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Orthognathic surgery

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1958 8 29 (Indiana) (Gary) Jackson 5

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1985 20

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45 2

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(Plastic surgery) (Orthognathic surgery)

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Causes of dentofacial deformity

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Differential Growth of the Head and Body

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Jaw discrepancies interfere with the proper alignment of the teeth, and may also affect speech articulation, breathing, chewing ability, and comfortable closure of the lips.

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Jaw surgery is performed in tandem with orthodontic treatment so that both the jaws and teeth are correctly positioned for proper occlusion (bite) and an improved facial appearance.

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General principles of facial growth

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: (suture complex) (apposition) (suture) :zygomaticomaxillary suture frontomaxillary suture zygomaticotemporal suture pteryopalatine suture

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(growth sites) condyle mandibular body mandibular angle coronoid process dentoalveolar process periosteal

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Genetic and environment influence

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( prognathism ) 1973 (1)75% (occlusal disharmony) (2)37% (malalignment of teeth) (3) (Angle class III) 5 %

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1982 (1) 7.56 % (2) 10 12 12.2% (3)

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Hunter : The heritability of attained growth in thehuman face. Am J Orthod 1970: 58: 128-134.

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Nakasima : Hereditary factors in the craniofacial morphology of Angles Class II and Class III malocclusion. Am J Orthod 1982: 82: 150-156.

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nasolabial angle (acute) labiomental fold

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(reverse horizontal overlap)

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class III

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Orthognathic surgery Treats and corrects abnormalities of the facial bones, specifically the jaws and the teeth. Often, these abnormalities cause difficulty associated with chewing, talking, sleeping and other routine activities.

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Orthognathic surgery Corrects these problems and, in conjunction with orthodontic treatment, will improve the overall appearance of the facial profile.

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(1) Eliminating or reducing dental compensation for the skeletal deformity (2) Obtaining alignment of teeth and establishing anteroposterior incisor position (3) Obtaining reasonable arch compatility

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Evaluation of patients with dentofacial deformity

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Presurgical orthodontic consideration

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Objectives of orthodontic treatment

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Indicate a need for orthognathic surgery: Difficulty chewing or biting food Open bite Unbalanced facial appearance Facial injury or birth defects Receding chin, Protruding jaw Sleep apnea (breathing problems when sleeping such as snoring, difficulty breathing, etc.)

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Common Types Of Orthognathic Deformities Apertognathia, or "Open Bite Retrognathia Prognathia "

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Apertognathia, or "Open Bite

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An "open bite" exists if there is space between the upper and lower teeth when the mouth is closed.

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Maxillary excess Facial skeleton grows long (vertically) "gummy smile" A deficient (small) lower jaw and a long and retruded chin. presence of blocked nasal airflow and a mouth-breathing (respiratory) habit that is ongoing during childhood

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Maxillary excess

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Apertognathia, or "Open Bite

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Retrognathia or "Over Bite

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Retrognathia With diminished forward projection of the lower face, there is loss of support for the overlying soft tissues of the cheeks, neck and chin. This results in an obtuse (flat) neck-chin angle, with submental fullness (double chin).

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ASO (ant. Subapical osteotomy)

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Mandibular deficiency

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Retrognathia or "Over Bite

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Prognathia lower jaw is overdeveloped and protrudes out beyond the upper jaw.

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(extraoral approach) (intraoral approach) ( sagittal split ramus osteotomy,SSRO ) ( intraoral vertical ramus osteotomy, IVRO )

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(1) (2) (3) (4) (5) (6)

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(7) (8) (9) (10) (11)

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(12) (13) (14) (15) (double jaw) (16)

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(1) (2) (3) (shift) (4)

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Prognathia:

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(1) (2) (rigid or semirigid) (3)

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(1) (2) (3) (4) (elastic band )

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Mandibular excess mandibular excess (prognathism), emphasis should be given to the overall appearance of the face with less concern about specific ceph-alometric (x-ray) measurements.

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Mandibular excess The orthodontist's goal will be to remove all dental compensations (poor positioning of the teeth) while the surgeon's objective is to reposition the jaws to achieve a functional occlusion and to enhance facial aesthetics.

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Mandibular excess

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Asymmetric Mandibular Prognathism The extent of deformity will be dependent on the timing of the unilateral (one sided) condylar overgrowth in relation to any further (residual) growth of the facial bones.

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Asymmetric Mandibular Prognathism

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Genioplasty

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Segment osteotomy

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3

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