ORTHOGNATHIC MANDIBULAR ORTHOGNATHIC MANDIBULAR SURGERYSURGERY
Dr V.RAMKUMARDr V.RAMKUMAR CONSULTANT CONSULTANT
DENTAL DENTAL &FACIOMAXILLARY &FACIOMAXILLARY SURGEONSURGEON
REG NO:4118-REG NO:4118-TAMILNADU-TAMILNADU-INDIA(ASIA)INDIA(ASIA)
Symmetrical malformationsSymmetrical malformationsCongenitalCongenital
Mand. PrognathismSevere RetrognathismCondylar Agenesis
AcquiredAcquiredInfl. disease of condyles
Severe Condylar Trauma
Etiology
EtiologyAsymmetrical MalformationsAsymmetrical Malformations
CongenitalHemihypertrophy of mand.Condylar HyperplasiaCraniofacial Microsomia
AcquiredInfectionsTraumaAnkylosis
Pathological CausesPathological Causes Plexiform Neurofibromatosis
Fibrous Dysplasia
Quantitative CriteriaQuantitative Criteria
Type of Surgery Bone: soft tissues
Le fort I = 3 : 1 Le fort II = 3 : 2 Le fort III = 1 : 1 Aug Genioplasty = 1 : 1(+/-) Slid. Genioplasty = 1 : 1(consistent)
Quantitative CriteriaQuantitative Criteria
The Rule of Fifths The Rule of Fifths
Mandibular DeficiencyMandibular Deficiency
I. Microgenia = I. Microgenia = Simple retrusion of chin
II. Retrogenia = Retrogenia = Deficient chin profileStevens(1968)
I Degree = < 10 mm II Degree = 10 – 20 mm
III Degree = > 20 mm
III . Sagittal Mandibular Deficiencies
IV. Mandibular deficiencyLow Angle typeHigh Angle type
Cont…
Mandibular ExcessMandibular Excess I. Asymmetric Mand Protrusion
With Open biteWithout Open bite
II . Unilateral Condylar HyperplasiaElongation of condylar neckDeviation of chin to normal sideLip line slopes to affected side & cross bite on unaffected side
Mandibular ExcessMandibular Excess
III . Mandibular HemihypertrophyLower border at lower level than affected sideMarked Convexity or BowingLittle or no displacement of chinNo midline deviation
GENERAL PRINCIPLESGENERAL PRINCIPLES
Access ( Primarily Intra-oral).Adequate Exposure.Good Postoperative Cosmesis.Good Postoperative Function.Preservation of essential structures.Maintenance of adequate nutrition and waste elimination.
Mandibular OsteotomiesMandibular Osteotomies
Body osteotomy (ostectomy)Body osteotomy (ostectomy) Sowray-Haskell Sowray-Haskell
modificationmodification Vertical subsigmoid osteotomyVertical subsigmoid osteotomy
Introral (IVRO)Introral (IVRO) ExtraoralExtraoral
Sagittal split osteotomySagittal split osteotomy Obwegeser/Dalpont; Obwegeser/Dalpont;
Bell/Epker; HunsuckBell/Epker; Hunsuck Inverted L-ramus osteotomyInverted L-ramus osteotomy
VariationsVariations Post condylar graftsPost condylar grafts
Mandibular setback osteotomiesMandibular setback osteotomies
Mandibular advancement Mandibular advancement osteotomiesosteotomies
Bilateral Sagittal Split OsteotomyBilateral Sagittal Split Osteotomy Introduced by Trauner & Obwegeser(1957) Obwegeser ( 1964) Modified by Dal Pont(1961) &
Hunsuck(1968) Use of natural plane of cleavage between
buccal and lingual plates Movements possible: Ant, Post & Rotations.
TechniqueTechniqueIncision & ExposureCorticotomyCorticotomy checkDivision by osteotome ( Wedge action)Nerve identification & preservationRelease of musculatureControl of bleedingFixationClosure Post-op care
Bilateral Sagittal Split OsteotomyBilateral Sagittal Split Osteotomy
Bony Cuts
Bilateral Sagittal Split OsteotomyBilateral Sagittal Split Osteotomy
ADVANCEMENT
The sagittal split osteotomy
Obwegeser/dal Pont
Bell/Epker procedure
Screw fixation for the sagittal split
The sagittal split advancement
Plate fixation
The reconstruction plate
Bilateral Sagittal Split OsteotomyBilateral Sagittal Split Osteotomy
Extraoral vertical subsigmoid Extraoral vertical subsigmoid osteotomyosteotomy
Vertical Ramus Osteotomy
Coronoidectomy
Retraction for the extraoral and intraoral V.S.S.
The inverted L osteotomy
Bone Grafting
Incision line – body ostectomyIncision line – body ostectomy
Ramus Osteotomy
Angle Osteotomy
GenioplastyGenioplasty
Indications
Retrogenia
Bird-face appearance
Prominent gonial angle
Shortened vertical ramus height
ProceduresProcedures
Sliding Horizontal Osteotomy
Double Horizontal Osteotomy
Hinge sliding Osteotomy
Oblique ( advancement) Osteotomy
Jumping Genioplasty
Wedge Osteotomy
Propeller Genioplasty
ProceduresProcedures
Triple Osteotomy
Quadruple Osteotomy
Genioplasty using Grafts
Kole’s Procedure
Lower Labial Segmental OsteotomiesLower Labial Segmental Osteotomies
Anterior Mandibular Subapical Osteotomies (AMSO)
AMSO with vertical alveolar osteotomy Vertical alveolar osteotomy Kole’s Procedure Symphyseal Ostectomy Anterior Mandibuloplasty
Lower Sub-apical
Osteotomy
IncisionsIncisions
Bur hole Bur hole MarkingsMarkings
ExposureExposure
Osteotomy Osteotomy cutscuts
Nerve Bundle Nerve Bundle RepositioningRepositioning
Kole’s ProcedureKole’s Procedure
Correction of minor degrees of AOB. Class 3 malocclusion Inferior border into defect caused due to
upward movement of ant. segment Chin augmentation Decreased ant. facial height