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Orthognactic surgery Maxillary vertical position by measuring the lip length at rest,

incisal show at rest: 0.5mm to 5mm depending on age, sex, ethnicity, upper lip length,
Jaw osteotomy surgery to restore anatomic and functional relationship of the jaw incisal attrition
Lip width: the distance from one oral commisure to the other approximates the
Aetiology : interpupillary distance
1. Dentofacial deformity- Condition associated with abnormal skeletal pattern which Upper lip length should be 30% or 1/3rd of the lower facial height
negatively affects facial appearance, function – speech, mastication, breathing, and Neck: chin-throat angle
social life.
2. Pathogenesis of facial development is complex , multifactorial – genetic,
developmental, habitual - represents extremes of variation of development GOALS OF ORTHOGNACTIC
3. May be associated with recognized syndromes, such as facial clefts, hemifacial
microsomia, treacher collins, aperts, crouzons syndromes  Establish a functional occlusion
 Establish harmony between the neuromusculature, the teeth and the TMJ
A surgeon/scientist (Dr Stephen marquardt) studied on facial  Improve facial balance
appearances came up with a consistent formula using a mask  Correct speech problems
of faces that contains a pentagon and a decagon as its  Correct abnormalities related to airway compromise
foundation.  Improve dental and periodontal health
This foundation of mask embodies Phi in all their dimensions
Phi is a golden ratio of the face that makes up a completely INDICATIONS
symmetrical, and perfectly geometric face.
 Deformity of the jaw in their Size, position, orientation, shape, symmetry
Examination of face done in  Severe class II, III skeletal deformity
Natural Head Position  Severe anterior open bite
(NHP) – patient standing or  Jaw deformity that CANNOT be camouflaged with orthodontics, due to
sitting erect with face  occlusal discrepancy is beyond limits of orthodontic tx
looking forward the  too significant jaw deformity despite good occlusion (eg. facial asymmetry)
horizon  Jaw deformity causing impairment or comorbid with other conditions
Systematic facial
examination through all
regions from frontal and
profile (lateral)
Upper third
position of eyes, shape and symmetry
superior orbital rims
Middle third: From Glabella to base of nose (subnasale)
Lateral orbital rims
Intercanthal distance approximates alar base width
Lower nose projection is affected by AP position of maxilla
Malar eminence
Nasolabial angle should be 100 degrees +/- 10 degrees
Lower third: From subnasale to bottom of chin (menton)
Evaluate lips statistically and dynamically for symmetry
 Clinical pictures for facial evualation
Non-compliant behaviour (with orthodontist/hygiene)  Cephalograms for detailed assessment of bony and soft tissues
Active growth spurt  Dental models – for model surgery
Psychologically unstable – psychiatry disorder  3D planning – prediction of surgical movement
Unreasonable demands from patients  Growth assessment – growth stability necessitates stability of tx
Unfit for GA procedure due to  Hand wrist xray (epiphysis and siaphysis fusion)
 Uncontrolled metabolic disorders; DM, Thyroid, Adrenal  Bone scan
 Hypokalemia, Hypocalcemia  Serial tracing
 Blood dyscrasia
 Liver and renal disorders Maxillary and mandibular ramus surgery
Metabolic bone disorder: hypophosphatemia, osteogenesis imperfecta, rickets
Metabolic growth disorder: acromegaly, gigantism Maxilla Mandibular
Le Fort 1 osteotomy – horizontal osteotomy  Sagittal split ramus osteotomy
from piriform rim to tuberosity Osteotomy along the medial surface of
Le Fort 1 osteotomy – to advance, setback, ramus, crossing sagittally towards the lateral
impact, downgraft and rotate maxilla surface of the mandible to allow sagittal
splitting of mandible
 Vertical ramus osteotomy
Osteotomy of the ramus vertically


1. Hemorrhage
2. Unfavorable fracture
3. Nerve damage
4. Condyle sagging leading to TMJ disorders
5. Tooth damage
6. Avascular necrosis of bone
7. Relapse