Current Concepts in Orthognathic Surgery

Abstract

This CME article outlines the goals of orthognathic surgery, highlighting advances in the field and current controversies. The principles of the sequencing of osteotomies are discussed and literature is reviewed that may assist in decision-making as to maxilla-first versus mandible-first surgery. The emergence of "surgery first," in which surgery precedes orthodontics, is discussed and important parameters for patient candidacy for such a procedure are provided. The emerging standard of virtual surgical planning is described, and a video is provided that walks the reader through a planning session. Soft-tissue considerations are highlighted, especially in the context of osseous genioplasty and fat grafting to the face. The utility of orthognathic surgery in the treatment of obstructive sleep apnea is discussed. The reader is provided with the most current data on complications following orthognathic surgery and advice on avoiding such pitfalls. Finally, outcome assessment focusing on the most current trend of patient-reported satisfaction and the psychological impact of orthognathic surgery are discussed.

Orthodontic-surgical treatment of a patient with Marfan Syndrome and Obstructive Sleep Apnea Syndrome: a case report with a 9-year follow-up

“…Orthognathic surgery for maxillomandibular advancement, eventually referred to as Stanford Phase II surgery, when focused on the treatment of OSAS [27,28], previously pulls all soft tissue adhered to the maxilla and mandible, including part of the pharyngeal musculature, palatine veil, tongue and buccal floor muscles, in addition to subcutaneous tissue. In theory, this protraction should increase the volume capacity of the upper airway, increasing its permeability during sleep [29]. In fact, the current surgical planning for surgical treatment of obstructive sleep apnea should be conducted in a multilevel fashion, so that all predisposing factors of the obstruction diagnosed (nasal, pharyngeal and skeletal) are treated with a single or staged procedure, as the case may be.…”

Current status of surgery-first approach (part III): the use of 3D technology and the implication in obstructive sleep apnea

“…Several studies have been added up to establish a methodologic process of the 3D virtual planning of orthognathic surgery [19,22,24,25]. It is a stepwise planning including diagnosis, 3D cephalometric measurements, virtual planning and osteotomy, and the prediction of the dentoskeletal movements and soft tissue changes [24,[26][27][28]. Preoperatively, MDCT or CBCT data were obtained, and a scanned dental cast data was fused to the virtual skeletal model by voxel-based matching methods [22].…”

Computational technology for nasal cartilage-related clinical research and application

“…Virtual surgical planning in orthognathic surgery is one ideal example. 117 The advancements in 3D imaging techniques guarantee better visualization of any preoperative, intraoperative and post-operative phenotypic changes of both bone and soft tissues, which can help improve the accuracy of diagnosis and treatment planning. Furthermore, virtual planning allows fabrication of custom cutting guides and fixation plates, which can help surgeons reproduce virtual surgical planning osteotomies and save time for placement and removal of intraoperative splints.…”