The problems that are most visible and create most worry among the patients that come to our office tend to be dental problems. Problems involving teeth – which can be aesthetic, functional or health-related – are those that patients are most aware of and cause them most concern. A high percentage of these patients also have some form of skeletal or bone-related problem. Clearly the most visible problem is the dental problem, nevertheless, these teeth are rooted in bone and gums, which are their foundations. If the bone is incorrectly positioned, the teeth will be so, too. In cases where skeletal discrepancies are very pronounced, dental movements will have to be used together with orthognathic surgery to try to redress the situation.
Facial deformities and orthognathic surgery
Facial deformities develop when one or more of the bones in the face do not grow sufficiently or grow excessively, creating discrepancies between them (any bone may be affected: the nose bone, cheek bones, chin, jaw bones, etc.). Such variations in bone growth tend to occur during the growth stage and stabilize with the completion of growth in adulthood. Orthognathic surgery corrects facial deformities, providing a solution to the lack of functional and aesthetic facial harmony.
When it is the jaws that are affected there also tends to be severe dental problems with the bite or the occlusion. This leads to serious malocclusions that, if left unchecked over time, produce problems involving wear and dental mutilations, receding gums and other periodontal issues including even the loss of teeth.
As mentioned previously, we sometimes see patients with one or more notable skeletal problems (relating to the bones in the face), the solutions to which require treatment with orthognathic surgery.
Orthognathic surgery is a part of maxillofacial surgery, and is the surgical specialty responsible for correcting problems in jaw bones and facial structures, or derivations such as growth problems, sleep apnea, TMJ (temporomandibular joint) disorders, cleft lip, malocclusions stemming from the positions of the bones, etc.
Orthognathic surgery must be performed by a trained maxillofacial surgeon, with cooperation from an orthodontist and a laboratory technician. Teamwork and communication between the professionals is essential for the successful outcome of the treatment. The reality is that many of these patients have severely damaged mouths as a result of going years without their mouths working properly. Such patients require multidisciplinary treatment involving the collaboration of various other professionals: periodontal treatment, implants, prostheses, aesthetics, etc.
How is orthognathic surgery carried out?
Following a painstakingly thorough surgical-orthodontic analysis, the orthognathic surgery is performed under a general anesthetic in a hospital environment. The maxillofacial surgeon ‘releases’ the bones that are to be treated, performing cuts in them called osteotomies. The bones are moved and set in the appropriate position in accordance with the planning. Subsequently they are fixed in that position with mini-plates and titanium screws (a procedure called osteosynthesis). In accordance with the three-dimensional positions of the bones, these components provide the correct amount of support and volume for the face’s soft tissue.
Problems that are often treated with orthognathic surgery
The conditions that are most frequently treated with orthognathic surgery are:
1. Long face – (lengthened facial appearance)
There are various possible causes for a long face:
- A very large maxilla with excessive vertical growth (the patient may have a ‘gummy smile’ – exposing much of the upper gum when smiling).
- An excessively long chin due to excessive growth of the lower jaw (the patient may have difficulty closing their lips).
- An open bite due to various causes (when the patient joins their back teeth, their front teeth do not touch).
2. Short face (shortened appearance of the lower third of the face)
The causes may be a very short upper jaw (the patient shows very little of their teeth when smiling) or a very short or retracted lower jaw and chin.
3. Flat or concave face
This tends to be caused either by a retracted upper jaw or a lack of cheek bone projection (or sometimes both of these); a well-balanced face is slightly convex.
4. Retrognathic face
This is usually caused by a small lower jaw, which tends to be accompanied by a lack of chin. These patients have the typical ‘bird profile’ and their upper teeth appear far forward. This deformity is related to that of a short face.
5. Prognathic face
This is usually the result of excessive lower jaw growth that projects forward and downward. This deformity is related to those of a long or flat face.
The lack of sufficient growth in the upper jaw is the most frequent cause, leaving the middle third of the face sunken and with little projection of the cheek bones, and giving a prognathic and ‘aggressive’ appearance to the face.
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