Management of Facial Deformity

Question 1

When is orthognathic surgery indicated?

Answer 1

Dentofacial problems too severe for ortho alone
Psycho-social considerations
Functional issue: speech and eating

Question 2

What pt are orthognathic surgery carried out in?

Answer 2

Non-growing

Question 3

If a pt is class II what factors to consider if surgical or ortho?

Answer 3

Age of pt
Severity - jaw and teeth
Inclination of incisors - camouflage possible?

Question 4

Example of class II pattern that would require orthognathic surgery?

Answer 4

Mandibular retrognathia

Question 5

What can cause progressive worsening AOB?

Answer 5

Age
TMJ dysfunction
Rheumatoid arthirtis

Question 6

What can AOB cause?

Answer 6

Speech and eating issue

Question 7

Issue w/ tx of AOB

Answer 7

Potential for relapse

Question 8

How are pt selected for orthognathic tx?

Answer 8

IOFTN

Index of functional treatment need - priorities those w/ severe malocclusion not amenable to ortho

Question 9

What are risks of orthognathic surgery?

Answer 9

Numbness
Operative risks: pain, swelling, bleeding, infection
Failure achieve proposed outcome
Relapse

Question 10

What to do if referring pt for orthgnathic surgery?

Answer 10

Must be adult pt
Warn may not fit criteria
Must discuss risk vs benefit

Question 11

Contra-indication for orthognathic surgery

Answer 11

BMI >35
TMJ - small condyles
Blood dysgrasias
Mental health issue
Bone disorder - osteoporosis
Meds - bisphosphontaes

Question 12

What is sequence of orthognathic surgery/tx?

Answer 12

1. Joint clinics and facial planning
2. XLA
3. Pre-surgical ortho
4. Surgery
5. Post-surgery ortho

Question 13

What is facial planning?

Answer 13

Decide which part of face is not within normal angles

Question 14

What expect Frankfurt maxillary plane angle to be?

Answer 14

27 degree +/- 4

Question 15

What expect nasolabial angle to be?

Answer 15

90-110 degree

Question 16

How long is pre-surgery ortho carried out for?

Answer 16

18-24 months

Question 17

Aim pre-surgery ortho?

Answer 17

Remove dentalcompensations
Tooth alignment
Correct arch width 
Level arch
Close XLA space

Question 18

What compensation might see in class II div I

Answer 18

Upper incisors may be retroclinic and lowers prolines = contact

Question 19

What compensation might see in class III

Answer 19

Retroclined lower incisors

Proclined upper incisors

Question 20

What is needed (Records) prior surgery?

Answer 20

Ceph
Photos
Surgical plan

Question 21

What is orthognathic tx?

Answer 21

Combination ortho and maxfac to correct skeletal, dental and soft tissue deformity of jaw and associated facial structures

Question 22

When orthognathic tx indicated?

Answer 22

Problems too severe to be correct ortho alone

Question 23

What pt would be suitable for orthognathic tx?

Answer 23

When ortho alone isn't effective
Facial, speech, eating concenrs
IOFTN/IOTN 
Benefit > risk
No medical contraindication

Question 24

Aim orthognathic surgery?

Answer 24

Align arches
Decomponsate teeth
Correct skeletal discrepancy

Question 25

What clinical exams and investigations are required?

Answer 25

Facial analysis, dental assessment, OH, perio assessment

Dental models, OPT, lateral cephalogram, imaging

Question 26

What is BSSO?

Answer 26

Bilateral sagittal split osteotomy - mandible repositioned and plated

Question 27

What other techniques are used in orthognathic surgery?

Answer 27

LeFort I osteotomy
SARME
Genioplasty

Question 28

What is SARME?

Answer 28

Surgically assisted rapid maxillary expansion

Question 29

When is genioplasty used?

Answer 29

Reposition chin/ change size

Risk mental nerve damage