ORHTOGNATIC SURGERY

INTRODUCTION
 Surgical correction of deformities
affecting the jaws & dental occlusion
 The aim: to achieve a functional
occlusion wouldn’t feasible by
orthodontics.
 Have to know what is normal
 Sistematic approach of facial
assesment:
Clinical exam. Radiograph Study models
analyisis

Problem

Diagnosis

Treatment plan
 INDICATIONS &
CONTRAINDICATION
 FUNCTIONAL ASPECT
 Mandibular prognati & open bite ant. GI
disturbance
 TMJ disturbance (Y/N)
 Speech problemspeech therapy
 Periodontal problem
 NON FUNCTIONAL
 Appearance
 POSTPONE UNTIL COMPLETE GROWTH
DIAGNOSE & Th/PLAN
 Complete anamesis
 Examination:
 Exam. EO
 Patient seated, back upright, visual axis//floor,
Facial feature assessed from in front first
 For symmetry divided into 5 portion
vertically
 In profile divided into 3.
 Diagnose & th/ plan

 Exam IO.

 Recorded:
 Opt, cephalometry, dental models
 Photographs:
 EO: full frontal, L &R profile, nasolabial
area(smiling)
 IO: frontal dental arches, R&L buccal
segmen, occlusal view
 Diagnose & th/ plan

 Hard tissue analysis

 Cephalometric:
 Maxilla to cranium
 Mandible to cranium
 Mandible to maxilla
 Facial growth
 Facial height
 Profile
 Dentoalveolar
Hard tissue analysis
Stainer analysis
Normal Normal
SNA SNB

SN/FH <7’ 82-85’ 79-83’

SN/FH 7-12’ 80-82’ 77-78’

SN/FH>12’ 76-80’ 73-76’

 Diagnose & th/ plan

 Soft tissue analysis

 Facial form
 Lipform
 ORTHOGNATIC SURGERY
TECHNIQUE
 Mandibular osteotomies
 Ramus osteotomy
 Sagital split, vertical subsigmoid, inverted L, C
osteotomy
 Body osteotomy
 One of the oldest tipe
 2 pararel osteotomi, Yshape cut, V shape cut,

trapezion design (external scar& transection

inferior alveolar nerve)
 Step cut design (mental nerve won’t disturb,

intra oral route

 ORTHOGNATIC SURGERY TECHNIQUE

 Dentoalveolar osteotomy
 Mainly indicated for hyperplasia dentoalveolus
(anteroposterior & vertical direction)
 Dental spacing will be closed

 Genioplasty
 To improve the aesthetic profile of the chin
 Has no functional rule on the occlusion

 Sliding genioplasty is common

 ORTHOGNATIC SURGERY TECHNIQUE

 Maxillary osteotomies
 Le fort I osteotomy
 Similar to the low level maxillary fracture
 It can be mobilized to any position

 Dentoalveolar osteotomy
 To correction the dentoalveolar hyperplasia in
the anterior maxilla
 3 main types:anterior down fracture, the

wunderer, wassmund osteotomy

 ORTHOGNATIC SURGERY TECHNIQUE

 High level osteotomy

 Include Le fort II, Le fort III, kufner osteotomi &
zygomatic osteotomy.
 The access: skin incision around nasal bridge, the
infra orbital or subciliary skin crease, or temporal
region.
 Corrected nasomaxillary hipoplasia infolving the
nose, medial infraorbital & maxillary occlution (Le
fort II)
 Le fort III: = Lefort II + movement of the maxillary
& nasal bone
COMPLICATIONS
 Bleeding
 The bone cut
 Damage nerve
 Repositioning
 Aseptic necrosis
CONCLUSION
 Patient > 18 yr with dentalfacial
anomali can’t treated with
orthodontic only
 Have to make a good anemesis,
recording, analysis hard & soft tissue
 Prepare the psychological aspect