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BDS4 CDS Oral Surgery > orthognathic surgery > Flashcards

orthognathic surgery Flashcards

1
Q

pt C/O for orthognathic surgery

A

don’t like their appearance and/or functional deficit

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2
Q

psychologist role in orthognathic team

A

Psychological assessment of patients requesting orthognathic surgery and the relevance of body dysmorphic disorder

  • Early recognition of psychological problems (Dysmorphophobia & Neurosis)
  • Understand real motivation for surgery
  • Postsurgical depression
  • Psychological adaptation to the new face
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3
Q

dentist should have brief understanding of the psychological state of pt
how

A
  • What is the patient’s mental state?

Medical history
* previous psychiatric problems
* existing disorders (anxiety & depression sleeping patterns, eating habits)
* shortness of breath, abdominal pain, nausea

If you are in doubt ..psychological consultation

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4
Q

body dysmorphic disorder

A

Pt requesting for non-existing deformity
* Preoccupation with a defect in appearance, minor defect and excessive concern
* Preoccupation leads to significant distress
* Associated mental disorders (anorexia nervosa)

Characteristics:
* obsession with exaggerated defect,
* doctor shopping

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5
Q

team members for orthognathic surgery

7

A
  • Psychology
  • Orthodontist
  • Surgical
  • Technologist
  • Restorative
  • Speech and language therapist
  • Hygienist
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6
Q

teachnologist role in orthognathic surgery

4

A
  • Model surgery planning
  • Provide occlusal wafer to guide the surgery
  • Building 3D skull models
  • Digital Prediction of final occlusion
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7
Q

orthodontist role in orthognathic surgery

3

A
  • Early recognition of dentofacial deformities
  • Orthodontic preparations before and after surgery
  • Follow up
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8
Q

importance of dx and tx planning for orthognathic surgery

A

The correct dx

The combined orthodontic and surgical approaches 90% of time (coordinate)
* Prediction planning

Pt needs to like the face – cannot undo surgery

Surgical correction isn’t reversible

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9
Q

causes of facial deformities

3 categories

A

Family trait

racial characteristics

Congenital deformity (e.g. hemifacial microsomia, Treacher Colllins), trauma (could also be acromegaly if continued growth into adult)

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10
Q

history of pt should assess

A

cause of deformity

psychological motivation
dysmorphophobia
hypochonriacal neurosis

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11
Q

extra oral exam of pt for orthognathic surgery

A

Aesthetic proportions

Front
* Vertical asymmetry
* Lip and Nose morphology
* Horizontal asymmetry (Mediolateral)

Profile
Antero-posterior relationship
* Lips - Length, Competence, Muscle activity, Vermillion, Teeth rest/smiling (2mm at rest, full crown smile)
* Chin - Asymmetry, mentalis

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12
Q

front on EO assessment consists of

3

A

Vertical asymmetry
Lip and Nose morphology
Horizontal asymmetry (Mediolateral)

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13
Q

lips assessment EO

5

A

Length
Competence
Muscle activity
Vermillion
Teeth rest/smiling (2mm at rest, full crown smile)

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14
Q

chin assessment EO

2

A

asymmetry
mentalis

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15
Q

intra oral assessment for orthognathic surgery

10

A
  • General dental assessment
  • Occlusal relationship
  • Central line discrepancy relative to the face
  • The overjet (2-3mm) and overbite(3mm, cover 1/3 LI)
  • Crossbite
  • Occlusal canting tilt
  • Incisors’ inclination
  • Crowing and spacing
  • Tongue size, mobility, speech pattern
  • Cleft cases and velopharyngeal incompetence (hypernasal tone)
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16
Q

special investigations needed for orthognathic surgery

3

A

radiographs
study models (casts)
photographs (2D, 3D)

17
Q

radiographs used for orthognathic surgery

3

A

OPT
* Impacted and unerupted teeth, pathology
* trabeculation pattern of the bone

Cephalographs
* Lateral ceph. to assess jaw bones in relation the base of the skull (tracing)
* PA ceph. to assess asymmetry vert. and lat.

Periapicals
* Occlusal
* CT scanning

18
Q

how to make study models for orthognathic surgery needs

4 steps

A

impressions
face bow
wax bite
articulator mounted

19
Q

use of study models for orthognathic surgery

7

A
  • Study occlusion
  • Orthodontic analysis
  • Orthognathic surgery planning
  • Model surgery – move how you want to move pt
  • Occlusal wafer for surgery – guide surgeon
  • Assess surgical changes
  • Assess long-term stability/relapse
20
Q

5 photos types needed for orthognathic surgery pt

A
  • 2D full face at rest and smiling
  • Right and left profiles
  • Teeth in occlusion (anterior and posterior)
  • 1:1 profile photograph (photo. Montage)
  • 3D imaging for 3D soft tissue analysis following surgery – prediction planning, can get pt opinion
21
Q

possible dx that require orthognathic surgery

3 categories, 8 options

A

Maxilla abnormality
* Prognathic or retrognathic (hypoplasia)
* Vertical excess or vertical deficiency
* Narrow or wide maxilla
* Asymmetry

Mandible abnormality
* Prognathic or retrognathic
* Asymmetry

Chin
* Progenia or retrogenia
* Vertical deficiency/excess

can be any combination of these

22
Q

maxilla abnormalities that need orthognathic surgery

4

A

Prognathic or retrognathic (hypoplasia)
Vertical excess or vertical deficiency
Narrow or wide maxilla
Asymmetry

23
Q

mandibular abnormalities that need orthognathic surgery

2

A

Prognathic or retrognathic
Asymmetry

24
Q

chin abnromalities that need orthognathic surgery

2

A

progenia or retrogenia
vertical deficiency/excess

25
Q

what 3 facial areas can be abnromal to require orthognathic surgery

A

maxilla
manidble
chin

or combo

26
Q

pt options if they have an abnormality in maxilla/mandible/chin

4

A

Orthodontic treatment only
Combined ortho/surgical treatment majority - majority of cases
Surgical treatment only

do nothing

27
Q

what does combined ortho/srugical tx entail

6 possible stages

A
  • Tooth alignment, eliminating crowding, spaces, and cross bite
  • Alteration and co-ordination of the arches
  • Correction of incisors’ inclination (de-compensation)
  • Flattening the occlusal plane
  • Surgical fixation
  • Postsurgical orthodontic fine tuning
28
Q

surgical procedures for maxilla

2 classes

A

le Fort I osteotomy
* superior (too long need to move up),
* inferior (deficient and no tooth show so bring down),
* forward (deficient and behind mandible)

Anterior maxillary osteotomy
* posterior - cannot just move back like mandible due pterygoid plates

29
Q

surgical procedures for mandible

2

A

Advancement
**Sagittal split osteotomy **- ramus split from body so mandible can move forward/upward/downward/right/left

Set-back
sagittal split osteotomy,VSSO

30
Q

surgical options for chin

A

genioplasty - advancement, set-back, rotation

31
Q

what is used for orthognathic surgeries

A

usually combination of anatomical abnormalities
so Augmentation and reduction (mix of all the surgical techniques)

Set in place with plates in screws

32
Q

4 adv of surgery first approach

followed by ortho

A
  1. Reduction of the duration of the treatment
  2. Faster orthodontic tooth movement
  3. Immediate improvement in facial appearances
  4. Cost effectiveness
33
Q

describe tx carried out here

A

Le fort I maxillary osteotomy fixed in place with 4 plates

Sagittal split osteotomy fixed in place with 2 plates

Genioplasty with 1 plate

No wires needed

BDS4 CDS Oral Surgery (19 decks)

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