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Orthodontic Therapy 2019 > Orthoghantic surgery > Flashcards

Orthoghantic surgery Flashcards

1
Q

Orthognathic surgery - definition

A

Surgery aimed at correcting dentofacial deformity

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2
Q

Dentofacial deformity: definition

A

Deviation from “normal” facial proportions and dental relationships severe enough to be handicapping to the patient
Handicap may be due to
-Aesthetics
-Jaw function

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3
Q

Jaw function

A

Eating

Speech

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4
Q

Indications for orthognathic surgery ?

A
  • severe skeletal discrepancy
  • severe dento-alveolar problem too extreme to correct with orthodontics alone
  • Unsuitable for growth modification or orthodontic camouflage
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5
Q

Sagittal indications?

A 
Severe class II skeletal malocclusions
Severe class III skeletal malocclusions
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6
Q

Vertical indications?

A

Severely increased traumatic overbite

Extreme AOB

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7
Q

Transverse indications?

A

Asymmetry

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8
Q

Types of Maxillary procedures

A 
Segmental procedures
Le Fort I
Le Fort II
Le Fort III
Surgically assisted rapid palatal expansion (SARPE)
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9
Q

Le Fort 1 procedure

A

Most common procedure
Horseshoe incision of buccal mucosa and bone
Maxilla freed and attached only by palatal vessels and soft tissues

Maxilla can be moved:
Upwards – bone removed
Downwards – bone graft
Forwards

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10
Q

Le Fort 2 procedure

A

More extensive than Le Fort I

For mid-face advancement

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11
Q

Le Fort 3 procedure

A

Commonly used for treatment of craniofacial anomalies

Access usually requires raising of a bicoronal flap

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12
Q

SARPE what does it stand for?

A

Surgically assisted rapid palatal expansion (SARPE)

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13
Q

Surgically assisted rapid palatal expansion (SARPE) procedure

A

An attempt to correct transverse inefficiency without segmental surgery
Corticotomies and rapid palatal expansion
RPE activated immediately

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14
Q

Mandibular procedures

A 
Segmental procedures
Ramus procedures
Body osteotomy
Genioplasty
Post-condylar graft
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15
Q

Remus procedure

A

Vertical subsigmoid osteotomy

  • For mandibular prognathism
  • Bone cut from sigmoid notch to lower border

Saggital split osteotomy

  • To advance or retrude mandible
  • Bone cut extends obliquely from above lingula, across retromolar region and vertically down buccal plate to lower border
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16
Q

Body ostiotomy

A

Rarely used
May be useful if natural space anterior to mental foramen
Otherwise extraction required

17
Q

Genioplasty proceedure

A

Chin tip moved
Limited only by bony contact and muscle attachments
Can avoid more complex procedures

18
Q

Post condylar graft

A

Used in growing children with severe mandibular retrognathism
Insertion of cartilage behind condylar head
Can get condylar fossa remodelling
However may require multipal interventions
May still require orthognathic surgery

19
Q

Bimaxillary surgery procedure

A

Surgery required in both maxilla and mandible
Skeletal discrepancy may be too severe for single arch treatment
Aesthetic balance

20
Q

Distraction osteogenesis procedure

A

Increasingly used to treat congenital craniofacial abnormalities
Attempt to overcome limitations on movement by soft tissues
Bone sectioned
Incremental traction applied to bone ends
Tension in callus
Bone formation stimulated in direction of traction

21
Q

Treatment sequence

A 
Extractions
Pre-surgery orthodontics
Reassessment and definitive surgical planning
Surgery
Post-surgery orthodontics
22
Q

What do we need to achieve with pre surgery ortho?

A 
Level and align
Co-ordinate arches
Decompensate
Specific space creation
Majority of movement before osteotomy
More accurate planning of surgery
More predictable surgery
23
Q

What does the surgey involve?

A 
Hospital procedure
Bony plates in maxilla
Plates or screws in mandible
Wafer inserted
Inter-maxillary elastics
24
Q

What are the surgical factors for relapse?

A 
Size of movement required
>5mm in maxilla
>8mm in mandible
Condylar head distraction from glenoid fossa during surgery
Inadequate fixation
25
Q

What are the orthodontic factors for relapse?

A

Extrusion movements less stable

Soft tissue habits such as tongue thrust

26
Q

What are the patient factors for relapse?

A

Original malocclusion such as anterior open bite
Increased soft tissue tension
Cleft lip and palate- scar tissue
Poor compliance- not wearing inter-maxillary elastics and/or retainers

Orthodontic Therapy 2019 (14 decks)

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