Corrective Jaw Surgery

Question 1

What does orthognathic surgery for dentofacial deformity encompass

Answer 1

Jaws
Speech
Mastication
Cosmetics
Surrounding Tissues
Etc

Question 2

Maxilla dimensional issues

Answer 2

AP too short? Flat midface, concave face, short face

Vertical too long? Gummy smile, long face, incompetent lips

Question 3

Mandible dimensional issues

Answer 3

AP too short? severe convex face, small chin
AP too long? Concave face or horse face

Transverse may be asymmetrical

Question 4

Problem list that may require orthognathic surgery

Answer 4

Protrusive jaw
Cannot bite well (associated with crossbite or open bite)
Retrognathia
Retrognathic chin
Prominent/protrusive lips
Crooked jaw
Incompetent lips
Breathing difficulty (obstructive sleep apnea due to small chin, tongue pushed back and obstructs airways)
Psychological issues
Speech defects
Gummy smile

Question 5

Procedure for tx plan formation

Answer 5

Clinical exam

X ray analysis
> DPT, rule out pathology
> Latceph, analyse AP and vertical movements required to achieve optimal occlusion and aesthetics
> KIV CBCT and 3D model creation

Tx plan type of surgery
> Single jaw (maxillary lefort osteotomy or mand BSSO/VRO)
> Bimaxillary
> Segmental osteotomies
> Genioplasty (if chin v small)
> Combination of the above

Post-op fixation (IMF) for 1-2 weeks, liquid diet
Normal for lips to be swollen for 1-2 days due to post-surgical edema