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4 - oral surgery > basics of orthognathic surgery > Flashcards

basics of orthognathic surgery Flashcards

1
Q

What are the fundamentals of orthognathic surgery?

A

Team approach
History
Careful clinical examination
Investigations
Prediction planning
Stable surgical techniques

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2
Q

Why is dysmorphophobia important in orthognathic surgery?

A

If the patient isn’t happy with their face, changing their face won’t then make them happy

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3
Q

Describe body dysmorphophobia

A

Pt may request tx of non-existing deformity
1. Preoccupation with a defect on appearance, minor defect and excessive concern
2. Preoccupation leads to significant distress
3. Associated mental disorders eg - anorexia nervosa

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4
Q

What are characteristics of body dysmorphophobia?

A

Obsession with exaggerated defect
Doctor shopping

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5
Q

Who is involved in the MDT of orthognathic surgery?

A

Psychologist
Orthodontist
Maxillofacial surgeon
Technologist
Restorative dentist
Speech and language therapy

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6
Q

What is viropharyngeal incompetence?

A

A short soft palate, so air escapes giving a hyper nasal tone

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7
Q

What is an orthodontists role in orthognathic surgery?

A

Recognition of dentofacial deformities
Orthodontic tx before and after
Follow up

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8
Q

What is the technologists role in orthognathic surgery?

A

Model surgery planning
Provide occlusal wafer to guide the surgery
Building 3D skull models
Digital prediction of final occlusion

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9
Q

What should be considered in pt history for orthognathic surgery?

A

May be a congenital cause
May be due to acromegaly (hormone with adenoma in pituitary gland)
May be due to pathology eg - cysts and tumours
Could just be racial characteristics (don’t need to change them all)
Find if there is a psychological motivation

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10
Q

What is paranasal hollowing?

A

Deficiency of the maxilla that needs treatment

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11
Q

What should be examined intra-orally before orthognathic surgery?

A

Occlusal relationship
Centreline discrepancies
OJ
OB
Crossbites
Occlusal canting
Incisors inclination
Crowding and spacing
Tongue size, mobility and speech pattern
Speech pattern
VPI

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12
Q

What radiographic views are commonly used before orthognathic surgery?

A

OPT
Lateral cephalogram
PA cephalogram
Periapicals
Occlusal
CBCT

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13
Q

What 3 points of reference must be recorded on a facebow?

A

Condylar heads
Orbitale
Maxillary dentition

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14
Q

What is stereophotogrametry?

A

A 3D image taken of the patient

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15
Q

How is 3D planning carried out for orthognathic surgery?

A

Soft tissues through 3D image (stereophotogrametry)
Skeletal tissue through CBCT
Dental tissue with intra-oral scan
All compiled together for a pt image for planning

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16
Q

How is a diagnosis that orthognathic surgery is needed made from the maxilla?

A

Prognathic or retrognathic
Vertical excess or deficiency
Narrow or wide
Asymmetry

17
Q

How is a diagnosis that orthognathic surgery is needed made from the mandible?

A

Prognathic or retrognathic
Asymmetry

18
Q

How is a diagnosis that orthognathic surgery is needed made from the chin?

A

Progenia or retrogenia
Vertical deficiency or excess
Asymmetry

19
Q

What are the stages of treatment before and and after orthognathic surgery?

A

Tooth alignment, eliminating crowding, spaces and cross bites
Alteration and coordination of the arches
Correction of incisors inclination (de-compensation)
Flattening the occlusal plane
Surgical fixation
Post-surgical orthodontic fine tuning

20
Q

What is the difference between retrognathism and proficiency (hypoplasia)?

A

In retrognathism the size is okay but it is positioned too far back
If proficient, there is a deficiency in size

21
Q

What orthognathic surgeries can be carried out for the maxilla?

A

Le Fort I osteotomy
Anterior maxillary osteotomy (posterior)

22
Q

Describe a Le Fort I osteotomy

A

Disarticulating the maxilla from the base of the skull and move it to a pre-planned position
Moves superiorly, inferiorly and forward
Maxilla cannot move backwards due to the pterygoid plates

23
Q

What surgery is carried out for the mandible and describe this procedure?

A

Sagittal split mandibular osteotomy
Separated the ramus from the body of the mandible
Body can be moved in any direction

24
Q

What orthognathic surgery is carried out for the chin and describe this

A

Genioplasty
Inferior border of the mandible can move in any direction
Advancement, set-back and rotation
Augmentation and reduction

4 - oral surgery (19 decks)

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