Orthognathic Surgery
Introduction
Orthognathic surgery, also known as corrective jaw surgery, is a specialized surgical procedure aimed at correcting a wide range of minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth. This surgery not only improves the patient's ability to chew, speak, and breathe but also enhances facial aesthetics. The term "orthognathic" is derived from the Greek words "ortho," meaning straight, and "gnathic," meaning jaw.
History
Orthognathic surgery has evolved significantly over the past century. The early 20th century saw the first attempts at jaw correction, primarily focusing on the mandible. The development of modern orthognathic surgery is attributed to advancements in anesthesia, surgical techniques, and the introduction of rigid fixation methods. The pioneering work of surgeons such as Hugo Obwegeser in the 1950s laid the foundation for contemporary practices.
Indications
Orthognathic surgery is indicated for various conditions, including:
- Severe malocclusion that cannot be corrected with orthodontics alone
- Congenital jaw deformities
- Facial asymmetry
- Obstructive sleep apnea
- Temporomandibular joint disorders
- Speech impediments due to jaw misalignment
Preoperative Assessment
A comprehensive preoperative assessment is crucial for successful orthognathic surgery. This includes:
- **Clinical Examination**: Detailed evaluation of dental and facial structures.
- **Radiographic Analysis**: Use of cephalometric radiographs, panoramic X-rays, and 3D imaging to assess skeletal and dental relationships.
- **Model Surgery**: Creation of dental models to simulate surgical outcomes.
- **Interdisciplinary Consultation**: Collaboration with orthodontists, maxillofacial surgeons, and sometimes speech therapists.
Surgical Techniques
Orthognathic surgery encompasses various techniques depending on the specific deformity being addressed:
Le Fort I Osteotomy
This procedure is used to correct maxillary (upper jaw) deformities. The maxilla is surgically separated from the skull base and repositioned. It can be moved in any direction to achieve the desired alignment.
Bilateral Sagittal Split Osteotomy (BSSO)
BSSO is commonly used to correct mandibular (lower jaw) deformities. The mandible is split bilaterally, allowing for forward or backward movement. This technique provides excellent stability and allows for precise adjustments.
Genioplasty
Genioplasty involves the surgical alteration of the chin. It can be performed in conjunction with other orthognathic procedures to enhance facial harmony.
Postoperative Care
Postoperative care is critical for optimal recovery and includes:
- **Pain Management**: Use of analgesics and anti-inflammatory medications.
- **Dietary Modifications**: Transition from liquid to soft foods as healing progresses.
- **Oral Hygiene**: Maintenance of oral hygiene to prevent infection.
- **Follow-Up Visits**: Regular follow-up visits to monitor healing and address any complications.
Complications
While orthognathic surgery is generally safe, potential complications include:
- **Infection**: Managed with antibiotics and proper wound care.
- **Nerve Injury**: Temporary or permanent sensory changes, particularly in the lower lip and chin.
- **Relapse**: Gradual return of the jaw to its preoperative position.
- **Malocclusion**: May require additional orthodontic treatment.
Outcomes
The outcomes of orthognathic surgery are generally favorable, with significant improvements in function and aesthetics. Patient satisfaction is typically high, and the benefits often outweigh the risks.