Orthognathic surgery Flashcards
List those involved in the multidisciplinary approach to orthognathic surgery. (8)
- Orthodontist
- Surgical
- Restorative
- technologist
- Periodontal
- Speech and language therapy e.g cleft lip and palate patient
- Psychology
- Hygienist
What is the psychologists role in orthognathic surgery? (4)
- Early recognition of psychological problems (e.g. Dysmorphophobia & Neurosis)
- understand the patients real motivation for surgery (could be external e.g. from family, friends)
- Manage postsurgical depression
- Aid psychological adaptation to the new face
What is body dysmorphic disorder?
Where patient requests treatment of a non-existing deformity
List the 3 types of body dysmorphic disorder.
- Preoccupation with a minor defect causes excessive concern
- Preoccupation with a minor defect leads to significant distress
- Associated mental disorders e.g. anorexia nervosa and bulimia
What are the main characteristics of body dysmorphic disorder? (2)
- Obsession with the exaggerated defect
- Doctor shopping
what is the technologists role in orthognathic surgery? (4)
- Model/plan the surgery
- Provide occlusal wafer to guide the surgery outcomes
- Building 3D skull models
- Digital Prediction of final occlusion
= Help decide the final occlusion
what is the orthodontists role in orthognathic surgery? (3)
Early recognition of dentofacial deformities
Orthodontic preparations before and after surgery
Follow up
What causes facial deformity/need for orthognathic surgery? (3)
- Family traits and racial characteristics
- Congenital deformity e.g. hemifacial microsomia,
- Trauma that hasn’t been treated correctly
What must we examine extra-orally during patient assessment for orthognathic surgery? (6)
Aesthetic proportions;
* Vertical asymmetry
* Lip and Nose morphology
* Horizontal asymmetry
Profile:
* Antero-posterior relationship
Frontal view:
* Lips
- Length (ratio: upper 1/3rd and lower 2/3rd)
- Competence
- Muscle activity
- Vermillion
- Teeth rest (2mm shown)/smiling (full crown)
- Chin
- Asymmetry
- Mentalis competency
What must we examine intra-orally during patient assessment for orthognathic surgery? (10)
- General dental assessment
- Occlusal relationship
- Central line discrepancy relative to the face
- The overjet and overbite
- Crossbite
- Occlusal canting (tilt)
- Incisors’ inclination
- Crowing and spacing
- Tongue size, mobility, speech pattern
- Cleft cases and velopharyngeal incompetence (short soft palate)
what radiographic imaging do all patient require before orthognathic surgery?
CBCT
What do study models facilitate in terms of orthognathic surgery? (6)
- Study occlusion
- Orthodontic analysis
- Orthognathic surgery planning
- Model surgery
- Assess surgical changes
- Assess long-term stability/relapse
- Occlusal wafer for surgery
Describe the importance of the wax wafer in orthognathic surgery.
Plan the surgery on the study models, study models produce the occlusal wafer, occlusal wafer used in surgery to guide the changes, once jaws in correct new position (using the wax wafer as a guide) they are fixed with plates and screws etc.
What is stereophotogrammetry?
What is the advantage of using this? (2)
3D imaging
- Allows surgeon to have a 3D copy of the patients head for surgery planning and prediction planning.
- Can show patient the final outcomes before surgery is carried out.
List the possible maxillary diagnoses seen in patient assessment before orthognathic surgery. (7)
- Prognathic (anterognathic)
- Retrognathic (hypoplasia)
- Vertical excess (lots of gingival show when smiling)
- Vertical deficiency
- Narrow
- Wide
- Perfect position however Asymmetric
List the possible mandibular diagnoses seen in patient assessment before orthognathic surgery. (3)
- Prognathic
- Retrognathic
- Perfect position however Asymmetric
List the possible diagnoses in relation to the chin seen in patient assessment before orthognathic surgery. (4)
- Progenia
- Retrogenia
- Vertical deficiency
- vertical excess
Whats involved in the orthodontic treatment alongside orthognathic surgery? (6)
- Improve Tooth alignment, eliminating crowding, spaces, and cross bites
-Alteration and co-ordination of the arches
-Correction of incisors’ inclination (de-compensation)
-Flattening the occlusal plane
-Can apply ortho appliances (brackets etc) which can help with Surgical fixation
- Postsurgical orthodontic fine tuning
List and describe examples of maxillary surgical procedures. (2)
which is the most commonly done?
Le Fort I osteotomy (most common)
- Cut the maxilla from the base of the skull and move it in any direction
- Anterior maxillary osteotomy
- Can’t move the whole maxilla back because of the pterygoid plates, only the anterior part is moved back
List and describe an example of a mandibular surgical procedures.
- Advancement = Sagittal split mandibular osteotomy
- Ramus is split from the body to allow the anterior part of the (body and the dentition) mandible to move in any direction.
List types of genioplasty surgical procedures. (5)
- Advancement, set-back, rotation, Augmentation, reduction
When is a superior le fort 1 maxillary osteotomy carried out?
used when maxilla too long
When is an inferior le fort 1 maxillary osteotomy carried out?
used when maxilla is deficient and px doesn’t show any teeth when smiling
When is a forward le fort 1 maxillary osteotomy carried out?
used when maxilla is deficient
What are the advantages of using surgery as a first approach? (4)
- Reduction of the duration of the treatment
- Faster orthodontic tooth movement
- Immediate improvement in facial appearances
- Cost effectiveness
