scholarly journals Orthognathic Surgery for the Maxilla-LeFort I and Anterior Maxillary Osteotomy

2021 ◽  
pp. 1513-1548
Author(s):  
Ashok Dabir ◽  
Jayesh Vahanwala
Keyword(s):  
Orthognathic Surgery ◽  
Three Dimensional ◽  
Surgical Techniques ◽  
Three Dimensions ◽  
Maxillary Osteotomy ◽  
Wisdom Teeth ◽  
Tissue Changes ◽  
General Guide ◽  
Bimaxillary Surgery ◽  
Soft Tissue Changes

AbstractThe chapter reviews the history and technique of maxillary orthognathic surgical procedures and highlights the sequence of bimaxillary surgery. A maxillary surgical procedure and its modification can be employed to correct skeletal deformities of the maxilla. With presently available surgical techniques, the maxilla may be independently repositioned in three dimensions. Segmentalization of the maxilla in turn allows repositioning different portions in different three dimensional planes, when done under direct vision. The changes in the position of the maxilla also causes soft tissue changes of the lips, cheeks, and nose. Changes in the nasal complex after orthognathic surgery, with the exception of nasal width, are complicated, and cannot be predicted. Having listed a general guide, the authors reiterate that no dogma should be given regarding the sequence of maxillary or mandibular surgery. Any surgical decision must be made after in-depth planning, preparation, and flexibility. If this is done, sequencing will follow logically.The chapter also includes key considerations in orthognathic surgery viz., adjustment to the base of the Nose and ANS; effect of changing the inclination (slope) of the osteotomy cut; impacted / erupted wisdom teeth; preoperative/intraoperative difficulties and proper positioning. An in-depth account of nutritional support and dealing with complications rounds off the discussion.

scholarly journals A Perioral Soft Tissue evaluation after Orthognathic Surgery Using Three-Dimensional Computed Tomography Scan

2018 ◽  
Vol 12 (1) ◽  
pp. 366-376
Author(s):  
Rahul Tiwari ◽  
P. Srinivas Chakravarthi ◽  
Vivekanand S. Kattimani ◽  
Krishna Prasad Lingamaneni
Keyword(s):  
Computed Tomography ◽  
Soft Tissue ◽  
Orthognathic Surgery ◽  
Soft Tissues ◽  
Three Dimensional ◽  
Computed Tomography Scan ◽  
Nasolabial Angle ◽  
Tissue Changes ◽  
Soft Tissue Changes ◽  
Tomography Scan

Background: Facial appearance is an important factor, affects social and psychological well-being. The ideal positioning of jaws and soft tissues is crucial during orthognathic surgery for a better outcome, but the response of facial soft tissues does not always reflect the exact movements of the underlying jaws in 1:1 ratio. So, soft tissue changes following orthognathic surgery require utmost attention during surgical correction to make successful treatment. Aims and Objectives: Evaluation of perioral soft tissue changes after orthognathic surgical procedures. The objectives of the study were to assess and compare pre and post-operative perioral soft tissue changes of lip width, nasolabial and mentolabial angle using Three Dimensional Computed Tomography scan (3DCT). Patient and Methods: The study involved ten patients for evaluation requiring orthognathic surgical procedures (maxillary or mandibular anteroposterior excess or deficiency, transverse deformities, vertical maxillary excess and facial asymmetry) presented to the department of oral and maxillofacial surgery during 2014-2016. Pre and post-operative 3DCT scan were taken after 12 months using iCT 256 slice whole body CT scanner and evaluated for changes using Dicom PMS D view. Results: Significant changes were observed in nasolabial angle after maxillary advancement (1.81°) and maxillary setback procedure (2.73°). The mentolabial angle was significantly increased with mandibular setback procedures (3.27°). Mandibular advancement procedures showed both increase (3.6°) and decrease (7.6°) in mentolabial angle. Conclusion: 3DCT showed a significant difference in perioral soft tissue changes in nasolabial and mentolabial angle but no significant change was observed in lip width. 3DCT is a reliable tool for 3D assessment. The conventional thought of changes in Nasolabial angle after surgery is changing due to the underlying factors which should be considered for prediction.

scholarly journals Soft Tissue Changes after Orthognathic Surgery: A Study

2011 ◽  
Vol 1 (1) ◽  
pp. 47-51 ◽  
Author(s):  
Chandran Upadhyaya ◽  
Mohan Baliga ◽  
Premalatha Shetty
Keyword(s):  
Soft Tissue ◽  
Orthognathic Surgery ◽  
Hard Tissue ◽  
Facial Soft Tissue ◽  
Lower Lip ◽  
Maxillary Osteotomy ◽  
Alar Base ◽  
Soft Tissue Profile ◽  
Tissue Changes ◽  
Soft Tissue Changes

Aim and objective: The main aim and objectives of this study was to determine the changes in the facial soft tissue profile following orthognathic surgery, to evaluate eventual treatment effects on stability of facial aesthetics and degree of predictability of these changes. Materials and method: 15 numbers of patients underwent with le fort I, anterior maxillary osteotomy, genioplasty and bimaxillary surgery. The alar base cinch suture and the V-Y closure techniques were used in each maxillary procedure. The criteria applied included an average follow-up of 6 months post-operatively. Results: In this study preoperative and postoperative cephalometric tracing were compared to analyze the soft tissue profile changes in relation to hard tissue changes in both upper and lower lip and chin regions after double jaw surgery. Only horizontal changes were analyzed for which an X-Y coordinate system was used. The upper lip responded variably to the direction and amount of maxillary positioning. The predictability and the significance of changes of soft tissue in relation to hard tissue are variable as it reaches towards the nose. Conclusion: It is important for the clinician to realize that numerous factors of variability exist so that he can understand that the soft-tissue profile will sometimes deviate quite markedly from what is expected, in spite of careful planning.

Three-dimensional analysis of lip soft tissue changes and related jaw changes in patients with skeletal class III malocclusion and facial asymmetry

2021 ◽  
pp. 1-14
Author(s):  
Wenjie Xu ◽  
Hao Tan ◽  
Xuehuan Meng ◽  
Ye Ming ◽  
Tao Wang ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Orthognathic Surgery ◽  
Three Dimensional ◽  
Facial Asymmetry ◽  
Class Iii ◽  
Class Iii Malocclusion ◽  
Skeletal Class ◽  
Tissue Changes ◽  
Soft Tissue Changes ◽  
Jaw Surgery

OBJECTIVE: To investigate three-dimensional soft tissue changes of lips and related jaw changes in patients with skeletal class III malocclusion and facial asymmetry using cone-beam computerized tomography (CBCT). METHOD: This study included 46 CBCT scans of patients with aforementioned character before (T1) and 6–12 months after orthognathic surgery (T2). Subjects were divided into 2 groups according to two types of orthognathic surgery namely, the one-jaw surgery group who underwent bilateral sagittal splint ramus osteotomy (BSSRO) and the two-jaw surgery group who underwent Le Fort I osteotomy and BSSRO. Mimics 19.0 software are used for model reconstruction, landmark location and three-dimensional cephalometric analysis. Descriptive statistics and correlation analyses are used to investigate jaw hard tissue and lip soft tissue changes. RESULTS: In one-jaw group, the mandible shows changes in contour and position (p <  0.05), and the surgery causes changes of lip structure on the deviated side. While in two-jaw group, jaws only show changes in spatial position, and surgery changes contour of bilateral lips and nasolabial angle (p <  0.05). At the same time, lip symmetry increases significantly in both groups postoperatively. CONCLUSIONS: Orthognathic surgery can improve lip aesthetics in patients with skeletal class III malocclusion and facial asymmetry. However, changes induced by two surgical approaches are different. Surgeons should have a clear acquaintance with this difference to deal with different situations.

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