Introduction to orthognathic surgery

Orthognathic surgery is the art and science of diagnosis treatment planning and execution of treatment by combining orthodontics and OMFS to correct musculo skeletal , dento osseous , and soft tissue deformities of jaws and associated structures . The word orthognathic comes from a Greek word

ORTHO = to straighten GNATHIA= Jaws Prior to that time, the term surgical orthodontics or facial orthopedics was used to describe the field

When is orthognathic surgery required?

In case of severe Dento-facial deformities , a person suffers from a multitude of problems functional as well as psychological problem due to unaesthetic appearance Also there is > Impairment of mastication > Associated speech problems > Difficulty in oral hygiene > TMJ pain / Dysfunction

Types of deformities are

Maxillary Deformities

> Maxillary antero-posterior excess > Maxillary antero-posterior deficiency > Vertical maxillary excess > Vertical maxillary deficiency > Transverse maxillary deficiency > Alveolar clefts Mandibular Deformities > Mn AP excess > Mn AP deficiency > Mn AP asymmetry > Unilateral condylar hyperplasia

Chin deformities > microgenia > macrogenia

Combined Mx- mn deformities >Bimaxillary protrusion >Nasomaxillary hypoplasia associated with prognathic mandible >Short face syndrome( brachyfacial ) >Long face syndrome ( dolicofacial ) >Apertognathia

Features of Vertical Mx excess

Increased height of lower third of face Large interlabial gap > 4mm with incompetent lips Gummy smile with excessive incisor display Angles class II molar occlusion Two variants .. With anterior open bite and without anterior open bite

Mandibular retrognathism
Convex profile Retruded chin bird face deformity

 Skeletal deep bite and increased overjet Everted lower lip,curled under protrusive incisors and deep mentolabial fold acute gonial angle

Mandibular prognathism
Prominent chin Concave profile Steep mandibular plane mentolabial fold diminished or absent

Obtuse gonial angle

Skeletal Bimaxillary protrusion

Convex profile Extreme protrusion of upper and lower incisors Lip incompetence Apparent chin deficiency

Anterior open bite/edge to edge bite

Indications ..
Severe class II or class III discrepancy Deep overbite and anterior open bite in pts. whose growth is complete

 Extreme vertical excess in Mx or Mn

Dento-alveolar problems too severe to be corrected by orthodontics

Skeletal asymmetry

Timing for the surgery ..

Best timing is after growth potential for the patient is over .

Surgery done in actively growing patients only if there are severe psychological problems associated with the deformity and a warning is given that a re-surgery may be required later on

What are the basic goals of orthognathic surgery?

The specific goal for orthognathic surgery vary from patient to patient, depending on the diagnosis.

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.