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Orthognathic

surgery
Ortho gnathic
Orthognathic surgery (Greek orthos means
straight and gnathos means jaw)
which is performed to reposition the jaws and
correction malocclusion
1 - Malocclusion may be classified into two
major groups: skeletal and dental
2 - Skeletal malocclusion is caused by
discrepancy in shape, size and/or position of
one or both jaw
Indication for treatment
1 patient with a receding chin
2 patient in whom there is a true or relative
mandibular retrusion
3 patient in whom there is a true or relative
mandibular protrusion
4 patient in whom the mandible deviates to one
side or asymmetrical due condoyle hyperplasia
5 patient with mal occlusion associated with a
gross skeletal malrelationshipe of the upper or
lower jaw
Why patient need
treatment
1 ugliness
2 masticatory difficulties
3 speech defect
4 soft tissue trauma due to the
malalignment of the teeth
5 prosthetic replacement
Preoperative assessment
1 - Cephalometric radiographs : to study
A - relationships between bony and soft
tissue land marker
B a diagnose facial growth abnormalities
prior to treatment
C - in the middle of treatment to evaluate
progress or at the conclusion of treatment

2 photograph of the face


3 model of upper and lower jaw (cast )
4 - radiograph assessment OPG and oblique
lateral
Vertical analysis: cephalometric
landmarks. S (sella), N (nasion), ANS
(anterior nasal spine), PNS (posterior
nasal spine), FH (Frankfort horizontal
plane), OP (occlusal plane), Ar
(articulare), Go (gonion), Me
(menton), Gn (gnathion) .
MAXILLARY ANTEROPOSTERIOR SKELETAL
ASSESSMENT

SNA
Purpose: establishes the horizontal location of the maxilla
relative to the cranial base. Note that the points being compared
by this angle are sella and nasion (cranial base points) as well as
A point (maxillary point).
Construction: the angle between a line drawn from S to N and a
line drawn from N to A.
Normal value and standard deviation: 822.
Interpretation:
<80 - maxilla is retrognathic relative to the cranial base.
80-84 - maxilla is normally positioned relative to the cranial
base.
>84 - maxilla is prognathic relative to the cranial base.

MANDIBULAR ANTEROPOSTERIOR SKELETAL


ASSESSMENT

SNB
Purpose: establishes the horizontal location of the mandible
relative to the cranial base. Note that the points being
compared by this angle are sella and nasion (cranial base
points) as well as B point (mandibular point).
Construction: the angle between a line drawn from S to N
and a line drawn from N to B.
Normal value and standard deviation: 802.
Interpretation:
<78 - mandible is retrognathic relative to the cranial base.
78-82 - mandible is normally positioned relative to the
cranial base.
>82 - mandible is prognathic relative to the cranial base
Facial Angle
Purpose: establishes the horizontal location of the mandible relative
to the cranial base. Note that the points being compared by this
angle are the cranial base references FH and nasion as well as Pog
point (mandibular point).
Construction: the angle between a line drawn from Po to Or (FH)
and a line drawn from N to Pog.
Normal value and standard deviation: 886.
Interpretation:
<82 - mandible is retrognathic relative to the cranial base.
82-94 - mandible is normally positioned relative to the cranial base.
>94 - mandible is prognathic relative to the cranial base.
ANB
Purpose: establishes the horizontal relationship between the maxilla and the
mandible. Note that the points being compared by this angle are A point
(maxillary), nasion (cranial base), and B point (mandible).
Construction: the angle between a line drawn from A to N and a line drawn
from N to B. Alternatively: ANB = SNA SNB. Therefore, any negative ANB, by
definition, will have the mandible ahead of the maxilla in a class III relationship.
Normal value and standard deviation: 22.
Interpretation:
<0 - The skeletal relationship is class III with either a retrognathic maxilla, a
prognathic mandible, or a combination of both. A second measurement is
required to determine which jaw is at fault
0-4 - The skeletal relationship is class I with the maxilla slightly ahead of the
mandible.
>4 - The skeletal relationship is class II with either a prognathic maxilla, a
retrognathic mandible, or a combination of both. A second measurement is
required to determine which jaw is at fault.
MANDIBULAR
ANTEROPOSTERIOR
SKELETAL
ASSESSMENT

Receding of the chin


1 recession of the chine un associated with
micrognathia or retroganathia is un common
causes
A as hereditary in some families
B due to trauma of the chin .e.g
comminuted fracture , gunshot wound
Treatment
1 onlays on the mental prominence
2 a sliding genioplast
3 abuccal inlay and prosthesis
4 Bilateral osteotomy of the mandible and
advancement of the anterior part of the
mandible and bilateral bone graft to fill the
the resulting gap
Technique
Correcting a Receding Lower Jaw or
"Weak Chin": The bone in the lower portion
of the jaw is separated from its base and
modified. The tooth-bearing portion of the
lower jaw and a portion of the chin are
repositioned forward.
2- patient whom there is true or
relative mandibular retrusion

causes
1 Pierre Robine syndrome
2 bilateral first arch defect
3 trauma to the condyle
4 infection
5 irradiation
classification
Angles class II malocclusion for whom
orthodontic treatment has not been successful
Treatment
There many surgical technique
1- Bilateral osteotomy of the ramus above the
level of lingula
2 bilateral body osteotomy with
advancement of anterior fragment
Patient in whom there is A true or
relative mandibular protrusion
the most common anomalies of the jaw
causes
1 may be familial as in case of the
Habsburgs
2 acromegaly the most common causes

classification class III


Treatment
1- osteotomies
2 osteoctomies
Technique
Correcting a Protruding Lower Jaw: The
bone in the a near portion of the jaw is
separated from the front portion and modified
so that the tooth-bearing portion of the lower
jaw can be moved back for proper alignment.
Patient with a retrusion of the upper
jaw
1 -This may occur with certain disease the
maxilla appear very small this some time may
be due to enlarge the mandible
2 the maxilla also may enlarge in size and
give class II
Treatment
In case of regression maxilla many certain
technique use
A - le fort I or II
B wessmund
Technique
Correcting an Open Bite: Some of the bone
in the upper tooth-bearing portion of the jaw
is removed. The upper jaw is then secured in
position with plates and screws.
Mandibular deformity
causes
1 condylar hyperplasia this either the
growth in the neck of condyal and present
A the angle of the mandible present more
anterior
B there is no open bite
C no tilting of occlussal plan
D the condition produce asymmetrical
prognathism
2 enlarge in the condyal head and present as
A the middle of the mandible centrally in
place
B the lower border tilted towards the
opposite site
C compensatory down growth of maxillary
alveolar to close the gap
Treatment
1 - Condyloctomy either unilateral or
bilateral
2 body osteotomy
Patient with malocclusion not associated with
skeletal anomaly of the upper and lower jaw

Treatment
1 alveolar ostectomy ( sub apical ostetomy )
2 immobilization of fragment following
osteotomy or ostectomy
Complications and adverse effects of
orthognathic surgery

1 - TMJ fibrous ankylosis or hypo mobility

2 - Vascular complications : Uncontrolled


hemorrhage in the jaws
3 Relapse : Relapse may be dental or
skeletal or both.
4 Infection :
5 - Nerve injuries
6 - Other complications : Fractures of the
osteotomized segments . Ophthalmic
complications . tooth damage