Cosmetic procedures in orthognathic surgery.

Orthognathic Surgery is surgery to correct conditions of the jaw and face related to structure, growth, sleep apnea, TMJ disorders, correct malocclusion problems owing to skeletal disharmonies or other orthodontic problems that cannot be easily treated with braces. Bones can be cut and re-aligned, held in place with either screws or plates and screws.
Gross jaws discrepancies (Anteroposterior , Vertical and /or Transverse discrepancies)

Orthognathic Surgery is performed by either an oral and maxillofacial surgeon or a craniofacial surgeon in collaboration with an orthodontist, often including braces before and after surgery, and retainers after the final removal of braces. Orthognathic surgery is often needed after reconstruction of cleft palate or other major craniofacial anomalies. Careful coordination between the surgeon and orthodontist is essential to ensure that the teeth will fit correctly after the surgery. This coordination often necessitates that the surgeon be trained in dentistry, where complex concepts of occlusion between upper and lower teeth are taught. Unlike Oral and Maxillofacial Surgeons who are trained in dentistry, Plastic Surgeons receive no or minimal training. Thus, it is rare that an Orthodontist would find it appropriate for the surgery to be referred to a non-Oral and Maxillofacial Surgeon.

Planning

Planning for the surgery usually involves input from a multidisciplinary team. Involved professionals are Oral and Maxillofacial surgeons, Orthodontists, and sometimes a Speech and language therapist. As the surgery usually results in a noticeable change in the patient's face a psychological assessment is occasionally required to assess patient's need for surgery and its predicted effect on the patient.

Radiographs and photographs are taken to help in the planning and there is software to predict the shape of the patient's face after surgery,which is useful both for planning and for explaining the surgery to the patient and the patient's family. Advanced software can allow the patient to see the predicted results of the surgery.

Procedure

The surgery might involve one jaw or the two jaws during the same procedure. The modification is done by making cuts in the bones of the mandible and / or maxilla and repositioning the cut pieces in the desired alignment. Usually surgery is performed under general anaesthetic and using nasal tube for intubation rather than the more commonly used oral tube; this is to allow wiring the teeth together during surgery. The surgery often does not involve cutting the skin, and instead, the surgeon is often able to go through the inside of the mouth.

Cutting the bone is called osteotomy and in case of performing the surgery on the two jaws at the same time it is called a bi-maxillary osteotomy (two jaws bone cutting) or a maxillomandibular advancement. The bone cutting is traditionally done using special electrical saws and burs, and manual chisels. Recently a machine that can make the bone cuts using ultra-sound waves has been introduced; this is yet to be used on a wide scale. The maxilla can be adjusted using a "Lefort I" level osteotomy (most common). Sometimes the midface can be mobilised as well by using a Lefort II, or Lefort III osteotomy. These techniques are utilized extensively for children suffering from certain craniofacial abnormalities such as Crouzon syndrome.