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What is Orthognathic (maxillofacial) surgery?

Orthognathic surgery combines orthodontic treatment with surgery of the jaw to correct or establish a stable functional balance between the teeth, jaws and facial structures. The goal of maxillofacial surgery is to treat any jaw imbalance and the resulting incorrect bite, which could adversely affect the cosmetic (esthetic) appearance as well as the proper functioning of the teeth. This involves diagnosis, treatment planning and execution of treatment, by combining orthodontics and oral/maxillofacial surgery to correct musculoskeletal, dento-osseous and soft tissue deformities of the jaws and associated structures.
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What does orthognathic mean?

The word orthognathic was coined by an oral & maxillofacial surgeon and means straight jaws, just as orthodontics mean straight teeth. Prior to that time, the term surgical orthodontics or facial orthopedics was used to describe the field.

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When is orthognathic surgery required?

Orthognathic surgery is needed when jaws dont meet correctly and/or teeth dont seem to fit with jaws. The teeth are straightened with orthodontics, and corrective jaw surgery repositions the mal-aligned jaws. This not only improves the facial appearance (esthetics), but also ensures that teeth meet correctly and function properly.
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Who needs orthognathic surgery?

There are many different types of abnormalities of the jaw structures that can result in facial deformity and improper bite. These abnormalities in the jaws and facial bones may be congenital (present at birth) or developed during growth and development. They may also be acquired after birth as a result of hereditary, environmental influences or trauma/illness to the face.
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Is this a common problem?

It has been estimated that Dentofacial (involving the teeth and face) deformities affect approximately 20% of the population.

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Who should be evaluated for possible orthognathic surgery?

Any individual with difficulty in the following areas should be evaluated for possible orthognathic surgery:
1. difficulty in chewing, biting or swallowing 2. speech problems 3. chronic jaw or TMJ (Temporomandibular joint) pain 4. open bite 5. protruding jaw 6. breathing problems

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Why Have Surgery?

1.When orthodontic treatment alone cannot correct a problem. 2.To improve jaw function. 3.To enhance the long term orthodontic result (stability). 4.Reduction in overall treatment time.

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Why Have Surgery?

5.Change in facial appearance.. 6.Improved breathing. 7.Improved speech. 8.Improvement in jaw pain

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What kind of specialists are involved in the evaluation for orthognathic surgery?
Successful orthognathic surgery requires the cooperation of the oral/maxillofacial surgeon, orthodontist and general dentist. Other specialists may include periodontists, prosthodontists, endodontists, neurosurgeons, ophthalmologist, otolaryngologists, plastic surgeons and speech pathologist. These professionals will work as a team to provide the diagnosis, treatment plan and actual execution of the treatment.
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What are the basic goals of orthognathic surgery?

The specific goal for orthognathic surgery vary from patient to patient, depending on the actual diagnosis. In general, the team will address:

1.Function: Normal chewing, speech, ocular (eye) function, respiratory function. 2.Esthetics: Establish facial harmony and balance 3.Stability: Avoid short and long term relapse 4.Minimize treatment time: Provide efficient and effective treatment.
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What is involved in the evaluation and diagnosis of orthognathic surgery?

The most important aspect of overall patient management is thorough evaluation and diagnosis. Patient evaluation for orthognathic surgery can be divided into four main areas:
1. Patient concerns or chief complaints 2. Clinical examination 3. Radiographic and imaging analysis (x-rays) 4. Dental model analysis

After an examination by each of the orthognathic surgery team members (dentist, orthodontist and maxillofacial/oral surgeon), a diagnosis and coordinated treatment plan is prepared. The complete process usually takes place in several stages over the coarse of one to two years.

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How long is the surgery?

The procedure may take 2-4 hours, depending on the complexity. Most patients are kept in the hospital for 2-5 days, again depending on the specifics of the procedure and postoperative condition.

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PLANNING

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PLANNING
PHOTOGRAPHS Extra-oral and intra-oral views

Negative patient profile fitting the ceph. bony & soft tissue to determine the effect of surgical options

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Common Surgical Procedures:

Maxillary Procedures 1.Segmental proceduresOne or more teeth and their supporting bone can be moved as a segment.Either distally to reduce increased overjetOr upwards to reduce excessive upper incisor show

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SEGMENTAL PROCEDURE

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SEGMENTAL PROCEDURE

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Wassmund technique
Involve movement of the upper premaxillarysegment of incisors and canines as block

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Maxillary Procedures
Lefort1 (most widely used technique) Horseshoe incision of the buccal mucosa and underlying bone The maxilla can be moved upward
downward

forward
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LefortII Achieve mid-face advancement LefortIII Management of craniofacial anomalieS

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MANDIBULAR PROCEDURES
Vertical subsigmoidosteotomy: Used for mand. prognathism Bone cut from sigmoid notch to lower border

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Sagittalsplit Osteotomy:Used to advanceOR push backthe mandible OR to correct asymmetryBone cut extends obliquely from above the lingulaacross the retromolarregion, vertically down the buccalplate to the lower border

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The main complication is damage to the inferior alveolar nerve

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Body osteotomy Used in patient with mand. Prognathism, if there is a natural gap in the lower arch

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GENIOPLASTY
To move the tip of chin in any direction Sliding bony contact and the muscle pedicle Used as masking procedure to avoid complex treatment

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THANKYOU!
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