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Introduction |
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The English derivation of the word orthognathic comes from the root
words "ortho," which means straight, and "gnathic,"
which means jaw. Thus, we have "orthognathic," meaning, straight
jaws. Orthognathic surgery, then, is the surgery to create a straight
jaw. This surgery is designed to treat those patients with dentofacial
deformities who do not have a proper jaw relationship. The concept
of
molding function into an acceptable result rests with the hands of
many different clinical disciplines. Contemporary practice requires
a dentist to be knowledgeable in many different subjects. With approximately
5% to 7% of the United States population having skeletal facial deformities
resulting in jaw misrelationships, there is a definite need for the
dental practitioner to understand and recognize the various misalignments
and be able to diagnose them in an appropriate manner. |
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Diagnosis |
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   There
are many indications for using orthognathic surgery to correct
a malocclusion
resulting from a facial dysplasia. These can be categorized in terms
of the dental relationship using the angle classification of malocclusion,
or they may be classified through the diagnosis of the skeletal abnormality.
Generally, these two classifications are interrelated and the
malocclusion
and the skeletal problem are treated simultaneously. The use of the
angle classification is the most common method of establishing
a direct
pathway to treatment and giving the best result. |
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Treatment |
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 Even
though orthognathic surgery, orthodontics, and aesthetic dentistry offer
significant changes and improvement in a patient's overall function
and appearance, there are still treatments not met by these procedures.
More than 40% of the patients seeking initial orthodontic care are primarily
interested in an improved facial appearance. Although our primary goal
as practitioners is to provide an improved functional result, we must
not lose sight of the patient's primary reason for seeking care. Such
adjunctive procedures as rhinoplasty, blepharoplasty, face-lift surgery,
liposuction, laser facial skin resurfacing, and cheiloplasty are all
now being performed by oral and maxillofacial surgeons. These procedures
dovetail with already common orthognathic surgical procedures. |
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Recovery |
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Since
the introduction of orthognathic surgery more than 30 years ago,
there
has been a continued trend towards improvement in techniques and materials.
Recently, there has been significant improvement in rigid fixation
using
smaller plates and screws, improved plate designs, and the introduction
of resorbable plates and screws. These advances have allowed the
patient
to return to limited function in several days, negating the need for
long-term maxillomandibular fixation. The use of rigid internal
fixation allows
improved speech, enhanced nutritional intake, and a return to the workplace
or school much sooner. New outpatient therapy, with improved anesthesia
modalities and surgical instrumentation, has led to the same-day surgery
concept. Many patients are now treated and released in the same
day,
thus reducing the hospital costs to the patient or the insurance company.
With the aid of advanced diagnostic modalities, including computer-assisted
diagnostics, improved surgical instrumentation and surgical techniques,
plus a very predictable series of procedures, orthognathic surgery
provides
excellent results with minimal trauma to the patient. |
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