Management of Facial Deformity Flashcards
When is orthognathic surgery indicated?
Dentofacial problems too severe for ortho alone
Psycho-social considerations
Functional issue: speech and eating
What pt are orthognathic surgery carried out in?
Non-growing
If a pt is class II what factors to consider if surgical or ortho?
Age of pt
Severity - jaw and teeth
Inclination of incisors - camouflage possible?
Example of class II pattern that would require orthognathic surgery?
Mandibular retrognathia
What can cause progressive worsening AOB?
Age
TMJ dysfunction
Rheumatoid arthirtis
What can AOB cause?
Speech and eating issue
Issue w/ tx of AOB
Potential for relapse
How are pt selected for orthognathic tx?
IOFTN
Index of functional treatment need - priorities those w/ severe malocclusion not amenable to ortho
What are risks of orthognathic surgery?
Numbness
Operative risks: pain, swelling, bleeding, infection
Failure achieve proposed outcome
Relapse
What to do if referring pt for orthgnathic surgery?
Must be adult pt
Warn may not fit criteria
Must discuss risk vs benefit
Contra-indication for orthognathic surgery
BMI >35 TMJ - small condyles Blood dysgrasias Mental health issue Bone disorder - osteoporosis Meds - bisphosphontaes
What is sequence of orthognathic surgery/tx?
- Joint clinics and facial planning
- XLA
- Pre-surgical ortho
- Surgery
- Post-surgery ortho
What is facial planning?
Decide which part of face is not within normal angles
What expect Frankfurt maxillary plane angle to be?
27 degree +/- 4
What expect nasolabial angle to be?
90-110 degree
How long is pre-surgery ortho carried out for?
18-24 months
Aim pre-surgery ortho?
Remove dentalcompensations Tooth alignment Correct arch width Level arch Close XLA space
What compensation might see in class II div I
Upper incisors may be retroclinic and lowers prolines = contact
What compensation might see in class III
Retroclined lower incisors
Proclined upper incisors
What is needed (Records) prior surgery?
Ceph
Photos
Surgical plan
What is orthognathic tx?
Combination ortho and maxfac to correct skeletal, dental and soft tissue deformity of jaw and associated facial structures
When orthognathic tx indicated?
Problems too severe to be correct ortho alone
What pt would be suitable for orthognathic tx?
When ortho alone isn't effective Facial, speech, eating concenrs IOFTN/IOTN Benefit > risk No medical contraindication
Aim orthognathic surgery?
Align arches
Decomponsate teeth
Correct skeletal discrepancy
What clinical exams and investigations are required?
Facial analysis, dental assessment, OH, perio assessment
Dental models, OPT, lateral cephalogram, imaging
What is BSSO?
Bilateral sagittal split osteotomy - mandible repositioned and plated
What other techniques are used in orthognathic surgery?
LeFort I osteotomy
SARME
Genioplasty
What is SARME?
Surgically assisted rapid maxillary expansion
When is genioplasty used?
Reposition chin/ change size
Risk mental nerve damage
