Orthognathic surgery

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• Orthognathic surgery

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• 1958? 8?29??????????(Indiana) ???(Gary),??????????
  ???????,??????????Jackson 5 (??????)??,????????,??
  ???????????,?????????,???????????????

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• ?1985???,???20??????????????,?????????,???????????
  

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• ??45??????????????2????,?????,????????????????,???
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• ?????
• (Plastic surgery)
• ?????(Orthognathic surgery)

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Causes of dentofacial deformity

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Differential Growth of the Head and Body
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• Jaw discrepancies interfere with the proper
  alignment of the teeth, and may also affect
  speech articulation, breathing, chewing ability,
  and comfortable closure of the lips.

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• Jaw surgery is performed in tandem with
  orthodontic treatment so that both the jaws and
  teeth are correctly positioned for proper
  occlusion (bite) and an improved facial
  appearance.

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General principles of facial growth

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• ????????(suture complex)?????(apposition)???????
• ??(suture)????zygomaticomaxillary
  suture?frontomaxillary suture?zygomaticotemporal
  suture ??pteryopalatine suture

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????????

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• ???????(growth sites)??condyle?mandibular
  body?mandibular angle?coronoid process?dentoalveol
  ar process ? periosteal

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Genetic and environment influence

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????? ( prognathism )

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• 1973?????????????????
• (1)75???????????????(occlusal disharmony)
• (2)37???????????(malalignment of teeth)
• (3) ??????(Angle class III)?????????5

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• 1982??????????????????????????
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• (2)?10??????????,???????,
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• Hunter The heritability of attained growth in
  the human face.
• Am J Orthod 1970 58 128-134.
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  ????,???????????????

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• Nakasima Hereditary factors in the craniofacial
  morphology of Angles Class II and Class III
  malocclusion.
• Am J Orthod 1982 82 150-156.
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????????????????

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• ??????????????????????,nasolabial
  angle???(acute),?labiomental fold????????

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• ?????????????????????,??????????????(reverse
  horizontal overlap)?
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• ???????????class III ????????, ????????????????
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Orthognathic surgery

• Treats and corrects abnormalities of the facial
  bones, specifically the jaws and the teeth.
• Often, these abnormalities cause difficulty
  associated with chewing, talking, sleeping and
  other routine activities.

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Orthognathic surgery

• Corrects these problems and, in conjunction with
  orthodontic treatment, will improve the overall
  appearance of the facial profile.

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• ???????????
• (1) Eliminating or reducing dental
• compensation for the skeletal deformity
• (2) Obtaining alignment of teeth and
• establishing anteroposterior incisor
• position
• (3) Obtaining reasonable arch compatility

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Evaluation of patients with dentofacial deformity

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Presurgical orthodontic consideration

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Objectives of orthodontic treatment

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Indicate a need for orthognathic surgery

• Difficulty chewing or biting food
• Open bite
• Unbalanced facial appearance
• Facial injury or birth defects
• Receding chin, Protruding jaw
• Sleep apnea (breathing problems when sleeping
  such as snoring, difficulty breathing, etc.)

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Common Types Of Orthognathic Deformities

• Apertognathia, or "Open Bite
• Retrognathia
• Prognathia "

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Apertognathia, or "Open Bite
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• An "open bite" exists if thereis space between
  the upperand lower teeth when themouth is
  closed.

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Maxillary excess

• Facial skeleton grows long (vertically)
• "gummy smile"
• A deficient (small) lower jaw and a long and
  retruded chin.
• presence of blocked nasal airflow and a
  mouth-breathing (respiratory) habit that is
  ongoing during childhood

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Maxillary excess
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Apertognathia, or "Open Bite
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Retrognathia or "Over Bite
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Retrognathia

• With diminished forward projection of the lower
  face, there is loss of support for the overlying
  soft tissues of the cheeks, neck and chin. This
  results in an obtuse (flat) neck-chin angle, with
  submental fullness (double chin)
• .

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ASO(ant. Subapical osteotomy)
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Mandibular deficiency
                                    
                                    
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Retrognathia or "Over Bite
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Prognathia

• lower jaw is overdevelopedand protrudes out
  beyond the upper jaw.

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?????????????

• ??????????(extraoral approach),??????????(intraora
  l approach),???????????????????( sagittal split
  ramus osteotomy,SSRO ) ????????????( intraoral
  vertical ramus osteotomy, IVRO )?

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• (7) ????????,?????????
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• (10) ????????????
• (11) ???????????,??????????????

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• (12)??????????????, ???????,????????????????????
• (13) ??????????????
• (14) ?????????????????
• (15) ????(double jaw)?????????????
• (16) ????????????????????????

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• (1) ???????
• (2) ??????????
• (3) ?????????????????,???????????????(shift)
• (4) ??????????????

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Prognathia????????
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• (2)????????????????,?????????(rigid or
  semirigid)???,?????????
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• (1) ????????????????
• (2) ????????
• (3) ??????????????
• (4) ??????????,????????,???????????????(elastic
  band ),??????????

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Mandibular excess

• mandibular excess (prognathism), emphasis should
  be given to the overall appearance of the face
  with less concern about specific ceph-alometric
  (x-ray) measurements.

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Mandibular excess

• The orthodontist's goal will be to remove all
  dental compensations (poor positioning of the
  teeth) while the surgeon's objective is to
  reposition the jaws to achieve a functional
  occlusion and to enhance facial aesthetics.

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Mandibular excess


                                                       
                                                       
                                                       
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Asymmetric Mandibular Prognathism

• The extent of deformity will be dependent on the
  timing of the unilateral (one sided) condylar
  overgrowth in relation to any further (residual)
  growth of the facial bones.

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Asymmetric Mandibular Prognathism
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Genioplasty
 
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Segment osteotomy
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