Orthognathic Surgery

Definition

• Orthognathic Surgery: is that branch of surgery concerned with the

correction of developmental and acquired dentofacial deformity,
particularly disproportions of the tooth-bearing segments of the
jaws, and associated facial skeleton.
 Indications for Orthognathic Surgery
• Severity of skeletal and dental malocclusion
• When growth modification can not be achieved
• Esthetic and psychosocial considerations
Indications

• Severe skeletal discrepancy or severe dento-

alveolar problem too extreme to correct with
orthodontics alone
• Severe class II skeletal malocclusions
• Severe class III skeletal malocclusions
• Vertical disproportions – anterior open bite
• Vertical disproportions – severely increased
overbite
• Skeletal asymmetries
Timing of Surgery

• Usually done when all growth is complete

• Can be performed when growth is not yet complete in cases of

psychosocial problems or great severity when function is
compromised (i.e. breathing, chewing)
Phase I Presurgical treatment
• Orthodontics
• Surgical plan

Phase II Surgical treatment

• Mandible
• Maxilla

Phase III Postsurgical treatment

• Orthodontics
• restorative/prosthetic treatment
• follow-up
Presurgical Treatment Phase

 Presurgical orthodontics
 Final surgical planning
Primary goals of presurgical orthodontics

• Position the teeth over their respective basal bone

• Align and level the teeth
• Adjust for tooth size discrepancies
• Correct rotated teeth
• Co-ordination of upper and lower arch widths
• Divergence of roots away from surgical sites
Objectives —— Presurgical orthodontics
 Decompensation
dental compensation for skeletal deformity
angulation of teeth
accentuate the deformity
Objectives —— Presurgical orthodontics
 Alignment of the arches
 Compatibility of the arches
Final Surgical Planning- Computer Assisted Simulation System
for Orthognathic Surgery

 Computerized imaging CASSOS

Final Surgical Planning
 Model Surgery

Exact surgical movements

(distance, direction)
Postoperative occlusion
 Surgical Treatment Phase

 Surgeries for maxillary deformity

 Surgeries for mandibular deformity
Surgical techniques

Mandibular osteotomies Maxillary osteotomies

• Body 1. Segmental osteotomies
• Ramus Anterior segmental osteotomies
Sagittal split osteotomy a. E.g. Wassmund technique
Inverted L osteotomy Posterior segmental osteotomies
C-shape osteotomy
Oblique subcondylar 2. Midface osteotomies
Vertical subsegmoid a. Le Fort I osteotomy
• Segmental osteotomy b. Le Fort II osteotomy
• Genioplasty c. Le Fort III osteotomy
Surgeries for maxillary deformity

 Segmental osteotomy (Anterior / Posterior)

Indications:
- maxillary protrusion
- marked protrusion of
maxillary teeth
- open bite
Surgeries for maxillary deformity

 Le Fort I osteotomy
(total or segmental)

Indications:
- maxillary deformities
- mandibular deformities
Le Fort I osteotomy
Surgeries for maxillary deformity

 Le Fort I osteotomy
 Le Fort II or III osteotomy

Indications:
- midface deficiency
Surgeries for mandibular deformity
 Sagittal split ramus osteotomy,
SSRO

Indications:
- mandibular excess
- mandibular deficiency
- mandibular asymmetry
Sagital Split Osteotomy (Obwegeser)
Sagital Split Osteotomy (Obwegeser)
Surgeries for mandibular deformity

 Vertical ramus osteotomy

Indications:
- mandibular excess
- mandibular asymmetry
(combined with SSRO)

back
Surgeries for mandibular deformity

 Subapical osteotomy

Indications:
- bimaxillary protrusion / open bite
- leveling the plane of occlusion
- uprighting anterior teeth
 Surgeries for mandibular deformity
 Body osteotomy

Indications:
- mandibular excess (body)
combined with ramus procedure or not
- open bite / spee’s curve reduction
Surgeries for mandibular deformity

 genioplasty

Indications:
- chin deformities
Perioperative complications

 Airway obstructionedema /
bleeding / displacement… …
 Bleeding
 Infection
 Necrosis of teeth / bone
 Healing
 Injury of nerve
 Postsurgical Treatment Phase

 Completion of orthodontics
 Postsurgical restorative/prosthetic treatment
 Follow-up
Genioplasty
 Surgery for a receding lower jaw

The jaw is moved forward, a portion of the chin is moved forward and
both areas of the jawbone are held in place using plates and screws
Relapse and Stability

• Rigid fixation has improved stability

• Stability is mostly influenced by the pattern of rotation of the mandible
as it is advanced
• Advancement of maxilla and/or mandible will stretch soft tissues
promoting relapse
• The more advancement needed, the greater the probability for relapse