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Orthognatic surgery chirurgie orthognathique

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Description of orthognatic surgery Le Fort 1, bilateral sagittal split osteotomy and genioplasty

Description of orthognatic surgery Le Fort 1, bilateral sagittal split osteotomy and genioplasty

Published in Health & Medicine
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  • Merci. Thank you. J'ai du traduire pour comprendre 'Je suis d'accord, le fil de fer utilisé par des mains expertes et dans des cas bien évalués il(elle) peut fonctionner égal ou meilleur que les plaques et est plus économique. '
    I had to translate to understand: I agree, the wire used by expert hands and in valued well cases it can work equal or better than the plates and is more economic..
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  • Estoy de acuerdo, el alambre utilizado por manos expertas y en casos bien valorados puede funcionar igual o mejor que las placas y es más economico.
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  • 1. Orthognathic surgery A visual aid of what happen. slideshare.net/sylvainchamberland©Sylvain Chamberland
  • 2. Le Fort 1 OsteotomyZygomatic Piriform rimbuttress Infraorbital nerve • Osteotomy half way between apices of the teeth and infraorbital nerve Courtesy Dr Carl Bouchard©Sylvain Chamberland
  • 3. Le Fort 1 Osteotomy Parasagittal cuts • Down fracture of the maxilla viewed from above ! The maxilla has been separated down from the 1 4 2 skull 3 ! Ostetomy cuts are done each side of the mid palatal suture and distal to the canine©Sylvain Chamberland Courtesy Dr Martin Gaboury Distal to canine cuts
  • 4. Segmentation of the maxilla Parasagittal cuts • When transversal expansion is needed, the maxilla is segmented ! Islet 1, 2, 3 are the 3 segmented part of the maxilla 4 1 2 ! Islet 4 is the midpalatal suture 3 ! Blood flow is maintained by soft tissue from the palate and soft palate©Sylvain Chamberland Courtesy Dr Martin Gaboury Distal to canine cuts
  • 5. Le Fort 1 Osteotomy Sinus floor Cortocospongious bone • Autogenous corticospongious bone grafting ! Donor site are either the malar bone or the mandibular ramus. Iliac crest can be used. ! Demineralized allogenic bone particles fills the interstice©Sylvain Chamberland Allogenic bone particles Courtesy Dr Martin Gaboury
  • 6. Positionning the maxilla • The surgical splint is fixed to the maxilla • The lower jaw is attached to the upper jaw by the intermediary splint to guide the maxilla to its new position Intermediary splint Surgical splint©Sylvain Chamberland Courtesy Dr Martin Gaboury
  • 7. Rigid fixation • Osteotomy sites filled with bone from the slice removed at the symphysis • Rigid fixation to the piriform rim & zygomatic buttress©Dr Sylvain Chamberland DL 130312 Courtesy Dr Carl Bouchard
  • 8. Bilateral sagittal split osteotomy • Osteotomy cut vertically extending down near the 1st molar and horizontally extending posteriorly to the ramus • 3 bicortical screws on each side©Dr Sylvain Chamberland Courtesy Dr Carl Bouchard
  • 9. Genioplasty • Pre-bended 6 mm monocortical plate • 2 lateral cortical plates to avoid rotation of the distal segment and improve bone contact Mental nerve©Dr Sylvain Chamberland Courtesy Dr Carl Bouchard
  • 10. Genioplasty • Wire fixation for genioplasty ! This avoid having any fixation in the resorptive zone ! The twisted part of the wires will be embed by bone apposition • Note the amount of advancement obtained©Dr Sylvain Chamberland Courtesy Dr Dany Morais
  • 11. Why I dont like rigid fixation for a genioplasty Lu.Mo.010710 Lu.Mo.130212 Apposition zone Screw Embed Screw in the resorptive zone Screw Poor contact between distal prominent Note bone formation over superior & proximal segment portion of fixation device and resorption in area of inferior portion of fixation device©Dr Sylvain Chamberland
  • 12. • Lack of bone contact between distal and proxmial segment • Horizontal rotation of distal segment to the right • Notch on the left side of the chin This surgery was NOT©Dr Sylvain Chamberland performed in Quebec
  • 13. Why do I prefer osteosynthesis? Apposition zone R: Remodeling A: Apposition Courtesy Dr Dany Morais Resorptive Note complete coverage of fixation zone wires by bone and smooth labial Resorptive zoneImproved contact between proximal and cortical bone of anterior manbibledistal segmentDe.Le060608 De.Le130410©Dr Sylvain Chamberland Precious D., Armstrong J., Morais D., Anatomic placement of fixation device in genioplasty, OOO 1992,; 73-2-8
  • 14. Why I dont like posterior openbite after orthognathic surgery? Pressure Condyle resorb • Lack of posterior occlusion may increase pressure at the condyle and cause non-physiologic remodeling or condylar resorption Screwed Setting Jam-packed Slight progressive occlusion retrusion The bite open©Dr Sylvain Chamberland