Orthognathic surgery is the art and science of diagnosis , treatment planning and execution of treatment by combining both orthodontics and oral and maxillofacial surge

1. Orthognathic surgery
Done by:
Dr.Sarah Abd Al-Salam

2. contents
 Orthognathic surgery
 Indication and contra indication of the treatment
 Diagnosis and treatment planning
 Mandibular orthognathic procedures
 Maxillary orthognathic surgery
 Sequence of the treatment
 Retention, relapse and stability of the treatment
 3D surgical development
 Complication
 Post operative care

3. Orthognathic surgery
Is the art and science of diagnosis, treatment planning and
execution of treatment by combining orthodontics and oral and
maxillofacial surgery to correct musculoskeletal , dent-osseous and
soft tissue deformities of the jaws and associated structures

4. A dentofacial deformity is a deviation from normal facial
proportions and dental relationships that is severe enough to be
handicapping to the patient by two possible ways
 Jaw function
 Aesthetics

6. Indication for treatment
Combined orthodontics and orthognathic surgery is indicated for
patients who have a severe skeletal or very severe dento-alveolar
problems that is to extreme to correct with orthodontics alone

7. When faced with a skeletal discrepancy the
clinician has three choices
 Growth modification
 Orthodontic camouflage
 Combined orthodontic and orthognathic
surgery

9. Contraindication
 Patient with systemic disease or local factor that affect normal
wound healing
 Compromised vascularity of the surgical region
 Non complaint patient
 Patient with poor oral hygiene

10. Objectives of the treatment
The objective of the treatment are the same as for orthodontic
treatment:-
 Acceptable dental and facial esthetic
 Good function
 Optimal oral health
 Stability

11. Diagnosis and treatment planning
Diagnosis and treatment planning for combined
orthodontic and orthognathic surgical patient
should follow the same sequence that used for
orthodontic treatment planning by taking
 Appropriate history
 Clinical examination
 Collection of appropriate diagnostic records

12. History
The purpose of the history is to determine :-
 Patient concerns
 Patient’s motivation, expectation and
psychological status
 Medical and dental history

13. Clinical examination
 Preoperative assessment of the patient:- the clinical examination
should consist of a systemic approach of both hard and soft tissue

14. Full face assessment

17. Profile assessment

22. Temporomandibular joint

23. Intra-oral assessment

25.  Radiographic assessment of the patient

27.  Study model

28. Treatment planning

29. Mandibular orthognathic surgery
It can be divided into several section:-
 Surgery in which the jaw is moved in antrio-posterior
direction by an osteotomy either in the ramus or body of the
mandible
 Surgery to the dentoalveolar area, such as segmental surgery
to shift the teeth and alveolus but maintaining the integrity of
the lower part of the mandible
 Surgery into the chin, moving it in superior , inferior ,
posterior or anterior direction sometimes accompanied by
reshaping

30. Ramus procedures
 Bilateral sagittal split osteotomy(BSSO)

42.  Vertical subsigmoid osteotomy (VSS)

46.  Inverted L-Osteotomy

48.  Body osteotomy

50. Mandibular segmental procedures
 Anterior subapical procedure

52.  Posterior subapical osteotomy

54. Genioplasty

59. Maxillary orthognathic surgery
 Le Fort I osteotomy

65.  Le Fort II osteotomy

66.  Le Fort III osteotomy

70. Surgical assisted rapid palatal expantion(SARPE)

71. Distraction osteogenesis

73. Surgery of obstructive sleep apnoea (OSA)

74. Sequence of the treatment
 Extraction

75.  Pre surgical orthodontic

76.  Surgery

77.  Post surgical orthodontic

78. Retention and relapse
Relapse can be defined as movement of osteotomized fragment
back to their original position . Many of factors that are associated
with post treatment relapse:-

79. Surgical factors
 Poor planning
 The size of the movement required. Movement of the
maxilla by more than 5-6mm in any direction is more
susceptible to relapse as is movement of the mandible by
more than 8mm
 Direction of the movement
 Distraction of the condylar head out of the glenoid fossa
 Inadequate fixation

80. Orthodontic factors
 Poor planning
 Movement of the teeth into the zones of soft
tissue pressure will lead to relapse when
appliances are removed .Therefore treatment
should be planned to ensure that the teeth will
be in the zone of soft tissue balance post-
operatively and that the lip will be competent
 Extrusion of the teeth during alignment tend
to relapse post-treatment, particularly in cases
of anterior open bite

81. Patient factors
 The nature of the problem for example,
anterior open bites associated with abnormal
soft tissue behavior are difficult to treat
successfully and have marked potential to
relapse
 In patient with cleft lip and palate,
advancement of the maxilla is difficult and
prone to relapse because of the scar tissue
 Failure to comply with treatment for example
patient does not wear itermaxillary elastic
traction as instructed

82. Complication of orthognathic surgery
 Pain
 Swelling
 Bleeding
 Infection
 Numbness
 Limited mouth opening
 TMJ problem
Change in the facial appearance
 Dietary changes with weight loss
 Problems swallowing
Opthalmic complication
 Reduction in auditory capacity

83. Stability of orthognathic surgery

84. Future developments in orthognathic surgery

88. Post operative care
 Diet is very important after the surgery to accelerate the
healing process , liquid diet is common
 Teeth cleaning 4-6 times per a day especially after eating,
also mouth rinsing with chlorohexidine is very important
 For some surgery , pain may be minimal due to the minor
nerve damage and lack of feeling , prescribe pain medication
and prophylactic antibiotic
 The speech will improve with practice
 Nasal congestion may occur both from the tube placed in
nostrils or from surgical procedure of the upper jaw it can be
managed by using nasal spray or clean the nostrils
 The surgeon will see the patient for check up frequently to
check on the healing, infection and to make sure nothing has
moved

89. Thank you