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Orthognathic Surgery
What is Orthognathic Surgery?
Ortho means straighten and gnathia means jaw and hence, Orthognathic Surgery means straightening of the jaw(s) by surgery. An Oral & Maxillofacial Surgeon carries this out. It is a cosmetic surgery and the surgeon envisages changing the face of a person from distortion to proportion. Orthognathic Surgery is sometimes called “Surgical Orthodontics” because just as an orthodontist repositions the teeth with the help of braces within the oral cavity, the Oral & Maxillofacial Surgeon repositions one or more jaws (skeletal bones) through surgical procedures to produce a much more pleasing appearance and also improved ability to chew, speak and breathe. The main objective of Orthognathic Surgery is the correction of a wide range of minor and major facial and skeletal (jaw) irregularities. The shape of the face depends on the architectural framework of the facial skeleton. Through Orthognathic Surgery the Surgeon could reposition the bones of the face and the jaw to a more aesthetically acceptable position.
Who needs Orthognathic Surgery?
Jaw growth is a slow and gradual process and in some instances the upper and lower jaw or one side of the jaw to the other may grow at different rates. This may cause many functional and psychological problems. Injuries to the jaws at a young age or during birth (delivery) or birth defects may also affect the normal growth and positioning of the jaws. While Orthodontic treatment (braces) can correct many problems if only the teeth are involved Orthognathic Surgery maybe required if the jaws (bone) also need repositioning. The results of orthognathic surgery can have a dramatic and positive affect on many aspects of your life.
The common maxillofacial deformities and their clinical appearances are the following:
1.Protruded Maxilla (upper jaw) : The upper jaw is protruded beyond the normal limits along with the teeth. The person cannot close his lips (lip incompetence) without effort. The teeth are always visible and in most cases the whole of the gums are visible on smiling (gummy smile). A gummy smile is mainly due to the vertical excess of the maxilla.
2.Retruded Maxilla : This deformity is due to under development of the upper jaw mainly seen in people who have cleft lip or palate. After the surgical correction of the cleft lip or palate at a young age the growth of the maxilla is retarded along with displacement or destruction of the tooth bud. This results in a dish shaped face with a hooked or flaring nose and irregularly aligned, rotated or missing teeth.
3.Protruded Mandible (lower jaw) : In some people there will be extra growth of the lower jaw resulting in long jaw. Their faces are very long with protrusion of the lower teeth and thick lips. Normally on biting the lower teeth will be inside the upper teeth while in people with long jaws usually the lower teeth will be outside the upper arch.
4.Retruded Mandible : In some people due to developmental deformity or due to hereditary factors the lower jaw is very small resulting in a “bird face”. There is no proper development of the chin.
5.Facial Asymmetry : Sometimes a part of the face maybe overdeveloped or underdeveloped causing one part of the face to be small or large. One side of the face is not in symmetry with the other side giving an unaesthetic appearance.
6.Akylosis of Tempromandibular Joint (TMJ) : Injury during birth or trauma or infection at a young age to the tempromandibular joint will result in restricted mouth opening and reduced growth of the mandible.
7.Nasal Deformity : Nasal deformities are often seen along with deformities of the jaw. Some common deformities of the nose are: deviated nasal septum, flared or constricted ala of the nose, saddle nose, hooked nose, asymmetrical nose, etc.
Common Surgical Procedures are
1.Lefort I Osteotomy: This is the surgical procedure done on the maxilla (upper jaw) to shorten or lengthen the maxilla to correct maxillary protrusion or retrution respectively. Also done to correct the vertical excess of maxilla (gummy smile). After an incision is placed inside the mouth the maxilla is down fractured and the excess bone is removed. After repositioning of the jaw the jawbones are held together in place with the help of wires or bone plates. The incision is sutured with absorbable sutures.
2.Anterior Maxillary Osteotomy: This is used to correct the protrusion of the maxilla when there is no vertical excess of maxilla or gummy smile.
3.Saggital Split Osteotomy: This procedure is done on the mandible (lower jaw) to shorten or lengthen the mandible to correct long jaw or retruded jaw respectively. After putting an intraoral incision a split is made at the ramus of the mandible. The jaw is repositioned and the jawbones are held together with the help of screws and bone plates or by wires. The incision is closed with absorbable sutures. If wires are used to hold the bones in position then the jaws maybe immobilized through intermaxillary fixation for 3 weeks to allow proper healing of the bone.
4.Genioplasty: This is used to correct the defects of the chin. The chin can be augmented (increased) if it is deficient. This gives a marked change to the facial appearance. It can even be done under local anesthesia.
Since the chin can be moved by surgery in all dimensions of space genioplasty is used in Facial Asymmetries. A modification of this procedure referred to as Extending Sliding Genioplasty has been developed by Dr Varghese Mani (1993). This is mainly used to correct the facial asymmetries, and to bring the midline of the chin closer to the midline of the face.
5.Rhinoplasty: This is used to correct the deformities of the nose. It can be done along with orthognathic surgery or separately. In cleft lip and palate cases nasal deformity is common. This can be corrected to a very great extend by rhinoplasty.