Dentofacial Deformities

The Surgical Principles

Ashraf Abu Karaky

BDS MSc MFDSRCSEd FFDRCSI
 Dentofacial deformities
• Maxillary Deficiency
• Mandibular Excess
• Combined
• Cleft Palate
 General Strategy
1.Assessment & Planning
2.Choice of Surgical Procedure
3.Surgical Management
4.Patient Management
5.Continuing care & Follow up
 Model Surgery

1.Plan Operative Movements

2.Practice Operative Movements
3.Assess Dental Interferences
4.Construct Wafers
5.Plan Fixation
 Preoperative Policy
1.Eliminate Dental Compensation
2.Propery Manage Transverse
Discrepancies
3.Identify and Manage Tooth Size
Discrepancies
4.Assure proper leveling and root
divergence in segmental cases
5.Prepare the Patient Psychologically
SURGERY & FIXATION
Choice of Surgical Procedure
1.Mandibular
2.Midface
3.Bimaxillary
4.Segmental
BSS0
Surgical Technique
Incision Design
Bone Cuts
Bone Cuts
Bone Cuts
Bone Cuts
Fixation
IMF
Complications
 GENIOPLASTY
1.Reduction
2.Augmentation
3.Forward Slide
4.Backward Slide
5.Mental Paraesthesia
6.Care with Incision
7.Apicectomies
Incision Design
Bone Cuts
Bone Cuts
Fixation
MIDFACE PROCEDURES
1.Segmental
2.Le Fort l
3.Le Fort ll
4.Le Fort lll
 Le Fort 1
• Versatile
• Increases in vertical maxillary height tend
to be unstable
• Advances to 7mm stable (Luyk & Ward-
Booth 1985)
Operative Technique
Bone Cuts
Bone Cuts
Down Fracture
Seperation
Downfracture
Fixation
Fixation
IMF
 Complications
1.Bleeding
2.Nerve Damage, 25% at first year
3.Skull Base Fracture
4.Nasolabial aesthetics: alae, tip, septum.
5.Non vital teeth; 8%
6.Sinusitis, up to 50%
7.Loss of sulcus depth
8.Velopharyngeal incompetence
9.Relapse
Bimaxillary Osteotomy
Pre & Post
Pre & Post
Pre & Post
Anterior Open Bite
Pre and Post
Pre and Post
Distraction Osteogenesis
Thank You