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xD3 Oral Surgery Ex 3 > Orthognathic Surgery (Strauss) > Flashcards

Orthognathic Surgery (Strauss) Flashcards

1
Q

What includes surgically created, controlled facial bone fractures?

A

Orthognathic surgery

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2
Q

What are the goals of orthognathic surgery?

A
  1. Restoration of occlusal and masticatory harmony
  2. Improved facial appearance
  3. Maintain, restore or establish joint function
  4. Improve psych outlook
  5. Improve airway
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3
Q

What is the most important goal of orthognathic surgery?

A

Achieve facial balance symmetry

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4
Q

What is the highest malocclusion type in the US?

A

Severe crowding

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5
Q

What is the normal growth direction pattern for the maxilla and mandible?

A

Down and forward

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6
Q

Which completes growth first: mandible or maxilla?

A

Maxilla (age 12)

Mandible (>age 16)

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7
Q

Why is knowing the maxilla starts growing first a consideration in orthognathic surgery?

A

Can do distraction osteogenesis during growth to maxilla to attempt to avoid surgery

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8
Q

More than ___ mm overjet in either direction is considered abnormal.

A

2mm

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9
Q

Knowing the maxilla is almost fully grown by age 12 and the mandible after age 16 is important when considering what pathology

A

Hyperplasia

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10
Q

What are 3 things to evaluate on the face when considering orthognathic surgery?

A
  1. Form
  2. Balance
  3. Symmetry
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11
Q

What is the fraction for symmetry when viewing a patient from left to right/from ear to ear?

A

1/5

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12
Q

What is the fraction for symmetry when viewing the patient from the side?

A

1/3

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13
Q

What must be done prior to orthognathic surgery?

A
  1. Level and align the arches

2. Resolve crowding or spacing issues

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14
Q

What method can be used to determine spacing and crowding issues?

A

Bolton analysis “determines the ratio of the mesiodistal widths of the maxillary versus the mandibular teeth”

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15
Q

What is the difference between standard Bolton
space analysis and the Bolton space analysis used prior
to orthognathic surgery?

A

Standard Bolton analysis excludes 2nd molars Pre-Orthognathic Bolton analysis INCLUDES 2nd molars

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16
Q

How long must the orthodontic wire be passive after leveling and aligning prior to final orthognathic work up?

A

Approximately 4 weeks

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17
Q

What is the most unstable orthognathic treatment?

A

Widening the maxilla

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18
Q

What is the most stable orthognathic treatment?

A

Moving the maxilla up / impacting the maxilla

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19
Q

What are 3 methods to evaluate asymmetry?

A
  1. Serial exams
  2. Old photos
  3. Tc99m scintography (bone scan)
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20
Q

What functional deficits could necessitate orthognathic surgery when symmetry and such are fine?

A
  1. Airway
  2. Mastication, feeding
  3. Speech
  4. Damage to dentition
  5. TMJ disorder
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21
Q

When leveling and aligning, where is the ideal location for the teeth to be moved in the bone prior to orthognathic surgery?

A

Into the central trough of bone

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22
Q

What are 4 etiologies for functional deficits requiring orthognathic surgery?

A
  1. Trauma
  2. Genetics
  3. Muscular disturbances
  4. Environmental
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23
Q

There is a _______ component to mandibular and maxillary prognathism

A

Genetic

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24
Q

What is another term for long face syndrome and what is a concern with it?

A

Vertical maxillary hyperplasia. Airway problems and a possible anterior open bite and Class II or Class III occlusion

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25
Q

Mandibular hypoplasia is more commonly found in European nobility or in Stickler’s syndrome?

A

Stickler’s (also Pierre Robin’s Sequence)

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26
Q

Why is it important to determine the etiology of airway problems prior to doing orthognathic surgery?

A

if you do not address the cause of the airway problem and do orthognathic surgery, the airway problem will relapse

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27
Q

How can a nasal obstruction (Choanal atresia, large adenoids, or tonsil problems) lead to a lower airway obstruction?

A

Nasal obstruction leads to open mouth posture and a vertical growth of the maxilla leading to the mandible repositioning posteriorly causing a lower airway obstruction

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28
Q

Difficulty chewing, speech problems, lower incisors supererupting over time, underbite, and a large lower jaw with a small upper jaw are all types of what type of deformities?

A

Class III deformities

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29
Q

What are the anatomical locations for a Le Fort I osteotomy?

A
  1. Above the palatal plane
  2. Below the interior turbinate
  3. 4mm above the roots
  4. Avoid the pterygomandibular fissure
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30
Q

Why is the pterygomaxillary fissure to be avoided in a Le Fort I osteotomy?

A

It is near the internal maxillary artery (within 10mm)

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31
Q

What must the maxilla remain attached to and why during a Le Fort I osteotomy?

A

Attached to soft tissue for blood supply

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32
Q

What are 2 general regions for the blood supply to the down-fractured maxilla in a Le Fort I osteotomy?

A
  1. Buccal pedicle mucosa from 1st molar to tuberosity

2. Palate

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33
Q

What are 2 arteries that supply blood to the down-fractured maxilla in a Le Fort 1 osteotomy

A
  1. Ascending pharyngeal artery

2. Descending palatine artery

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34
Q

Of the 2 arteries supplying blood to the down-fractuered maxilla in a Le Fort I osteotomy, which one can be cut if need be?

A

Descending palatine artery (Dr Lui emphasized that this is one to be concerned with)

35
Q

What are the gingival disorders in vertical maxillary hyperplasia secondary to?

A

Secondary to air exposure

36
Q

What are 2 arteries to be concerned with in Le Fort I osteotomy?

A
  1. Internal maxillary artery

2. Descending palatine artery

37
Q

What is an esthetic concern for the mandible if you intrude the maxilla in orthognathic surgery

A

The chin will rotate down and forward, therefore you should consider genioplasty

38
Q

What are 2 major mandibular surgeries?

A
  1. Bilateral sagittal split osteotmy (BSSO)

2. Intraoral Vertical Ramus Osteotomy (IVRO)

39
Q

Where is the osteotomy for the intramural vertical ramus osteotomy?

A

Behind the lingual, you should approach from the lateral

40
Q

Is the intramural vertical rams osteotomy indicated for mandibular advancement?

A

No

41
Q

Which Le Fort is below the maxillary buttress down to the Pterygomaxillary junction, but inferior and medial to the infraorbital foramen?

A

Le Fort II osteotomy

42
Q

What is an indication for Le Fort II osteotomy?

A
  1. Maxillary deficiency

2. Nasal deficiency

43
Q

What must be avoided when doing a Le Fort II osteotomy?

A

Medial tendon to the eyeball

44
Q

A patient with a depressed nasal bridge would be a candidate for what osteotomy?

A

Le Fort II

45
Q

Which Le Fort osteotmy is done between the medial canthal ligament and anterior to the ethmoid artery, and inferior to the orbital fissure?

A

Le Fort III osteotomy

46
Q

What is another name for a Le Fort III osteotomy?

A

Craniofacial disjunction

47
Q

What are 3 indications for Le Fort III?

A
  1. Craniofacial Synostosis
  2. Maxillary / zygomatic / nasal hypoplasia
  3. Syndromes
48
Q

A Le Fort III can be combined with what in order to do immediate advancement instead of waiting on distraction osteogenesis?

A

Le Fort I

49
Q

What causes craniofacial synostosis that can be corrected with Le Fort III and Le Fort I surgery?

A

Early fusion of cranial sutures

50
Q

What type of incision is done for Le Fort III?

A

Coronal incision

51
Q

A patient with Crouzon’s syndrome (Class III occlusion, bulging eyes) would benefit from what surgery

A

Le Fort III / Le Fort I / genioplasty

52
Q

A patient with mandibular hypoplasia, either deficiency or retrusion, a deep bite occluding on palate, or an open bite ,having airway problems and difficulty chewing has what class deformities?

A

Class II

53
Q

A Class II deformity can be corrected with what procedure?

A

BSSO

54
Q

How many sections are in a BSSO?

A

Two. one stays with TMJ, one is moved

55
Q

Which segment goes the IAN go with in the BSSO, the second attached to the TMJ or the dentate section?

A

Dentate section

56
Q

The function of the face is what?

A

To look normal

57
Q

What determines the surgery in orthognathic surgery?

A

Diagnosis and etiology of what is indicating surgery (e.g. asymmetry, airway problem, function, etc)

58
Q

What are 4 reasons a history and physical are done prior to orthognathic surgery?

A
  1. Determine cause of deformity
  2. Determine type of deformity
  3. Determine clinical effects
  4. Determine anesthesia suitability
59
Q

What is the goal of pre-surgery orthodontics?

A

To decompensate (leve, align, coordinate, close space)

60
Q

What are 3 reasons to do model surgery prior to orthognathic surgery?

A
  1. Determine feasibility of surgery
  2. Determine the extent of moves
  3. Provide splint
61
Q

When is an indication for a total mandibular sub apical surgery?

A

The patient has severe dental deformity, but the bone is good

62
Q

What are physical exam findings that would indicate a BSSO?

A
  1. Overly convex face
  2. Retruded chin
  3. Procumbent lip
  4. Increased mentolabial fold
  5. Poor throat form
  6. Flat or high mandibular plane
63
Q

What is the most common osteotomy in the US?

A

BSSO

64
Q

Can BSSO be used for mandibular advancement as well as mandibular setback?

A

Yes

65
Q

When doing a BSSO what is dissected down to and what cut is made where?

A

Dissect to identify the lingual, then cut ramus horizontally above and behind the lingual

66
Q

Why are shorter screws and plates used for the rigid fixation of the BSSO?

A

Decrease the risk of hitting the IAN

67
Q

What are 7 complications of BSSO?

A
  1. V3 injury
  2. Poor split
  3. Condylar fracture
  4. Ramus fracture
  5. Mal-union
  6. Bleeding
  7. TMJ dysfunction
68
Q

What are orthognathic surgeries internal to the jaw rather than the entire bone and can be done in the anterior or posterior maxilla, or the anterior mandible, to move in any direction (can have a single tooth osteotomy)?

A

Segmental surgery

69
Q

Which Le Fort osteotomy is indicated to correct both maxillary excess and maxillary deficiency, correct vertical or horizontal symmetry problems, correct transverse issues, or for cosmetics?

A

Le Fort I

70
Q

What are 5 phases of distraction osteogenesis?

A
  1. Osteotomy
  2. Latency
  3. Distraction
  4. Consolidation
  5. Remodeling
71
Q

When does gradual traction work during fracture healing for distraction osteogenesis?

A

Between soft callus and hard callus formation

72
Q

In what 3 areas of the face can distraction osteogenesis be performed?

A
  1. Midline
  2. Ramus
  3. Vertical
73
Q

Which Le Fort osteotomy is indicated for maxillary deficiency?

A

Le Fort II

74
Q

Orthognathic surgery is what type of fracture?

A

Controlled fracture

75
Q

When doing the lateral sinus wall section in the Le Fort II osteotomy, what must be maintained and watched out for?

A

Descending palatine artery

76
Q

What percentage of V3 injuries are permanent?

A

1%

77
Q

What is the main complication of BSSO surgery?

A

V3 injury

78
Q

What is the most common orthognathic surgery procedure?

A

Mandibular advancement (the most common of which is BSSO)

79
Q

Is rigid fixation easy with BSSO?

A

Yes

80
Q

What are 4 ways to achieve rigid fixation with BSSO?

A
  1. Wire osteo-synthesis and IMF
  2. Position screw osteosynthesis
  3. Lag screw osteosynthesis
  4. Bone plate fixation
81
Q

What are some complications of BSSO?

A
  1. V3 injury
  2. Poor split
  3. Condylar fracture
  4. Ramus fracture
  5. Mal-union
  6. Bleeding
  7. TMJ dysfunction
82
Q

Does a mandibular setback have a higher or a lower likelihood of nerve damage (than BSSO, I guess)?

A

Lower likelihood of nerve damage

83
Q

What should you beware of when you see a patient in the dental clinic after orthognathic surgery?

A
  1. Neurosensory disturbance of V2 (maxillary surgery) and V3 (mandibular surgery) distribution
  2. Presence and location of internal fixation hardware
  3. Postoperative orthodontic treatment
84
Q

What 3 places can distraction osteogenesis be performed?

A
  1. Midline
  2. Ramus
  3. Vertical

xD3 Oral Surgery Ex 3 (4 decks)

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