Orthognathic surgery

Question 1

What is orthognathic surgery?

Answer 1

Surgery that aims to position the jaw bones in their ideal position to each other and to the skull base as would happen in an ideal growth pattern.

It should result in facial harmony, facial attractiveness and improved oro-facial functions: biting, chewing, speech, breathing and facial expressions.

Cases are planned with an Orthodontist who treats the frequent malocclusion present in such a way that the dental occlusion will be correct following the surgical procedure.

Question 2

What is the typical orthognathic treatment plan?

Answer 2

1. OHI
2. Dental restorative work
3. Surgery
4. Orthodontic therapy for 18 months where you look at the level occlusal plane curve, align and decompensate
5. Finishing orthodontic therapy

Question 3

What are the steps that lead to coming up with a treatment plan?

Answer 3

1. Initial visit
2. Joint multidisciplinary clinic
3. Records
4. Work up
5. Review options
6. Refine plan
7. Treatment plan

Question 4

What is assessed in a facial assessment?

Answer 4

• Eyeball
• Facial skeletal clinical assessment in three planes
• Cephalometrics: the analysis of the dental and skeletal relationships in the head by dentists, orthodontists, and oral and maxillofacial surgeons as a treatment planning tool.

Question 5

What is involved in the ‘big plan’?

Answer 5

• facial assessment
• facial aesthetics
• mandibular osteotomies
• facial aesthetic surgery
• craniofacial surgery
• cleft lip and palate surgery
• distraction osteogenesis

Question 6

What is Le Fort Osteotomy?

Answer 6

Le Fort osteotomy is upper jaw surgery that involves sectioning and repositioning the maxilla, or upper jaw, to correct its abnormal position.

There are three types of Le Fort osteotomy:

Le Fort I osteotomy:
advancement or treatment of upper jaw malocclusion and cleft palate
Le Fort II osteotomy:
treatment of upper jaw fractures
Le Fort III osteotomy:
treatment of midface problems and deficiencies

Question 7

What is Mandibular Sagittal Split Osteotomy?

Answer 7

The back of the lower jaw is split bilaterally under general anaesthetic in the region of the wisdom teeth, which are generally removed in a separate operation at least 6 months prior to corrective surgery.

The procedure is carried out in about 1.5 hours and permits the lower jaw to be advanced or pushed back with adequate bone contact for healing.

The bone is fixed in its new position by screws which are inserted through tiny external skin incisions which are located at the angle of the jaw. These heal with minimal external scarring.