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Oral surgery II 2020 > Dentofacial deformities > Flashcards

Dentofacial deformities Flashcards

1
Q

What percent of individuals that have malocclusion are attributed to facial deformities?

A

2.7%

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2
Q

What direction is normal growth of the face?

A

-Downwaard and forward with lateral expansion

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3
Q

What two types of radiographs are essential when determining orthognathic surgery?

A
  • Cephalometric

- Panoramic

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4
Q

T/F Any non-restorable teeth should be extracted before surgical intervention

A

True

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5
Q

The general rule is delay surgery until growth is complete in patients with problems of excess growth. What is a condition of excess growth?

A

-Mandibular prognathism

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6
Q

What is mandibular hypoplasia? When can you do surgery on these individuals?

A
  • Growth deficiency

- earlier

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7
Q

What is the advantage of computer digitalized analysis?

A

-More accurate prediction of facial change

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8
Q

What are the disadvantages of computer digitalized analysis?

A
  • Limited to two dimensional prediction
  • Inability of computer to predict accurately every surgical change for every patient
  • Adds cost
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9
Q

What was one of the earliest dentofacial deformities treated?

A

-Mandibular excess

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10
Q

How can you treat mandibular excess?

A
  • Body ostectomy
  • Anterior mandibular subapical osteotomy
  • Vertical Ramus Osteotomy
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11
Q

What are three ways to do a vertical ramus osteotomy?

A
  • Extra-oral approach
  • Intra-oral approach
  • Rigid fixation
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12
Q

What was the revolutionized way to treat mandibular deficiency?

A

-Bilateral sagittal split ramus osteotomy

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13
Q

Where does the cut go on a sagittal split osteotomy?

A
  • Medial aspect via horizontal osteotomy

- Lateral aspect via vertical osteotomy

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14
Q

Besides the sagittal split osteotomy what other ways can you use to advance the mandible?

A
  • Total subapical osteotomy
  • Genioplasty (inferior border osteotomy
  • Alloplastic chin implants
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15
Q

What three directions might excess maxillary growth occur?

A
  • Anterior posterior
  • Vertical
  • Transverse
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16
Q

What are the facial characteristics with vertical maxillary excess?

A
  • Elongation of face
  • Narrow nose
  • Excessive incisal and gingival exposure
  • Lip incompetence
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17
Q

What type of bite is vertical maxillary excess frequently associated with?

A

-Anterior open bite caused by excess downward growth of MX that causes downward rotation of Md giving premature contact of posterior teeth

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18
Q

How do you correct a vertical maxillary excess?

A
  • superior repositioning of maxilla in one or several pieces

- Le Fort I osteotomy with or without segmentalization

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19
Q

What are characteristics of maxillary and midface deficiency?

A
  • Retruded upper lip
  • Deficiency of paransal and infraorbital rim areas
  • Inadequate tooth exposure while smiling
  • Prominent chin
  • Class III with reverse anterior
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20
Q

What is the treatment of a maxillary and midface deficiency?

A

-Le Fort I with or without bone grafting and segmentalization

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21
Q

What is the treatment of a maxillary horizontal deficiency?

A

-Le Fort I advancement

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22
Q

With orthognathic surgery how long are you in the hospital?

A

-1-4 days

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23
Q

What is the most common serious congenital anomoly affecting the orofacial region?

A

-Cleft lip and palate

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24
Q

When does cleft lip and palate occur?

A

-Between fifth and tenth weeks of fetal life

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25
Q

What is the risk of a parent having a child with a cleft?

A

1 in 700

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26
Q

If parents have a child with a cleft what is the odds that the next child will have a cleft?

A
  • 2-5%

- this risk is the same for each succeeding child

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27
Q

If more than 1 person in immediate family has cleft what does the risk of cleft rise to?

A

10-12%

28
Q

What is the objective of a cheilorhapy?

A
  • Repair cleft lip
  • Function and esthetics
  • Restore orbicularis oris muscle
29
Q

What is the objective of a palatorhaphy?

A
  • Repair cleft palate

- Create mechanism capable of speech and deglutition without interfering significantly with maxillary growth

30
Q

what are 4 periodontal considerations when evaluating a patient for dentofacial surgery?

A
  • OHI
  • perio charting
  • scaling and root planing
  • evaluation of attached keratinized tissue
31
Q

when malocclusion involves skeletal discrepancy, treating with orthodontics alone may result in adequate ___ but poor ___ or ___

A
  • occlusion
  • poor facial or dental esthetics
  • poor long-term prognosis for post-treatment retention
32
Q

presurgical orthodontics often takes how long before the patient is ready for dentofacial surgery?

A

12-18 months

33
Q

what were the early surgical corrections for mandibular deficiency, and what was the issue?

A
  • early correction included an extraoral approach, vertical ramus osteotomy, and iliac bone grafting
  • resulted in high relapse
34
Q

describe how correction of mandibular deficiency was revolutionized in the 70s

A
  • bilateral sagittal split ramus osteotomy (BSSO)
  • significant bone overlap for post-op stability, reducing relapse
  • use of rigid fixation with screw and plates
  • no need for IMF usually
35
Q

which surgical approach for mandibular deficiency can increase lower facial heigh with simultaneous bone grafting, and is rarely used?

A

total subapical osteotomy

36
Q

what type of mandibular deficiency is the total subapical osteotomy procedure typically used?

A

class 2 dental relationship but the anterior-posterior position is ok (chin)

37
Q

which surgical approach for mandibular deficiency is used with or without other osteotomies, is considered “cosmetic” by insurance, and can also correct asymmetries?

A

genioplasty (inferior border osteotomy)

38
Q

3D computerized surgical planning combines what 3 things to produce computerized models of skeletal and occlusal abnormalities?

A
  • laser
  • optical
  • CT scans
39
Q

3D computerized surgical planning improves the understanding of what 3 things?

A
  • bone movements required at surgery
  • potential difficulty with bone interferences
  • possible need for bone grafting
40
Q

orthognathic surgery is typically performed in what setting?

A

hospital setting, in an operating room

41
Q

what are the components of perioperative and postoperative care for patients receiving orthognathic surgery?

A
  • antibiotics, steroids, and close observation
  • pain medication as needed
  • nasal airway as needed for maxillary surgeries
  • liquid to soft diet
  • oral hygiene
42
Q

cleft lip and cleft palate is less frequent in what population? more frequent?

A
  • less frequent in african americans

- more frequent in asians

43
Q

what gender is cleft lip and palate more common in?

A

-boys more than girls with a ratio of 3:2

44
Q

clefts typically can affect what 3 anatomical structures?

A
  • lip
  • alveolar ridge
  • hard and soft palates
45
Q

what fraction of clefts are unilateral (what side is more common)? bilateral?

A
  • 3/4 are unilateral (left > right)

- 1/4 are bilateral

46
Q

the causes of clefts are unknown, but may be related to what factors?

A
  • genetic predisposition

- environmental factors, like nutrition, radiation, drugs, hypoxia, viruses, and vitamin excesses or deficiencies

47
Q

a parent who has a cleft has a ___% chance that their child will have a cleft

A

2-5%

48
Q

unaffected siblings of a child with a cleft have ___% chance of their child having a cleft

A

1%

49
Q

if a syndrome is involved in clefting, the risk for recurrence within the family can be as high as ___%

A

50%

50
Q

what are the dental problems with clefts?

A
  • alveolar cleft
  • malformed or missing teeth
  • displaced teeth
  • supernumerary teeth
51
Q

what are the malocclusion problems with clefts?

A
  • class III (pseudo-prognathism)
  • collapse of lesser segments
  • need for orthodontics and/or orthognathic surgery care
52
Q

what are the nasal deformity problems with clefts?

A
  • alar flare on the cleft side
  • columella pulled to non-cleft side
  • lack of bony support at the nasal base
53
Q

in surgical corrections of clefts, what should be the last surgery performed?

A

nasal correction

54
Q

what are the feeding problems with clefting?

A
  • can’t feed normally
  • can’t generate negative pressure
  • use specially designed nipples, eye droppers, or large syringes
55
Q

what are the ear problems associated with clefting?

A
  • levator veli and tensor veli palatini muscles can be unattached
  • make the middle ear a closed space
  • requires myringotomy
  • leads to hearing loss
56
Q

what are the speech difficulties associated with celfting?

A
  • retardation of consonant sounds
  • hyper-nasality
  • persists after surgical correction
  • need speech therapy
57
Q

what is the rule of 10 for surgical repair of cleft lips?

A
  • 10 lbs
  • 10 weeks old
  • 10 g/dL hemoglobin
  • should be treated as early as possible under these conditions
58
Q

when should the treatment of cleft palate be performed?

A
  • usually 8-18 months

- sometimes wait until 4-5 years old

59
Q

what are the advantages of early surgery for the surgical repair of cleft lip and palate?

A
  • facilitate palatal and pharyngeal muscle development
  • ease of feeding
  • development of phonation skills
  • better auditory function
  • better hygiene
  • psychologic
60
Q

what are the disadvantages of early surgery for the surgical correction of cleft lip and palate?

A
  • more difficult on small structures

- scar formation causes maxillary growth restriction

61
Q

what are the esthetic considerations of cheilorrhapy?

A

-normal appearance of vermillion, cupids bow, and philtrum

62
Q

T or F:

surgical techniques for palatorrhaphy and cheiloplasty vary widely with the surgeon and patient

A

true

63
Q

T or F:

palatorrhaphy surgery that corrects a palatal cleft involves fusing the separated bone fragments together

A

false

-it is closed with soft tissues only

64
Q

how is a palatorrhaphy performed?

A
  • soft tissues are incised along the cleft margin and dissected from the palatal shelves
  • lateral releasing incisions are used to obtain a tension-free closure
65
Q

palatalorrhaphy is closed in what 3 layers?

A
  • nasal mucosa
  • muscle
  • oral mucosa

Oral surgery II 2020 (12 decks)

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