Orthognathic surgery); also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and face related to. Faculty of Dental Medicine Al-Azhar UniversityOrthognathic surgery is the Bilateral sagittal split osteotomy (BSSO) has a wide range of. Mandibular osteotomies in Orthognathic Surgery Mandibular Recently good stability after BSSO is also shown by polylactate bone plates and.
Originally coined by Harold Hargis, this surgery is also used to treat congenital conditions such as cleft palate. The word “osteotomy” means the division, or excision of bone. The dental osteotomy allows surgeons to visualize the jawbone, and work accordingly. Many surgeons prefer this procedure for the correction of a dentofacial deformity due to its effectiveness.
A disproportionately grown upper or lower jaw causes dentofacial deformities. Chewing becomes problematic, and may also cause pain due to straining of the jaw muscle and bone. Deformities range from micrognathiawhich is when the mandible doesn’t grow far forward enough over biteand when the mandible grows too much, causing an under bite; all of which are uncomfortable. Also, a total maxilla osteotomy is used to treat the “long face syndrome,” known as the skeptical open bite, idiopathic long face, hyper divergent face, total maxillary alveolar hyperplasia, and vertical maxillary excess.
Prior to surgery, surgeons should take x-rays of the patient’s jaw to determine the deformityand to make a plan of procedures.
Orthognathic surgery is a well established and widely used treatment option for insufficient growth of the maxilla in patients with an orofacial cleft. A potentially significant long-term outcome of orthognathic surgery is impaired maxillary growth, due to scar tissue formation.
Although infrequent, there can be complications such as bleeding, swelling, infection, nausea and vomiting. There can also be some post operative facial numbness due to nerve damage. The numbness may be either temporary, or more rarely, permanent.
Bilateral Sagittal Split Osteotomy
Orthognathic surgery is performed by an oral and maxillofacial surgeon in collaboration with an orthodontist. It often includes braces before and after surgert, and retainers after the final removal of braces. Orthognathic surgery is often needed after reconstruction of cleft palate or other major craniofacial anomalies. Careful coordination between the surgeon and orthodontist is essential to ensure surger the teeth bssoo fit correctly after the surgery.
Planning for the surgery usually involves input from a multidisciplinary team, including oral and maxillofacial surgeons, orthodontists, and occasionally a speech and language therapist. Although it depends on the reason for surgery, working with a speech and language therapist in advance can help minimize potential relapse.
The surgery usually results in a noticeable change in the patient’s face; a psychological assessment is occasionally required to assess patient’s need for surgery and its predicted sudgery on the patient. Radiographs and photographs are surfery to help in the planning. There is also advanced software that can predict the shape of the patient’s face after surgery,   which is useful for the planning and also explaining the surgery to the patient and the patient’s family.
The main goals of orthognathic surgery are to achieve a correct bite, an aesthetic face, and an enlarged airway. While correcting the bite is important, if the face is not considered, the resulting bone changes might lead to an unaesthetic result. All dentofacial osteotomies are performed under general anesthesiacausing total unconsciousness. General anesthesia allows surgeons to perform dentofacial osteotomies effectively without involuntary muscle movement or complaints about minor pain.
Prior to any Osteotomy, third molars wisdom teeth are extracted to reduce the chance of infection. Dentofacial osteotomy is usually performed using oscillating and reciprocating saws, burs, and manual chisels. Reciprocating saws are straight and are used for making straight bone cuts. Oscillating saws are angled, to different degrees, in order to make deep curved cuts suggery certain osteotomies like mandible angle reduction.
The recent advent of piezoelectric saws has simplified bone cutting, but such equipment has not yet become the norm outside of the most developed countries. The bswo might involve one jaw or both jaws cuncurrently. This surgery is usually performed with the use of general anaesthetic and a nasal tube for intubation.
The nasal tube enables the teeth to be wired together during surgery. The surgery usually does not involve cutting the skin. Instead, the surgeon is often able to go through the interior of the mouth. Cutting one bone is known as an osteotomywhile performing the surgery on both jaws simultaneously is known as a bi-maxillary osteotomy cutting the bone of both jaws or a maxillomandibular advancement.
The maxilla can be adjusted using a ” Lefort I ” level osteotomy most common. These techniques are utilized extensively for children that suffer from various craniofacial abnormalities, such as Crouzon syndrome.
The jaws will be wired together inter-maxillary fixation using stainless steel wires during the surgery to ensure the correct re-positioning of the bones. In most cases, these wires are released before the patient wakes up. However, some surgeons prefer to wire the jaws shut instead. In some instances, the change in jaw structure will cause the cheeks to become depressed and shallow.
Some procedures will call for the insertion of implants to give the patient’s face a fuller look. This procedure is intended for patients with an upper jaw deformity, or with an open bite. Operating on the upper jaw requires surgeons to make incisions below both eye sockets, making it a bilateral osteotomy, enabling the whole upper jaw, along with the roof of the mouth and upper teeth, to move as one unit.
At this time, the upper jaw can be moved and aligned correctly in order to fit the upper sufgery in place with the lower teeth. Then, the jaw is stabilized using titanium screws that will eventually be grown over by bone, surgeyr staying in the mouth. The mandible osteotomy is intended for those with a receded mandible lower jaw or an open bite, which may cause difficulty chewing and jaw pain. For this procedure cuts are made behind the molarsin between the first and second molarsand lengthwise, detaching the front of the jaw so the palate including the suryery and all can move as one unit.
From here, the surgeon can smoothly slide the mandible into its new position. Stabilization screws are used to support the jaw until the healing process is done. This procedure is used to correct mandible retrusion and mandibular prognathism over and under bite. First, a horizontal cut is made on the inner side of the ramus mandibulaeextending anterally to the anterior portion of the ascending ramus. The cut is then made inferiorly on the ascending ramus to the descending ramusextending to the lateral border of the mandible in the area between the first and second molar.
Surgfry this time, a vertical cut is made extending inferior to the body of the mandibleto the inferior border of the mandible. All cuts are made into the middle of the bone, where bone marrow is present. Then, a chisel is inserted into the pre existing cuts and tapped gently in all areas to split the mandible of the left and right side. From here, the mandible can be moved either forwards or backwards.
If sliding backwards, the distal segment must be trimmed to provide room in order to slide the mandible backwards.
Lastly, the jaw is stabilized using stabilizing screws that are inserted bswo. The jaw is then wired shut for approximately 4—5 weeks. This procedure is used for the advancement movement srugery or retraction movement backwards of the chin. First, incisions are made from the first bicuspid to the first bicuspidexposing the mandible. Then, soft tissue of the mandible is detached from the bone; done by stripping attaching tissues.
Bso horizontal incision is then made inferior to the first bicuspidsbilaterally, where bone cuts osteotomies are made vertically inferior, extending to the inferior border of the mandiblethereby detaching the bony segments of the mandible.
The bony segments are stabilized with titanium plates; no fixation binding of the jaw necessary. If advancement is indicated for the chin, there are inert products available to implant onto the mandible, utilizing titanium screws, bypassing bone cuts.
When a patient has a constricted oval shape maxillabut normal mandiblemany orthodontists request a rapid palatal expansion.
This consists of the surgeon making horizontal cuts on the lateral board of the maxillaextending anterally to the inferior border of the nasal cavity. At this time, a chisel designed for the nasal septum is utilized to detach the maxilla from the cranial base.
Then, a pterygoid chisel, which is a curved chisel, is used on the left and right side of the sbso to detach the pterygoid palates. Care must be taken as to not injure the inferior palatine artery.
Prior to the procedure, the orthodontist has an orthopedic appliance attached to the maxilla teeth, bilaterally, extending over the palate with an attachment so the surgeon may use a hex-like screw to place into the device to push from anterior to posterior to start spreading the bony segments.
Beso orthognathic surgery, patients are often required to adhere to an all-liquid diet for a time. Weight loss suggery to surhery of appetite and the liquid diet is common.
Normal recovery time can range from a few weeks for minor surgery, to up to a year for more complicated surgery. For some surgeries, pain may be minimal due to minor nerve damage and lack of feeling.
Doctors will prescribe pain medication and prophylactic antibiotics to the patient. There is often a large amount of swelling around the jaw area, and in some cases bruising.
Most of the swelling will disappear in the first few weeks, but some may remain for a few months. All dentofacial osteotomies require an initial healing time of 2—6 weeks with secondary healing complete bony union and bone bso taking an additional 2—4 months.
If the jaw is sometimes immobilized movement restricted by wires or elastics for approximately 1—4 weeks. However, the jaw will still surhery two to three months for proper healing. Lastly, if screws were inserted in the jaw, bone will typically grow over them during the two to three month healing period. Patients also may not drive or operate vehicles or large machinery during the consumption of painkillers, which are typically taken for six to eight days after the surgery, depending on the pain experienced.
Immediately after surgery, patients must adhere to certain infection preventing instructions surger as daily cleaning, and the consumption of antibiotics.
Cleaning of the mouth should always be done regardless of surgery to ensure healthy, strong teeth. Mandible and maxilla osteotomies date to the s. They were used to correct dentofacial deformities like a malocclusionand a prognathism. Inmandible and maxilla osteotomies were effectively used to correct more extreme deformities like receding chins, and to relieve pain from temporomandibular joint disorder TMJ.
Prior tosome patients undergoing a dentofacial osteotomy still had third molars wisdom teethand had them removed during surgery. An extensive study done by Dr. M Lacy and Dr. R Colcleugh, was used to identify threats of combining the two surgeries used 83 patients from the time span of and Patients were reviewed, and divided into two groups; those who had, and those who sutgery have their third molars extracted during the dentofacial Osteotomy.
The data indicated that getting the osteotomy and the third molar extraction at the same time highly increases the chances of infection development. Advances in the surgical techniques allow surgeons to perform the surgery under local anesthesia with assistance from surgerry sedation.
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