ORTHOGNATHIC SURGERY

Dr Shruthi Rangaswamy
 Definition

 Orthognathic surgery is The art and science

of diagnosis, treatment planning and
execution of treatment to correct
musculoskeletal , dento osseous and soft tissue
deformities of jaws and associated structures
 Maxillary and mandibular bones are sectioned
intentionally and repositioned at desired site
 Introduction

 Deals with surgical correction of common developmental

abnormalities of maxilla & mandible.

 Developmental defect:-
 may be deficient in growth (retrognathia)
 or excessive (prognathism)

 or may affect in any plane i.e; AP plane, vertical or

transverse.
 It involves surgical positioning of one or both jaws

 thought to be aesthetic surgery

 & extra benefit -- repositioning of the jaws in

normal functional occlusion.
Treatment
 Treatment objectives (Goals of surgery)
Basic therapeutic goals Examples

Function Normal mastication, speech, ocular function,

respiratory functions.

Esthetics Establishment of facial harmony & balance.

Stability Prevention of short term & long term relapse

Minimizing of treatment time Provision of effective & efficient treatment

Indications for orthognathic surgery

 Severe class II or class III discrepancy

 Deep over bite
 Severe anterior open bite
 Vertical excess in maxilla or mandible
 Skeletal asymmetry
 Severe dento alveolar problem cannot be corrected
by orthodontic treatment
 Transverse dimensions

 Rule of 5
 One helix to other side
 Outer canthus = bigonial width
 Medial canthi = ala of the nose
 Medial margins of iris = corner of mouth
Eyes
 Intercanthal distance

 Interpupillary distance

 Width of intercanthal+
alar base+ palpebral
fissure width
CEPHALOMETRIC ANALYSIS
 Introduction
 Successful treatment of the orthognathic surgical patient is
dependent on careful diagnosis

 Cephalometrics can be an aid in the diagnosis of skeletal and

dental problems and a tool for simulating surgery and
orthodontics by the use of acetate overlays (Tracing sheets).
COGS – Cephalometrics for Orthognathic Surgery

 Developed at university of Connecticut.

 Developed by Charles Burstone et al

 Presented first in Journal of Oral Surgery. 1978 April

A. Anteroposterior discrepancies
 1. Maxillary/mandibular incisor relationship; any:
 a. Horizontal overjet of ≥ 5 millimeter (mm)
 b. Zero to a negative value (norm 2mm)

 2. Maxillary/mandibular anteroposterior molar

relationship discrepancy of ≥ 4 mm (norm is 0–1
mm)
 Mandibular prognathism
 Mandibular retrognathism
Vertical discrepancies; defined as any:

 Vertical facial skeletal deformity of ≥ 2 SDs from

norms for accepted skeletal landmarks

 Vertical maxillary excess

 Vertical Maxillary deficiency
 mandibular excess –acromegaly
Transverse discrepancies
 Collapsed maxillary arch
 Cross bite

 Telescopic bite

Excess mandible
 Scissors bite
Asymmetries
 defined as anteroposterior, transverse or lateral
asymmetries > 3 mm with concomitant occlusal
asymmetry
 Condylar hypoplasia/ hyper plasia
Combination
 Naso maxillary hypoplasia
 Bimaxillary protrusion
Clinical features
Maxillary excess
Vertical maxillary deficiency
Mandibular excess
Mandibular difficiency
Kkkkkkkkkkkkkkkkkkkkk
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Various orthognathic
surgical procedures
 Maxillary Surgeries
1. Segmental Osteotomy
a. Single tooth osteotomy
b. Corticotomy
c.Anterior maxillary osteotomy
-Wassmund technique
-Wunderer
-Cupar
d. Posterior subapical osteotomy

2. Total Maxillary osteotomy

-LeFort I
-Lefort II
-Lefort III
Mandibular Surgeries
1. Ramus Osteotomy
-Vertical
- Sagittal Split
2. Body osteotomy
3. Subapical osteotomy
- Anterior
-Posterior
4. Genioplasty
a.Horizontal osteotomy with anterioposterior reduction.
b.Tenon technique
c.Double sliding
d.Vertical reduction.
e.Alloplastic augmentation.
AMO
 Cupar
 Wassmund

 Wunderer
Total maxillary osteotomy
Le Fort I Osteotomy
Lefort 2 osteotomy

Midface deformity
Binders syndrome-
nasomaxillary hypoplasia
Cleft lip and palate
Lefort 3 osteotomy
BSSO - SS0
 Bilateral sagital split osteotomy
 Sagital split osteotomy
 Ramus Osteotomy

Sagittal split
Anterior Subapical Osteotomy
Body Osteotomy of mandible
Genioplasty
 Indications
 Retruded chin
 Long chin
 Hypoplastic chin
THANK YOU