This is a modest effort to simplify and demystify the

preoperative planning process for orthgonathic surgery.

Thanks to all my teachers and mentors who kept me intrigued.

Thanks to all my students and residents who keep me challenged.

I hope you find it clear, simple and easy to follow.

And a special thanks to Dr. Nadia Al-Hazmi for her assistance in

illustrations in this manual.
 Orthgonathic Pre-operative Work-up Check list

Patient Name:__________________________________ Record #______________

Telephone numbers_____________________________ Age______
Date of Surgery___________________________ Consultant____________
Physician________________________________ Tel___________________

Planned Procedure

Checklist: check when done

PAPER WORK& MEDICAL

 History and physical (clerking)
 Medical clearance (if applicable)
 Consent
 Labs  CBC  Coagulation profile  Serology  Other
 Blood donation (if applicable)
 Anesthesia pre-operative visit
 OR booking
 Bed booking

PREOPERATIVE WORKUP:
 Clinical exam worksheet
 Two sets of models taken without wires
 Surgical hooks
 Photographs
 Face bow transfer
 Bite registration
 Radiographs:
 Lateral Cephalometric  OPG
 PA  Intraoral
 Model surgery
 Intermediate splint
 Final splint
 Orthognathic Surgery Clinical Exam Worksheet

Vertical Facial Height
UFH/LFH ratio _____ N= 0.67
Frontal Evaluation Skeletal Pattern brachy doico meso
Midlines: nasal tip____ philtrum____chin____
Symmetry: eyes_____ Nose _____
Scleral show: ____mm
IP Line parallel to occlusal plane Y N
Maxillary Cant _____mm
Lips Overclosure incompetence ___mm
Interlabial gap ____mm (0-3mm)
Tooth show at rest ____mm
Tooth show at smile ____ + ____mm gingiva
Chin: square round narrow wide flat

Lateral Evaluation (profile) : FH parallel to the floor

Facial configuration: convex concave flat
Infraorbital rim projection ______ 0-2 mm
Cheeks convex concave flat
Paranasal area convex concave flat
Subnasale vertical: chin _____ 3+/- 3 mm
upper lip suprlabrale _____ 1-3 mm anterior
Nasolabial angle______ 90-105
Labiomental fold flat excessive
Chin throat angle_____ 135 

Dental Evaluation
 TMJ: R Click Pain Crepitus L Click Pain Crepitus
 Maxillary midline is __mm to R , L of skeletal midline
 Mandibular midline is __mm to R , L of skeletal midline
 Mandibular dental midline is ___mm to R , L of maxillary dental midline
 Overjet _____ mm Crossbite______mm
 Overbite _____mm Openbite______mm
 Canine relationship R_______ L _______
 Molar relationship R_______ L _______
 Crossbite (at which teeth) R_______ L _______
 Missing & Impacted teeth:
 Facial Evaluation

VERTICAL:

 Skeletal pattern
 Upper: From hairline to glabella 44+/- 4

 Middle: From glabella to subnasale

 Lower: From Subnasale to soft tissue menton 68+/- 5
 UFH/LFH: 0.67
 Upper lip length
(from subnasale to upper lip) 22 mm +/- 2 M, 20 +/- 2 F
 upper lip should be 1/3 of the lower facial height.

FRONTAL:

 Skeletal Pattern:
o Brachycephalic
o Mesocephalic
o Dolicocephalic
 Symmetry of eyes, orbits, nose
 Midlines: facial =nasal=lip = dental =chin
 Scleral show: lower eyelid should be level with or
slightly
above the most inferior aspect of the iris. Increased
scleral show = infraobrbital hypoplasia
 Intercanthal distance 32 mm +/- 3 W, 35+/- 3 AA
 Interpupillary distance 65 mm +/- 3
 Intercanthal = alar base=palpebral fissure width
 Nasal dorsum width = ½ of intercanthal distance
 Nasal lobule distance= 2/3 Intercanthal distance
FRONTAL:

 Interpupillary line parallel to the occlusal plane

 Cant of the maxilla ___mm, measure from infraorbital to
the tip of the canine.
 Lips: Overclosure incompetence __ mm
 Upper lip to tooth: 2.5 +/- 1.5 mm of the incisal edge
 Interlabial gap 0-3 mm
 Tooth show at rest __mm
 Tooth show at smile (Smile line) Vermillion border of
the upper lip should fall at the cervico-gingival margin
with no more than 1-2 mm of exposed ginigiva
 Chin: flat, square, round, narrow, wide

LATERAL:

 FH must be parallel to the floor

 Facial configuration: flat, convex, concave
 Paranasal area: convex, concave, flat
 Infraorbital rim projection:
o rim should be 2mm anterior to the globe
 Subnasale Vertical:
o A line perpendicular to the FH through the
subnasale then
measure the chin distance 3 +/- 3 mm
o Upper lip superlabrale is 1-3mm anterior

 Nasolabial angle: 90-105

 Labiomental Fold flat, excessive
 Chin throat angle: 135 
 A line perpendicular to the FH and tangent to the globe should fall on
the infraorbital soft issue +/- 2 mm
DENTAL:

 TMJ R Click Pain Crepitus

L Click Pain Crepitus
 Maxillary midline is __mm to (R, L) of skeletal midline
 Mandibular midline is __mm to (R,L) of skeletal midline
 Mandibular dental midline is ___mm to (R,L) of maxillary dental midline
 Overjet ___ mm + -
 Overbite ___mm + -
 Canine relationship R____ L ____
 Molar relationship R____ L ____
 Crossbite (at which teeth) R____ L ____
 Missing & Impacted teeth:
 CEPHALOMETRIC ANALYSIS
And
Prediction using surgical treatment

objective (STO)
\

CEPHOLMETRIC REFERENCE POINTS:

A (subspinale): The point of greatest concavity of the maxilla bt anterior nasal spine and
maxillary dental alveolus.

ANS (anterior nasal spine): The most anterior part of the nasal floor.

B (supramentale): The point of greatest concavity of the mandible bt mandibular dental

alveolus and pogonion.

Ga (glabella): the most prominent point of the forehead

Go (gonion): the point located by bisecting the angle formed by tangents to the posterior
border of the ramus and inferior border of the mandible.

Gn(ganthion): A pint that bisects the angle perpendicular to the mandibular plane thru pog.

Me (menton): The most inferior point on the mandibular symphysis.

Me’ (soft tissue menton): The most inferior point on the soft tissue of the chin.

N (nasion): the point formed by the frontonasal suture.

Or (Orbitale): the most inferior point of the orbital rim.

Pog (pogonion): The most anterior point on the mandibular symphysis.

Pog’ (soft ts. Pog): The most anterior point on the soft tissue chin.
 Pr (porion): The most superior point on the curvature of the bony ear canal (IAM).

S (sella): The midpoint of sella turcica.

St (stomion): the most inferior point on the upper lip.

Sn (Subnasale): The most posterior superior point on the nasolabial curvature

LINES:

NA
NB
SN
A-Pog
FH (Frankfort): Anatomic porion-orbitale plane
MP: mandibular plane: A line from menton through gonion
Occlusal plane

CEPHALOMETRIC ANALYSIS
Hard tissue Angles and measurements

Angle What it indicates Norm

SNA AP Relation of the maxilla to the skeletal base 82+/- 2°
Low = deficient maxilla
SNB AP Relation of the mandible to the skeletal base 80 +/-2°
Low = deficient maxilla
ANB Difference bt maxilla and mandible 2°
FH – NA AP Maxillary Depth AP position of the maxilla 90 +/- 3°

FH –NB AP Mandibular Depth AP position of the mandible 88 +/- 3°

MPA A line from the menton through the gonion 25 +/- 5°

(FH –MP) (Mandibular plane) relative to the FH. Gives you the
direction of the facial growth. Low angle or high
angle..
OPA Occlusal plane angulation: a line tangent to the 8 +/- 4°
(FH- occlusal) buccal groove of the mandibular second molar
through the cusp tip of the premolars and the angle of
this line relative to the FH
AP Upper incisor angulation: Long axis of the maxillary 22+/- 2°
U1: NA incisor to the NA line.

U 1: NA distance AP Measurement from the labial tip of the upper incisor 4 +/- 2 mm
tip to NA line should be 4+/- 2 mm anterior to the NA
line
 AP Lower incisor angulation: Long axial of the 20 +/- 2°
L1: NB mandibular incisor to the NB line.

L1: NB distance AP Measurement from the labial surface of lower incisor 4 +/- 2 mm
tip should be 4+/-2 from NB
McNamara’s AP The distance in mm from point A to aline from nasion 0 +/- 2mm
Nasion constructed perpendicular to FH
perpendicular
L1: MP V A line from the lower incisor to the mandibular plane. 90 - 95°
Shows the inclination of the lower incisor
N- ANS V N to anterior nasal spine, measures the middle facial 54+/- 3
height ( High in Maxillary excess) mm
ANS -Me V Measures lower facial height 65+/- 4mm
Upper lip to tooth V Amount of incisal show. 0 +/- 2mm
This measurement must be correlated with the upper
lip length. When the upper lip is excessively short.
Use 3-5 mm of incisal show. When the upper lip is
excessively long, use 0-2 mm.

CEPHALOMETRIC ANALYSIS

Angle What it indicates Norm

Pog - NB = L1-NB AP Pogonion Projection: Measured from the most
protrusive point of the bony pogonion to the NB
line. Optimal mandibular balance is achieved
4+/- 2 mm
when the labial surface to the lower incisors and
pog are 1:1 ration anterior to the NB line.
.
L 1 -A Pog Line AP Distance of the lower incisor to the A-Pogonion 2+/- 2mm
line. Disadvantage of this line is that it depends ahead of Apo
on the position of the lower incisor. line
Ga:Sn-Sn:Pog’ AP From glabella to subnasale, then from 11 mm +/- 4 °
(Angle of facial subnasale to soft tissue pog.
convexity ) Greater negative indicates a convex profile(
maxillary A/P excess or mandibular Ap
deficiency . Smaller negative values indicate a
concave profile (maxillary AP deficiency or
mandibular AP excess)
Subnasale AP Distance from the soft tissue chin to a line Chin is 3 +/- 3
Vertical perpendicular to FH through Subnasale. mm
Indicates A-P position of the chin
0° Meridian AP Distance from the soft tissue chin to the a line Chin should
perpendicular to FH thru soft tissue nasion be 0 +/- 2mm
E-Line (Aesthetic AP Distance between the lower lip and nose and a Lower lip 2mm
line) line going form the chin to the nose +/- 2 behind it
LDH V Lower incisal tip to a line tangential to the hard M 44+/- 2 mm,
(Lower anterior tissue menton or distance from the incisal edge F 40 +/- 2 mm
dental height.) of lower incisor to lower border of the mandible.
Indicates excess of the lower facial height.
The lower anterior dental height should be
TWICE the upper lip length.
Lower lip length V The lower anterior soft tissues height. M 51 +/- 3mm
F 48 +/- 3mm
Ratio of upper lip V 1:2
to lower lip length
Soft tissue Measured form the upper lip to the labial surface 11 to 14
thickness of the of the upper incisor, form the lower lip to the 1:1:1
upper lip, lower labial surface of the lower incisor and from the
lip, and chin soft tissue menton to the hard tissue menton
Chin measurements
 CEPHALOMETRIC ANALYSIS
Soft tissue angle and measurements

Angle What it indicates Norm

Upper Lip Length V Measured form the base of nose Sn (subnasale) to M 22+/-2
Sn:St inferior part of upper lip St (upper lip stomion). F 20+/- 2
Upper lip length is the basis for establishing vertical
facial dimensions in the lower third of the face since
the upper lip length usually is not easily altered.
This measurement is the basis for establishing the
vertical length of the mower two thirds of the lower
third of the face.
Nasolabial Angle A line tangent to columella through subnasale, and 90 to 105°
a line tangent to the upper lip.

Sn-St : St: Me V Distance from subnasale to stomion, and from 1:2

stomion to menton. Increased ration indicates either
a short upper lip or a vertical excess of anterior
mandible. This ratio is often also increased in
anterior open bite cases. A decreased ratio is
indicative of a vertically deficient anterior mandible
or deep bite.
Interlabial distance V Upper lip stomion to lower lip stomion. High values 0-3 mm
indicate lip incompetence, very often due to vertical
maxillary excess.
Chin throat angle V Indicate mandibular vertical position. Valuable in 135 °
deciding genioplasty and submental liposuction.
Nasal projection A line tangent to soft ts. of nasal dorsum and a line M 36°
perpendicular to FH through the soft tissue nasion F 34°

Soft tissue V Measured perpendicular from FH from bone menton 7 +/- 2 mm

thickness of the to soft ts menton. Excessive thickness or thinness
menton of this area may influence the alterations in the
height of the anterior mandible
 KING ABDULAZIZ UNIVERSITY Patient Name
Faculty of Dentistry Date
Department of Oral and Maxillofacial Surgery Examiner

Orthognathic Surgery Cephalometric Analysis Worksheet

HARD TISSUE

Angle Patient Comment Norm

SNA 82+/- 2°
SNB 80 +/-2°
ANB 2°
FH – NA (maxillary depth) 90 +/- 3°
FH – NB (mandibular depth) 88 +/- 3°
FMA (FH-MP) 25 +/- 5°
OPA (FH-occlusal plane) 8 +/- 4°
U 1 -NA 22+/- 2°
U 1- NA distance 4 +/- 2 mm
L 1 - NB 20 +/- 2°
L1- NB distance 4 +/- 2 mm
McNamara’s nasion perpendicular 0mm +/- 2 mm
L 1 - MP 90 – 95 °
N- ANS 54+/- 3 mm
ANS -Me 65+/- 4mm
Ratio 0.8
Upper lip to tooth (incisal show) 1 - 4 mm

CHIN
Pog - NB 4+/- 2 mm
L 1 -A Po Line 2+/- 2mm ahead of Apo line
Ga:Sn-Sn:Pog’ 11 mm +/- 4 °
(Angle of facial convexity )
Subnasale Vertical Chin is 3 +/- 3 mm
0° Meridian Chin should be 0 +/- 2mm
E-Line (Aesthetic line) Lower lip 2mm +/- 2 behind it
LDH (Lower anterior dental ht.) M 44+/- 2 mm, F 40 +/- 2 mm
Lower lip length M 51 +/- 3mm F 48 +/- 3mm
(lower anterior soft tissues ht.)
Ratio of up lip to lower lip length 1:2
Soft tissue thickness of upper 11 to 14 mm
lip, lower lip, and chin 1:1: 1 ratio

SOFT TISSUE
Upper Lip Length Sn- St M 22+/-2 , F 20+/- 2
Nasolabial Angle 90 to 105°
Sn-St : St-Me 1:2
Interlabial gap 0 - 3mm
Chin throat angle 135 °
Nasal Projection 36° males, 34° Females
Soft ttissue thickness Menton 7 +/- 2 mm
Analysis and Movements:

Step -by- Step Predication tracing STO

 For Double Jaw Surgery

On the original cephalometric tracing (CT)

 Complete a ceph tracing on acetate paper with all points and angles.
 Note: your pre-surgical orthodontic goals must be satisfied.
o U1 –NA 22+/- 2°
o U1- NA distance 4 +/- 2 mm
o L1 – NB 20 +/- 2°
o L1 –NB distance 4 +/- 2 mm
o Alleviate crowding and spacing

 Label this tracing CT.

 Record these angles and measurements on the worksheet.
 Draw two plus marks on the edge of the acetate as reference points.
 Draw reference lines for the surgical cuts: BSSO and LeFort and genioplasty.

Place another acetate paper on top of the first one

 label it STO.
 Trace the cranial base, frontal bone nasal bone and orbital rim.
 Draw the following lines:
o FH
o A line perpendicular to FH going through the nasion
o Occlusal plane

 Determine the NEW central incisor position with the lip at rest, by using the following
relations:

1. Vertical Position of the maxilla: this is dictated by the position of the central incisor:
upper lip to tooth length (how much incisal show). Ideally 2-4 mm, if long lip (0-2mm)
if short (3-5mm)
2. AP position of the maxilla: here clinical exam is vital in determining the AP position of
the maxilla, don’t go by the ceph alone.
a. Maxillary depth (FH:NA) 90+/- 3 °
b. McNamara’s nasion perpendicular (0+/-2mm)
c. SNA (not so good)
3. Occlusal plane angulation: This is a whole story in itself. Normal = 8+/- 5 °. When the
mandible autorotates, it may create an acceptable occlusal angulation. However, in
certain situations, the occlusal angulation may be altered to affect the final esthetics
and chin AP position. If you decide not to alter the occlusal angulation, disregard this
point and move on to the next step. If you decide to increase or decrease, draw the
new occlusal angulation and complete the next step.

 Mark the determined NEW maxilla position by drawing a horizontal line on the STO marking
the vertical position of the central incisor (as determined by point#1).
 Mark the determined NEW AP maxilla position by drawing a short vertical line to the desired
distance anterior to the McNamara Nasion (nasion perpendicular). Example: If the distance
between A and Nasion perpendicular is 6 mm and we know that the ideal is 0-2 mm, the
 difference is 4 mm. So, draw a line 4 mm anterior to nasion perpendicular and that is your
vertical position.
 Move the STO to the left to align the incisal tips on the horizontal reference line. The labial
surface of the maxillary central incisor should be placed against the vertical reference line.
 Trace the anterior maxillary segment and the surgical cut line.
 Trace the mandible to best fit the maxilla using the maxillary central incisor as a reference
and the occlusal plane angulation. Trace only the distal segment.
 Trace the mandibular distal surgical cut on the STO.
 The proximal segment on the cephalometric tracing is rotated until the horizontal surgical
reference line contact each other.
 Trace the proximal segment and surgical reference line on the STO.
 The posterior segment of the maxilla on the cephalometric tracing is then positioned and
integrated with the best fit into the mandible and this traced on the STO.
 Trace the appropriate maxillary surgical reference lines.

For the chin:

 Draw NB line on the STO

 The bony pogonion should be 2-6 mm anterior to NB
 The labial of the mandibular centrals should be 2- 6 mm anterior to the NB line
 Ideally, the distance between Pog to Nb and L1 to Nb is 1:1 (equal)
 The vertical height of the mandible ( from the incisal tips to hard tissue menton)
should be equal twice the upper lip length for optimal facial balance.
 Draw the surgical reference line for the genioplasty
 Trace the soft tissue on the STO. In order to trace the soft issue you have to put in mind
the soft tissue changes associated with orthognathic surgery.
Soft tissue changes associated with orthognathic movements. Wolford L, Fields T: Diagnosis and
treatment planning for rothognathic surgery. In: Fonseca, Raymond J (ed). Oral and Maxillofacial
Surgery. W B Saunders. 2000.
 Frontal bone
Roof of the orbit
Cribriform plate of
ethmoid
sella Nasofrontal
suture
GW Nasal bone
sphenoid
Pterygo Orbital floor
maxillary
fissure
clivus Ant. nasal
spine
post. nasal spine

Airway

Hyoid bone
 G
N N’
S

Pt
P O

ANS
Ba A Sn
PNS A‘
UL

St

Go LL
B‘
B
Pog Pog ‘
Me
Gn

Me ‘
 90 --------------------- FH-NA
88 --------------------- FH-NB

22 --------------------- U1-NA °

22(20)-- upper lip

8
Occlusal plane 4 ---------------- U1-NA

2.5-------- Incisal show

4 ---------------- L1-NB

20- --------------------- L1-NB °

44(40)
4- --------------------- Pog-NB

LDH: Lower anterior dental ht. 7-------------------- soft ts. Me

Soft tissue thickness

12-16mm
1:1:1 ratio
 MODEL SURGERY
FOR DOUBLE JAW SURGERY
 MODEL SURGERY - FOR DOUBLE JAW SURGERY

Armamentarium:
 Model Surgery Platform
 Semiadjustable articulator
 Ortho resin- self cure in two colors (pink and clear)
 Straight hand piece (or dremel) and acrylic burs
 Trimmer
 Torch
 Saw
 Face bow
 Bite registration wax
 Acrylic spray for the models
 Vaseline or separating media
 Sticky wax
 Play doe
 Soft rope wax
 Plastic carving instrument
 15 blade and handle
 Crown and bridge scissors
 Tongue depressors
 Disposable cups
 Plaster of Paris
 Bowl and spatula
 Super glue
 Thick elastic bands
 20 cc syringe
 14 gauge needle
 Ruler
 Boley gauge
 Pencil and colored pencils
 MODEL SURGERY - FOR DOUBLE JAW SURGERY
Armamentarium:

Model Surgery Platform Semi-adjustable ariculator

Acrylic spray for the casts Orthodontic resin

A lot of patience.
 MODEL SURGERY MEASURMENTS- FOR DOUBLE JAW SURGERY
Vertical

VM: Vertical position of the MB cusp of the VI: Vertical position of the Incisors.
1st molar
Right_____mm Left_____mm Right_____mm Left_____mm

Anterioposterior AP

Distance from the facial surface of the most AP position of the facial surface of the most
prominent central incisor to the articulator pin. prominent central incisor.
_____mm _____mm

Mediolateral (transverse)

ML position of the posterior maxillary dental ML position of the maxillary dental (incisor)
arch. The caliper is in contact with the facial midline. The caliper is in placed in contact with
surface of the 1st molar or ortho tube. the interdental space between the incisors.
_____mm _____mm
 MODEL SURGERY SEQUENCE- FOR DOUBLE JAW SURGERY
 Take two upper and two lower impressions, pour BOTH sets in stone. NO BUBBLES!
 Keep one set of models as a back-up. Mount it if you can.
 Take a face bow and transfer to the semi-adjustable articulator.
 Mount the maxillary cast. Make sure the pin is zero’d.
 Mount the lower cast to the upper using the bite registration.
 Make square bases for the upper and lower models where the walls are parallel. A
trimmer is used to achieve this.
 Make measurements on the maxillary cast using the model platform–see page 22.
 Record all measurements.
 Mark the upper and lower casts using the platform or a boley gauge. Please do not use
a ruler or your eyes!
 Make sure you actually make grooves in the cast because by the end of this process
your pencil marks will be gone.
 Cut the maxillary cast with a saw.
 Remove the maxillary cast from the articulator and set the maxillary cast to the base
again with the new movements in vertical, AP and transverse positions.
 To help stabilize the maxillary cast, I use playdoe between the cast and the base. Then
once I achieve the movement, I use very dilute plaster of paris in a syringe and inject in
the small space between the cast and base.
 Place the maxillary cast back on the articulator and drop the pin if you changed the
vertical position of the maxilla.
 Allow the mandible to autorotate into the new maxilla position.
 Make sure you plug all the undercuts and holes in the cast with soft wax.
 Use ortho resin to make an intermediate splint. I use a different color of ortho resin to
distinguish the intermediate from the final.
 Use acrylic burs to finish the splint.
 Make hole in the borders to allow for wiring.
 Cut the mandibular cast with a saw.
 With the maxillary cast mounted, flip it and place the mandular cast, hold with an elastic
band.
 Use plaster to stabilize the mandibular cast in place.
 Make the final splint. PAPER THIN. You want to see holes in the areas where is contact
between teeth. DO not make the flanges over-extended; you will not see if the splint
t7nb jhgt is seated in the operating room.
 Make holes in the final splint.
 Finish the final splint. You may use a pressure cooker to get a nice clear finish.
MODEL SURGERY SEQUENCE- FOR DOUBLE JAW SURGERY
A picture is worth more than a thousand words!
 REFERENCES

 Arnett W, Jelicc J, Kim J, et al. Soft tissue cephalometric analysis: diagnosis and t the
treatment planning of dentofacial deformity. Am J Orthod Dentofacial Orthop 1999; 116:
239-53.
 Arnett W and Bergman R, Facial keys to orthodontic diagnosis and treatment planning. Part
I. Am J Orthod Dentofacial Orthop 1993: 103: 299-312.
 Bamber M, Harris M, Nacher C.Validation of two orthognathic model surgery techniques. J
of orthod 2001; 28: 135-142.
 Bell WH. Modern Practice in Orthognathic and Reconstructive Surgery. Philadelphia: WB
Saunders Co;1992.
 Ellis E. Accuracy of model surgery. Evaultion of an old technique and introductin of a new
one. J Oral Maxillofac surg 1990; 48: 1151-1167.
 Epker BN, Stella JP, Fish LC. Dentofacial Deformities: Integrated Orthodontic & Surgical
Correction. Year Book Medical Pub;1998.
 Fonseca, Raymond J (ed). Oral and Maxillofacial Surgery. W B Saunders. 2000.
 Graber TM, Vanarsdall RL. Orthodontics: Current Principles and Techniques. Year Book
Medical Pub;2000.
 Marko J. Simple hinge and semiadjustable articulators in orthognathic surgery. Am J Orthod
Dentofacial Orthop 1986; 90: 37-44.
 Proffit, William R, White Jr., Raymond P, Sarver, David M. Contemporary Treatment of
Dentofacial Deformities. C V Mosby. 2002.
 Wolford L, Hillard F, Dugan D. Surgical treatment objective, a systemic approach to the
prediction tracing. The CV Mosby Company. 1985
NOTES
 USEFUL NOTES and FORMS
References:

Reyenke, McCollum & Evans: Towards greater acuity in

orthognathics, 2003.

William Arnett: Orthodontics and orthognathic Surgery Concepts in

Excellence, Advanced Facial Reconstruction course, 2003.