Orthognathic Surgery Seminar 6 Final
Orthognathic Surgery Seminar 6 Final
Orthognathic Surgery Seminar 6 Final
PLANNING IN
ORTHOGNATHIC SURGERY
PRESENTED BYNIKHIL SRIVASTAVA
MODERATED BYDr. DEEPIKA KENKERE
Contents
Introduction
Development of orthognathic surgery
Timing of treatment
Envelope of discrepancy
Treatment objectives
Indications
Contraindications
Systematic Clinical Patient evaluation
Radiographic evaluation
Visualised Treatment Objective
Model surgery
Phases of orthognathic surgery
Orthognathic Procedures
Conclusion
INTRODUCTION
ORTHOGNATHIC SURGERY is the art and
science of diagnosis treatment planning and
execution of treatment by combining
orthodontics and oral and maxillofacial
surgery to correct musculoskeletal, dento
osseous and soft tissue deformity of the jaws
and associated structures .
DEVELOPMENT OF ORTHOGNATHIC
SURGERY
Hullihen in 1849 was the first to perform osteotomy on the
MODE OF TREATMENT
Growth Modification
Orthodontic Camouflage
Orthognathic Surgery
ENVELOPE OF
DISCREPANCY
Proffit and Ackerman have described the process
ENVELOPE OF
DISCREPANCY
The inner circle, or envelope, represents the limitations of
correction.
Envelope of discrepancy
10
6
4
10
12
15
2
5
15
10
Envelope of discrepancy
10
6
4
3
12 10
15
5
25
TIMING OF SURGERY
There is a definitive sequence in which growth is completed in
TREATMENT OBJECTIVES
Three treatment objectives are fundamental
in orthognathic surgery:
1.Function
2.Esthetics
3.Stability
These three objectives form the basis of goals
in treating patients with dentofacial deformities
and often go hand in hand.
INDICATIONS
Generally ,those deformities in patients which
CONTRAINDICATIONS
Mild to moderate discrepancies
Growing children
Uncontrolled systemic conditions
Psychological state of the patient
Uncontrolled pathologic conditions
Systematic patient
evaluation
1. ESSENTIAL PATIENT EVALUATIONS
2.ADJUNCTIVE EVALUATIONS.
SOCIOPSYCHOLOGIC EVALUATION:
It is important to consider patients motives for
treatment and to determine the patients
expectations from treatment.
There are mainly 2 causes for the patients
dissatisfaction
1. Failure of clinician to inform the patient
clearly of realistic and probable treatment
results( specially esthetic results)
2. Overoptimistic expectations of the patient
regarding the results of the treatment
FRONTAL ANALYSIS:
FACIAL TYPES
TRANSVERSE
DIMENSIONS:
Rule of fifths (Sarver)
Face is divided into five
equal
parts from helix to helix of
outer ear.
Symmetry
Symmetry checked in
relation to facial midline
formed by glabella, nasal
bridge, nasal tip,
philtrum, dental midline
and midpoint of chin.
Vertical relationship
In middle third
Nasal
projection
The nasal projection measured
horizontally from subnasale to
nasal tip is normally 16 to20mm ,
. Nasal projection is an indicator of
maxillary antero posterior position.
This length becomes particularly
important when planning for
anterior movement of maxilla.
Orbital rim
The orbital rim is an anteroposterior indicator of
maxillary position.
Deficient orbital rims may
correlate positionally with a
retruded maxillary position
because the osseous structures
are often deficient as groups
,rather than in isolation.
The Eye globe normally is
positioned 2-4mm anterior to
the orbital rim.
Radiographic Evaluation
LATERAL CEPHALOMETRIC EVALUATION:
LIP PROMINENCE
SKELETAL ANALYSIS
MEASUREME
NT
FEMALES
MALES
32.1mm
37.1mm
Ptm-N (11HP)
50.9mm
52.8mm
N-A-Pog ang
2.6
3.9
-2 3.7mm 0.0
3.7mm
-6.9
4.3mm
-5.3
6.7mm
N-Pg (11HP)
-6.5
5.1mm
-4.3
8.5mm
N-ANS (L HP)
50
2.4mm
54
3.2mm
ANS-Gn (L HP)
61.3
3.3mm
68.63.8
mm
CRANIAL BASE
HORIZONTAL
VERTICAL
MAXILLA
&
MANDIBL
E
FEMALE
MALE
PNS-ANS
(11HP)
52.5
3.5mm
57.5
2.5mm
Ar-Go
(linear)
46.8
2.5mm
52
4.2mm
Go-Pg
(linear)
74.3
5.8mm
83.7
4.6mm
B-Pg
(11MP)
7.2
1.9mm
8.9
1.7mm
Ar-Go-Gn
(angle)
122 6.9
119 6.5
7.1 2.5
6.1 5.1
DENTAL
OP upperHP (angle)
-1.1 2
POSTEROANTERIOR CEPHALOMETRIC
ANALYSIS:
DEVELOPMENT OF VISUAL
TREATMENT OBJECTIVES.
Accurate and realistic visual treatment objectives are
ORTHODONTIC PREDICTION
TRACING
Correct planning of orthodontic tooth
in black .
Draw ideal facial depth
angle (Between line
passing through N to pt
A & FH plane: 90 deg)
Draw ideal facial
contour angle (between
upper facial plane and
lower facial plane: -11
to -15 deg)
spee
occlusal plane
MODEL SURGERY
The primary goal of the model surgery is to
lefort I
Draw 2 horizontal lines, one line 5mm above the
osteotomy line and one line 5mm below it( 10mm total
between lines) this is done because the lateral walls of
the maxilla are not parallel and taper downword.
Draw vertical lines from the buccal cusps of the teeth
to the base of the cast.
Measure the length of vertical lines and record the
data.
Cut the cast along the osteotomy line.
PHASES OF ORTHOGNATHIC
SURGERY
The complete treatment protocol in
Time
required
Comments
1. Presurgical
orthodontics
918months
2. Surgery
/hospitalization
1-5days
3. Patient under
surgeons care before
beginning
postsurgical
orthodontics
3-8 weeks
4. Postsurgical
orthodontics
Effects
Widens nasal base
Highlights Para nasal areas
Reduces nasal prominence
Highlights upper lip
Shades the chin
Maxillary setback
Mandibular
advancement
Mandibular setback
Data base
(case history, patient examination,
Radiographic and model analysis)
Execution of treatment
MANDIBLE
Ramus osteotomies
Oblique subcondylar osteotomy
The vertical subsigmoid osteotomy
The sagittal split and its modifications
The inverted L and C osteotomies of the ramus
Condylectomy
MAXILLA
1. Lefort I
2.lefort II
3. lefort III
4. Segmental osteotomy
Surgical Techniques
BSSO
Genioplasty
Surgical Techniques
Le Fort I
Le Fort II
Le Fort III
Le Fort III
Le Fort II
Le Fort I
CONCLUSION
Orthognathic surgery has created vast and
REFERENCES
Essentials Of Orthognathic Surgery Johan P.
Reyneke
Orthodontics & Orthognathic Surgery :
Diagnosis & Treatment Planning-Jorge
Gregoret
Maxillofacial Surgery- Peter Ward Booth
Petersons Principles of Oral and Maxillofacial
Surgery
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