Osteotomies

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Please see Video & Photo Gallery for practical Examples...

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What is Orthognathic Surgery?

 

1. This is the surgical correction of a dentofacial deformity, necessitating an osteotomy of the upper or lower jaw or a combination of both.

2. In most cases, once the orthodontic preparation has been completed, the orthodontist will determine if the patient is ready for jaw surgery.

3. As a general rule for the receded lower jaw, the ideal age is from 15y to 16y of age and older. The lower jaw is advanced, and if any growth in the lower jaw is still present, it could be to the patient’s benefit.

4. In the case of the Class III dental/skeletal position, growth of the jaw must be completed before a setback procedure of the lower jaw is performed. The reason being that if growth is still present, the lower jaw will still grow after the correction of the jaw/ bite, resulting in a protrusive bite again. In general, the ideal age is 16- 17 years in girls and 19- 21 years in boys.

5. For all other dentofacial deformities the ideal age is 16- 19 years of age.

 

THE TEAM APPROACH.

 

Orthognathic surgery is hardly ever performed without the combined involvement of an orthodontist. Sometimes the surgery could be performed prior to orthodontics, but orthodontic treatment will always be necessary. Only in the edentulous patient is surgery performed without the involvement of an orthodontist. In these cases, the osteotomy of the jaw is performed to accommodate a denture or superstructure in the edentulous jaw.

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OTHER CONDITIONS THAT CAN BENEFIT FROM ORTHOGNATHIC SURGERY.

 

1. Receding chin with normal dental occlusion.

2. Facial asymmetry. In most cases, an orthodontist will be involved.

3. Cleft lip and palate cases.

4. The anterior open bite. (It is where the front teeth don’t meet).

5. Difficult or unable to close lips.

6. Sleep apnea with excessive snoring.

7. Facial deformities after excessive facial trauma.

 

THE STAGES OF TREATMENT.

 

DIAGNOSES OF THE DENTO- FACIAL DEFORMITY

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                                   STAGE 1

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Consultation with the orthodontist and placement of braces.Only when all permanent teeth have erupted. Sometimes permanent teeth, including wisdom teeth might be removed. Wisdom teeth can cause weakening of the jaw when present during the surgical procedure, and in some cases are removed at least 8 months prior to the jaw operation.

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                                  STAGE 2

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Pre-surgical orthodontics for 6- 18 months prior to surgery.

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                                  STAGE 3.

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Orthognathic surgery is performed.

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                                  STAGE 4.

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Post-surgical orthodontics to finalize the bite prior to disbanding. This can take up to 6 – 8 months after surgery.

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                                  STAGE 5.

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The patient will wear an invisible retainer at night and might have the teeth splinted with a wire on the inside of the teeth. This is for a period of 6 – 12 months.

 

DIAGNOSES:

 

1. A patient with a dentofacial deformity is usually diagnosed at a very early stage in life. The dentist diagnoses the patient with an abnormal bite, resulting in crowding of the teeth as well. ​

2. The dentist refers the patient to an orthodontist for a consultation. ​

3. A diagnosis is made, and a formal treatment plan is formulated. ​

4. The treatment plan will involve alignment of the teeth, and position the teeth centrally on the respective jaw bone, regardless of the bite. This will result in a Class II (receded lower jaw), or a Class III (protrusive lower jaw). Vertical excess and asymmetric facial profiles can either be Class II or Class III. This phase of orthodontic treatment is called the orthodontic decompensation process.

 

THE RIGHT AGE FOR THIS OSTEOTOMIES

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1. In most cases, once the orthodontic preparation has been completed, the orthodontist will determine if the patient is ready for jaw surgery. ​

2. As a general rule for the receded lower jaw, the ideal age is from 15y to 16y of age and older. The lower jaw is advanced, and if any growth in the lower jaw is still present, it could be to the patient’s benefit. ​

3. In the case of the Class III dental/skeletal position, growth of the jaw must be completed before a setback procedure of the lower jaw is performed. The reason being that if growth is still present, the lower jaw will still grow after the correction of the jaw/ bite, resulting in a protrusive bite again. In general, the ideal age is 16- 17 years in girls and 19- 21 years in boys. ​

4. For all other dentofacial deformities the ideal age is 16- 19 years of age. ​

5. Orthognathic surgery is performed in all age groups ranging from 16 years to as old as 65 years. ​

6. The process stays the same. The patient will start with orthodontic treatment first followed by jaw surgery. ​

7. In some cases, edentulous patients wearing dentures, need a jaw osteotomy to correct the jaw relation between upper and lower jaws to enable a proper denture.

 

THE ROLE OF THE MAXILLOFACIAL SURGEON

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1. A final planning consultation will be arranged, and a formal quotation will be submitted.

2. A suitable date for the surgical procedure will be arranged.

3. In some instances, patients with Tempero- mandibular joint problems will visit our practice first, and if a jaw relation problem persists, we will refer this patient to an orthodontist to start with the orthodontic preparation for orthognathic surgery.

4. Consultation. X-rays, study models, and clinical photos will be taken, and surgical planning will be conducted.

5. As soon as the orthodontist has completed the orthodontic preparation, the patient will be referred to this practice for a surgical procedure.

 

THE RESULT OF UNTREATED DENTO- FACIAL DEFORMITIES.

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1. Difficulty in chewing food. This will ultimately lead to a TM joint problem. This starts early in life as a clicking joint, and will eventually cause a locking TM joint, resulting in pain in the joint with headaches.

2. Abnormal speech

3. Difficulty in swallowing

4. Breathing problems resulting in chronic sinus problems. Mouth breathing in the vertical access patient can lead to chronic sinusitis.

5. Abnormal wear on the teeth, resulting in premature tooth loss, with resulting chewing problems. This will affect the patient’s general health in the long run.

 

DIFFERENT JAW OSTEOTOMIES.

 

• LOWER JAW ADVANCEMENT OSTEOTOMY

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• LOWER JAW SETBACK OSTEOTOMY.

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• THE MAXILLARY ADVANCEMENT OSTEOTOMY​

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• THE MAXILLARY ADVANCEMENT WITH MANDIBULAR SETBACK

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• THE GENIOPLASTY ADVANCEMENT

 

THE SURGICAL PROCESS AND HOSPITALISATION:

 

1. Your operation will be performed in a Private Hospital with overnight facilities. In some major bi- maxillary cases ( upper and lower jaws simultaneously), you will be admitted in a high care facility.

2. If your operation is in the morning, stop eating and drinking from 10 pm the previous night. You will be admitted at 6 am. If your operation is in the afternoon, you can have a light breakfast at 7 am. After that, nothing to eat or drink. You must be admitted just after 12 pm.

3. Brush your teeth thoroughly prior to your operation, and remove all your elastics.

4. On admission, your anesthetist will consult you, and prepare you for your operation. Please inform your anesthetist of all your chronic medication.

5. Bring your own pajamas along to the hospital.

6. For information on your operation, see the animated YouTube videos as informed.

 

REDUCTION GENIOPLASTY

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Postoperative instructions for osteotomy patients (Courtesy of Prof. Johan Reyneke)

Liquidize Diet (Recipes – Courtesy of SASMFOS)