

~most commonly periodontal defects and
loss of vascularity
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~wound dehiscence ,change in colour and
tone of mucosa prolongs healing

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MANDIBULAR SURGERY
COMPLICATION
A.SAGITTAL SPLIT OSTEOTOMY
B.TRANS ORAL VERTICAL
RAMUS OSTEOTOMY
C.COMBINED VERTICAL RAMUS...
F.POSTERIOR SUB APICAL
OSTEOTOMY
G.TOTAL SUB APICAL
OSTEOTOMY
H.OTHER COMPLICATIONS

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A.SAGITTAL SPLIT OSTEOTOMY
FRACTURE BONE FRAGMENT
~ it is a problem seen more frequently with
mandibular surgical procedur...
1.proximal segment mandible intact
~when buccal fragment
shear of usually cause is
inadequate bone cut
~the bone split mus...
2.proximal segment split complete
~when fracture occur
more superiorly at the
ramus of mandible in
horizontal direction

w...
~fracture of condyle with coronoid and
angle of mandible in separate fragment

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3.lingual segment fracture
~occurrence is less
frequent because of
frequently impacted 3rd
molar
~when unwanted
fracture o...
~a wedge of bone can
Be taken from buccal
aspect and placed on
lingual aspect
~stabilization can be
done wires or screws
a...
4.lateral displacement
~it can occur during
vertical sub condylar
osteotomy
~proximal fragment or
condylar fragment may
be...
5.medially displacement
~in some fractures condylar fragment can
Be displaced medially
~in such cases post operatively pat...
NERVE AND VESSELS INJURY
~injury to mandibular nerve can occur, extreme
care must be taken to maintain the continuity
of n...
B.TRANS ORAL VRETICAL
RAMUS OSTEOTOMY
~complication in this
procedure is rare
~occasionally hemorrhage
results from injury...
C.COMBINED VERTICAL RAMUS
AND SAGITTAL OSTEOTOMY
~injury to inferior
alveolar neurobundle
~splitting of bone
fragment prod...
D.INFERIOR BORDER
OSTEOTOMY
~ dead space almost
always is created after
segments are repositioned
~wound dehiscence is
mor...
E.ANTERIOR SUB APICAL
OSTEOTOMY
~trauma to mental nerve
Which causes loss of
sensation in anterior
region
~planned osteoto...
F.POSTERIOR SUB APICAL
OSTEOTOMY
~blood supply can interrupt
causing devitalization of
the segment
~teeth may not respond ...
G.TOTAL SUB APICAL OSTEOTOMY
~injury to neuro vascular
bundle and long term
sensory disturbances
~injury to root apex

www...
H. OTHER COMPLICATIONS
SALIVARY INJURY
~ injury to parotid gland are possible with
extra oral procedure
~ painless fistula...
~commonly encountered problem is “condylar
Sag” which is most commonly occurs with
trans oral vertical ramus osteotomy
~in...
FACIAL SCARS
~with extra oral techniques chances of facial
Scars are more
~this technique was traditionally used
COMPLICAT...
AUGMENTATION MATERIAL
~autogenous bone and cartilage
~allogenous bone and cartilage
~alloplastic materials eg; silastic,pr...
~anteriolateral mandibular augmentation
~chin augmentation
COMPLICATION
~if dehiscence occurs with implants correcting
the...
POST-OPERATIVE ORTHODONTIC
COMPLICATION
ANTERIOR OPEN BITE
~it can be due to condylar distraction with
Mandibular surgery
...
LATERAL OPEN BITE
~no occlusal contact of posterior teeth after
Surgery
~tripod effect should be created to prevent
Forcin...
ASYMMETRY
~midline asymmetry frequently occurs
together with buccal segment asymmetry
~it is important to identify source ...
~In severe cases asymmetrical headgear
Is used to correct rotated maxilla

MANDIBLE
~due to surgical malposition crossbite...
TEMPROMANDIBULAR JOINT
DYSFUNCTION
A.SHORT TERM
~some patients develop TMJ problem after
surgery
~there can be acute or gr...
B.LONG TERM
~condylar resorption has been noted after
wire osteosynthesis and rigid fixation
~studies have shown that majo...
SURGICAL RELAPSE
PROFFIT AND WHITE (1970),A.O,were
among the first to mention relapse after
surgical-orthodontic therapy. ...
POULTON AND WARE (1971),AJO,
stated that, “Probably the suprahyoid
muscles, which have been lengthened, are
the main force...
Numerous fixation techniques to
reduce postsurgical relapse:
1.upper- and lower-border wiring
2.Steinmann pins to stabiliz...
Three principles that influence
post-surgical stability
I) Stability is greatest when soft tissues
are relaxed during the ...
“An ounce of prevention
is worth a pound
of cure”

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THANK - U
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com
Leader in continuing dental
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Complication of ortho gnathic surgery /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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Complication of ortho gnathic surgery /certified fixed orthodontic courses by Indian dental academy

  1. 1. COMPLICATIONS OF ORTHOGNATHIC SURGERY www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. CONTENTS • INTRODUCTION • VASCULAR COMPLICATION • ASEPTIC NECROSIS • DELAYED UNION OF BONE FRAGMENTS • NON-UNION OF BONE FRAGMENTS www.indiandentalacademy.com
  4. 4. •DENTAL AND PERIODONTAL INJURY •FISTULAS • NASAL COMPLICATIONS •MAXILLARY SURGERY COMPLICATION •MANDIBULAR SURGERY COMPLICATION www.indiandentalacademy.com
  5. 5. • ORTHODONTIC COMPLICATIONS • OTHER COMPLICATION www.indiandentalacademy.com
  6. 6. INTRODUCTION • • • Orthognathic surgery is one of the fast developing branch in oral and maxillo-facial surgery. It is probably the most gratifying field in the whole maxillofacial surgery Orthognathic surgery in conjunction with orthodontics can do wonders in improving the appearance of the face www.indiandentalacademy.com
  7. 7. • Typical,facial alteration by surgery • enhances physical appearance, thereby increases the confidence. Increase in the number of complication due to increased number of surgeries performed for facial aesthetics. www.indiandentalacademy.com
  8. 8. ANATOMY •MAXILLA CONSIST OF : A body 4 processes-zygomatic -Palatine -Frontal -Alveolar lateral surface of maxilla:Anterio lateral :Posterio lateral Anterio lateral surface also called as malar surface which shows canine fossa,superiorly www.indiandentalacademy.com
  9. 9. infra orbital foramen exist, above foramen Orbital plate of maxilla,laterally malar surface attaches to zygomatic bone,medially to frontal and nasal bone,posteriolaterally by infra temporal surface •From lower surface of body of maxilla arises alveolar process •Anterior nasal spine –a bony projection just below nasal aperture •Nasal cavity divided by nasal septum •Palatine process unites medially with alveolar process,hard palate is formed by palatal process of maxilla and horizontal plate of palatine bone www.indiandentalacademy.com
  10. 10. Mandible •Forms major part of lower 1/3 of face and contributes significantly to facial aesthetics •Mandible consist of horse shoe shaped body 2 vertical rami •External surface in midline has mental protuberance inferiorly,incisive fossa superiorly and laterally canine eminance •Mental foramen is apical to the premolars •Body unites with the ramus at gonial angle •The junction of alveolar process and the ramus is masked by external oblique ridge www.indiandentalacademy.com
  11. 11. Which extends anteriorly till mental foramen And upward to the coronoid process •The ramus of mandible exhibits anteriorly the coronoid process with tendons of temporalis attached to it and posteriorly to the condylar head and neck •Concavity between condylar and coronoid process is called as sigmoid or mandibular notch •Medial surface of the ramus exhibits on its lower half the roughened area where medial pterygoid inserts •Mandibular foramen at the center of ramus admits inferior alveolar nerve www.indiandentalacademy.com
  12. 12. VASCULAR SUPPLY ARTERIAL SUPPLY 1.External carotid artery 2.Facial artery 3.Lingual artery 4.Maxillary artery 5.Superficial temporal artery VENOUS SUPPLY 1.Facial vein 2.Retromandibular vein 3.internal jugular vein www.indiandentalacademy.com
  13. 13. NERVE SUPPLY 1.Motor nerve is Facial nerve its 5 branches are –Temporal Zygomatic Buccal Mandibular Cervical 2.Sensory nerve is Trigeminal nerve its 3 branches are – Opthalmic Maxillary Mandibular www.indiandentalacademy.com
  14. 14. Vascular complication •HEMORRHAGE MAXILLA - Acute injury Turvey and Fonseca proposed that most likely vessels at risk of injury during maxillary Surgery are Internal Maxillary artery and Greater palatine artery ~Massive blood loss can occur from injury to Internal Carotid artery and Internal jugular vein ~Thrombosis of internal carotid artery can occur during surgery,mortality rate of 40% and additional 52% patient left with neurological deficit www.indiandentalacademy.com
  15. 15. ~Delayed hemorrhage can occur as early as night of surgery of maxillary lefort-I to as late as 9 days post-operatively ~During separation of maxillary tuberosity from pterygoid plates maximum risk of injury is to internal maxillary artery and its branches. www.indiandentalacademy.com
  16. 16. Mandibular vascular injury ~Internal carotid artery injury can occur during sagittal split osteotomy ~Injury to internal maxillary artery are also reported ~Injury due to improper handling of instrument 1.due to forceful placement of channel retractor on the lingual surface of the mandible 2.forceful use of mallet and chisel on the medial aspect of the mandible www.indiandentalacademy.com
  17. 17. ASEPTIC NECROSIS ~Major loss of hard and soft tissue can occur due to compressed blood supply ~flattening of dental papilla, loss of gingiva to periodontal defects in area of osteotomy ~Due to excessive stripping of bone aseptic vascular necrosis of proximal segment with sagittal split osteotomy ~In 1974 Gammer et al noted that bone usually revascularised, if not occurs substantial loss of bone can occur www.indiandentalacademy.com
  18. 18. NON UNION,DELAYED UNION OF BONE MAXILLA due to local or systemic factor compromised because of previous surgery,as in cleft palate large advancement www.indiandentalacademy.com
  19. 19. MANDIBLE Avascular necrosis,insufficient bone contact and instability of bone fragment Any para-functional movement of jaw Can be treated effectively By prolonged RIF www.indiandentalacademy.com
  20. 20. DENTAL AND PERIODONTAL INJURIES ~related to poor planning and technical errors during surgery ~common problems are cut teeth,loss of teeth,post-operative R.C.T and periodontal defects ~minimum of 3mm of space left during placement of osteotomy cut between teeth ~cut should be 5mm above root apex www.indiandentalacademy.com
  21. 21. Periodontal bone loss And gingival recession www.indiandentalacademy.com
  22. 22. FISTULAS ~Oronasal and oroantral region ~injury from saw,osteotome, rotary instrument ~while attempting to stretch midpalatal tissue www.indiandentalacademy.com
  23. 23. NERVE INJURY A.Sensory nerve MAXILLA Parasthesia of teeth and mucosa is more common. ~usually sensation comes to normal with in 6 to 12 months ~injury to greater palatine neuro vascular bundle can cause permanent numbness www.indiandentalacademy.com
  24. 24. MANDIBLE ~Injury to inferior alveolar nerve can occur during sagittal split osteotomy ~Injury to lingual nerve can also occur but it is rare any dissection on lingual aspect of mandible in 3rd molar region can injure nerve www.indiandentalacademy.com
  25. 25. B.Motor nerve ~injury to facial nerve is more common with Extra oral approach than intra oral approach ~facial nerve injury have been reported both with sagittal split and vertical sub-condylar osteotomy ~It causes partial or total paralysis Retractor on medial aspect extending behind ramus www.indiandentalacademy.com
  26. 26. Extension of distal fragment beyond proximal segment www.indiandentalacademy.com
  27. 27. NASAL AND SINUS COMPLICATION A.Alteration in nasal form and septum ~repositioning of maxilla requires manipulation of nasal components and sinus as a result of these manipulation Complication can occur ~due to maxillary osteotomy adverse effect on alar base,nasal tip,supra tip depression may result in un aesthetic www.indiandentalacademy.com facial postoperative
  28. 28. ~Maxillary septum is disarticulated from entire maxilla during lefort,anterior maxillary surgery special attention should be given while repositioning the septum ~Septal deviation and obstruction can occur during maxillary superior repositioning B.Nasal valve ~Internal nasal anatomy,nasal airway resistance altered breathing pattern www.indiandentalacademy.com
  29. 29. ~as nasal valve is the smallest cross section of nose alteration in this area can cause nasal breathing problems C.ALAR BASE ~excessive alar base widening ~increased prominence of alar groove ~upturning of nasal tip ~flattening and thinning of upper lip ~down turning of labial commisures www.indiandentalacademy.com
  30. 30. D.SINUS INFECTION ~due to inadequate drainage and open fistula ~infection associated with alloplastic implant ~retention of large blood clots ~pre existing disease ~foreign object –wires, bone plates,screws www.indiandentalacademy.com
  31. 31. MODEL SURGERY ~it is done immediately before orthognathic Surgery ~it is important to use a face bow transfer to mount the cast on a semi adjustable articulator so that exact condyle-tooth relationship are recorded Model surgery serves two purposes 1.To verify that planned movements are possible 2.To prepare occlusal wafer splint www.indiandentalacademy.com
  32. 32. www.indiandentalacademy.com
  33. 33. OCCUSAL SPLINT ~it is placed immediately after orthognathic surgery in positioning the teeth in proper occlusion for stability ~it is made on dental cast that shows the result of model surgery ~it should be thin to produce the least amount of separation of the teeth ~it should be 2mm thick in its thinnest part to resist breakage www.indiandentalacademy.com
  34. 34. MODIFICATION OF SPLINT ~reduction of depth of occlusal index to remove interferences ~patient must able to do lateral excursion and bite up and down ~maintain adequate thickness (2mm) ~provision of removal of splint for cleaning ball end clasp can be placed www.indiandentalacademy.com
  35. 35. MAXILLARY SURGERY COMPLICATIONS A.LE-FORT I OSTEOTOMY B.ANTERIOR SUB-APICAL OSTEOTOMY C.POSTERIOR SUB-APICAL OSTEOTOMY www.indiandentalacademy.com
  36. 36. A.LE FORT-I OSTEOTOMY ~HEMMORHAGE Injury to internal carotid artery Internal jugular vein www.indiandentalacademy.com
  37. 37. ~INJURY TO PALATE intra operatively rowe disimpaction forceps are used to disimpact maxilla,beak of forcep injure palate ~ANSTHESIA RELATED cut in endo tracheal tube during surgery,some times patient need to be re intubated ~EMPHYSEMA cervical and facial region,some reports of air in soft tissues of head,neck and chest following lefort www.indiandentalacademy.com I osteotomy
  38. 38. ~HEMATOMA laceration to descending palatine artery during down fracture lefort I ~DELAYED HEMMORHAGE ~NON UNION,DELAYED UNION OF BONE ~NERVE INJURY ~OPTHALMIC COMPLICATION www.indiandentalacademy.com
  39. 39. B.ANTERIOR SUB APICAL OSTEOTOMY ~periodontal defects In between teeth and loss of blood supply to teeth adjacent to osteotomy cuts ~discoloration of teeth ~periapical bone loss www.indiandentalacademy.com
  40. 40. C.POSTERIOR SUB APICAL OSTEOTOMY ~most commonly periodontal defects and loss of vascularity www.indiandentalacademy.com
  41. 41. ~wound dehiscence ,change in colour and tone of mucosa prolongs healing www.indiandentalacademy.com
  42. 42. MANDIBULAR SURGERY COMPLICATION A.SAGITTAL SPLIT OSTEOTOMY B.TRANS ORAL VERTICAL RAMUS OSTEOTOMY C.COMBINED VERTICAL RAMUS AND SAGITTAL OSTEOTOMY D.INFERIOR BORDER OSTEOTOMY E.ANTERIOR SUB APICAL OSTEOTOMY www.indiandentalacademy.com
  43. 43. F.POSTERIOR SUB APICAL OSTEOTOMY G.TOTAL SUB APICAL OSTEOTOMY H.OTHER COMPLICATIONS www.indiandentalacademy.com
  44. 44. A.SAGITTAL SPLIT OSTEOTOMY FRACTURE BONE FRAGMENT ~ it is a problem seen more frequently with mandibular surgical procedure ~incidence of proximal segment fracture 1-3% whereas distal segment fracture 0.8% ~management of fracture depends on location and size of fracture www.indiandentalacademy.com
  45. 45. 1.proximal segment mandible intact ~when buccal fragment shear of usually cause is inadequate bone cut ~the bone split must be completed by making a deep groove on the inferior border and connecting with previous groove ~larger fragment should be stabilized with wires or screws and plates www.indiandentalacademy.com
  46. 46. 2.proximal segment split complete ~when fracture occur more superiorly at the ramus of mandible in horizontal direction www.indiandentalacademy.com
  47. 47. ~fracture of condyle with coronoid and angle of mandible in separate fragment www.indiandentalacademy.com
  48. 48. 3.lingual segment fracture ~occurrence is less frequent because of frequently impacted 3rd molar ~when unwanted fracture occurs surgeon should complete the split along the original planned osteotomy lines www.indiandentalacademy.com
  49. 49. ~a wedge of bone can Be taken from buccal aspect and placed on lingual aspect ~stabilization can be done wires or screws and plate www.indiandentalacademy.com
  50. 50. 4.lateral displacement ~it can occur during vertical sub condylar osteotomy ~proximal fragment or condylar fragment may be displaced medially or laterally www.indiandentalacademy.com
  51. 51. 5.medially displacement ~in some fractures condylar fragment can Be displaced medially ~in such cases post operatively patient complains of irritation of pharynx www.indiandentalacademy.com
  52. 52. NERVE AND VESSELS INJURY ~injury to mandibular nerve can occur, extreme care must be taken to maintain the continuity of neurovascular bundle ~bleeding may occur from inferior alveolar neuro vascular bundle,some times facial vessels may be lacerated during surgery ~less common injury to retromandibular vein which lies adjacent to posterior border of ramus www.indiandentalacademy.com
  53. 53. B.TRANS ORAL VRETICAL RAMUS OSTEOTOMY ~complication in this procedure is rare ~occasionally hemorrhage results from injury to massetric artery ~injury to retromandibular vein www.indiandentalacademy.com
  54. 54. C.COMBINED VERTICAL RAMUS AND SAGITTAL OSTEOTOMY ~injury to inferior alveolar neurobundle ~splitting of bone fragment producing a fracture of anterior projection of lateral cortical plate anterior to ramus segment www.indiandentalacademy.com
  55. 55. D.INFERIOR BORDER OSTEOTOMY ~ dead space almost always is created after segments are repositioned ~wound dehiscence is more likely to occur ~loss of keratinized tissue and periodontal defects can occur anterior teeth www.indiandentalacademy.com
  56. 56. E.ANTERIOR SUB APICAL OSTEOTOMY ~trauma to mental nerve Which causes loss of sensation in anterior region ~planned osteotomy cuts minimize injury to nerve www.indiandentalacademy.com
  57. 57. F.POSTERIOR SUB APICAL OSTEOTOMY ~blood supply can interrupt causing devitalization of the segment ~teeth may not respond to stimulation for 6 to 12 month ~periodontal bone defect Neurovascular bundle decompression www.indiandentalacademy.com
  58. 58. G.TOTAL SUB APICAL OSTEOTOMY ~injury to neuro vascular bundle and long term sensory disturbances ~injury to root apex www.indiandentalacademy.com
  59. 59. H. OTHER COMPLICATIONS SALIVARY INJURY ~ injury to parotid gland are possible with extra oral procedure ~ painless fistula can occur in first week of surgery CONDYLAR MALPOSITIONING ~inability to orient and maintain condylar position www.indiandentalacademy.com
  60. 60. ~commonly encountered problem is “condylar Sag” which is most commonly occurs with trans oral vertical ramus osteotomy ~in condylar sag posterior segment is separated with tooth bearing segment ~in some cases class-2 molar relationship, anterior open bite occurs immediately after release of fixation www.indiandentalacademy.com
  61. 61. FACIAL SCARS ~with extra oral techniques chances of facial Scars are more ~this technique was traditionally used COMPLICATION OF AUGMENTATION WITH IMPLANTS ~bony defects or deficiencies in maxilla or Mandible ~bony defects are often expressed in facial Contours www.indiandentalacademy.com
  62. 62. AUGMENTATION MATERIAL ~autogenous bone and cartilage ~allogenous bone and cartilage ~alloplastic materials eg; silastic,proplast, hydroxylapatite AUGMENTATION PROCEDURES ~paranasal augmentation ~infra orbital malar augmentation ~anterioinferior mandibular border augementation ~posterioinferior mandibular border augmentation www.indiandentalacademy.com
  63. 63. ~anteriolateral mandibular augmentation ~chin augmentation COMPLICATION ~if dehiscence occurs with implants correcting the problem is difficult,loss of implant may occur if wound does not heal with secondary intention ~wound infection can also be a serious consequence ~shifting and migration of implant www.indiandentalacademy.com
  64. 64. POST-OPERATIVE ORTHODONTIC COMPLICATION ANTERIOR OPEN BITE ~it can be due to condylar distraction with Mandibular surgery ~inadequate posterior impaction in lefort I Surgery ~it can be managed with headgear www.indiandentalacademy.com
  65. 65. LATERAL OPEN BITE ~no occlusal contact of posterior teeth after Surgery ~tripod effect should be created to prevent Forcing of condyle head into the fossa ~after buccal segment are in occlusion splint And composite can be removed ~several month of archwire stabilization is Necessary www.indiandentalacademy.com
  66. 66. ASYMMETRY ~midline asymmetry frequently occurs together with buccal segment asymmetry ~it is important to identify source of problem ~submentovertex radiograph can be helpful MAXILLA ~if asymmetry exist in maxilla headgear, Heavy elastics can be helpful ~posterior crossbite bilaterally cross elastics Can be used www.indiandentalacademy.com
  67. 67. ~In severe cases asymmetrical headgear Is used to correct rotated maxilla MANDIBLE ~due to surgical malposition crossbite and Midline discrepancy ~sufficient elastic traction is applied in Appropriate vector to achieve good occlusion www.indiandentalacademy.com
  68. 68. TEMPROMANDIBULAR JOINT DYSFUNCTION A.SHORT TERM ~some patients develop TMJ problem after surgery ~there can be acute or gradual increase in symptoms ~acute condition can be managed with anti-inflammatory and physical therapy like 1.EMG bio feed back and relaxation training 2.ultrasound 3.spray and stretch 4.friction massage www.indiandentalacademy.com
  69. 69. B.LONG TERM ~condylar resorption has been noted after wire osteosynthesis and rigid fixation ~studies have shown that majority of relapse Is due to movement at osteotomy site and not at the condyle www.indiandentalacademy.com
  70. 70. SURGICAL RELAPSE PROFFIT AND WHITE (1970),A.O,were among the first to mention relapse after surgical-orthodontic therapy. They felt that relapse could be avoided by concentrating on eliminating the original causes contributing to the original malocclusion as much as possible, and by not operating while patients are still growing www.indiandentalacademy.com
  71. 71. POULTON AND WARE (1971),AJO, stated that, “Probably the suprahyoid muscles, which have been lengthened, are the main force contributing to the relapse.” Theories for relapse: AJO-DO 1991 satrom, sinclair, wolford 1. stretching of the muscles of mastication and the suprahyoid musculature, 2. condylar distraction during surgery, 3. upward and forward rotation of the mandible, 4. changes in rotational position between the proximal and distal segments. www.indiandentalacademy.com
  72. 72. Numerous fixation techniques to reduce postsurgical relapse: 1.upper- and lower-border wiring 2.Steinmann pins to stabilize the maxilla 3.skeletal-wire fixation 4.rigid fixation Studies that examined independent mandibular advancements and maxillary LeFort I procedures have indicated a strong tendency toward reduced amounts of relapse when either skeletal-wire fixation or rigid fixation is used. www.indiandentalacademy.com
  73. 73. Three principles that influence post-surgical stability I) Stability is greatest when soft tissues are relaxed during the surgery and least when they are stretched II) Neuromuscular adaptation is essential requirement for stability III) Neuromuscular adaptation affects muscular length, not muscular orientation www.indiandentalacademy.com
  74. 74. “An ounce of prevention is worth a pound of cure” www.indiandentalacademy.com
  75. 75. THANK - U www.indiandentalacademy. com Leader in continuing dental www.indiandentalacademy.com

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