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Orthognathic surgery

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Title: Orthognathic surgery


1
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  • Orthognathic surgery

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  • 1958? 8?29??????????(Indiana) ???(Gary),??????????
    ???????,??????????Jackson 5 (??????)??,????????,??
    ???????????,?????????,???????????????

4
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  • ?1985???,???20??????????????,?????????,???????????

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  • ??45??????????????2????,?????,????????????????,???
    ???????,???????????,?????????,???????????????????

8
  • ?????
  • (Plastic surgery)
  • ?????(Orthognathic surgery)

9
Causes of dentofacial deformity
  • ??????
  • ??????????????????
  • ??????
  • ???????????

10
Differential Growth of the Head and Body
11
  • Jaw discrepancies interfere with the proper
    alignment of the teeth, and may also affect
    speech articulation, breathing, chewing ability,
    and comfortable closure of the lips.

12
  • Jaw surgery is performed in tandem with
    orthodontic treatment so that both the jaws and
    teeth are correctly positioned for proper
    occlusion (bite) and an improved facial
    appearance.

13
General principles of facial growth
  • ???????????????????????????????
  • ?????????????,???????????

14
????????
  • ????
  • ???????????????????

15
?????????
  • ???????
  • ????????(suture complex)?????(apposition)???????
  • ??(suture)????zygomaticomaxillary
    suture?frontomaxillary suture?zygomaticotemporal
    suture ??pteryopalatine suture

16
????????
  • ???????????????????????
  • ???????(growth sites)??condyle?mandibular
    body?mandibular angle?coronoid process?dentoalveol
    ar process ? periosteal

17
Genetic and environment influence
  • ??????????????
  • ??????????

18
????? ( prognathism )
  • ?????????????????????,??????????????????????????
  • 1973?????????????????
  • (1)75???????????????(occlusal disharmony)
  • (2)37???????????(malalignment of teeth)
  • (3) ??????(Angle class III)?????????5

19
  • 1982??????????????????????????
  • (1)???????????????7.56 ?
  • (2)?10??????????,???????,
  • ???12?????????12.2,????
  • ???????????????
  • (3)????????????????????
  • ????????????

20
  • Hunter The heritability of attained growth in
    the human face.
  • Am J Orthod 1970 58 128-134.
  • ?????????????????,???????????,??????????,?????????
    ????,???????????????

21
  • Nakasima Hereditary factors in the craniofacial
    morphology of Angles Class II and Class III
    malocclusion.
  • Am J Orthod 1982 82 150-156.
  • ????????????????????,???????????,??????????????

22
????????????????
  • ???????????
  • ??????????????????????,nasolabial
    angle???(acute),?labiomental fold????????

23
  • ?????????
  • ?????????????????????,??????????????(reverse
    horizontal overlap)?
  • ???????????
  • ???????????,?????????????????????

24
??????????
  • ???????????class III ????????, ????????????????
  • ???????????????????,?????????????????

25
Orthognathic surgery
  • Treats and corrects abnormalities of the facial
    bones, specifically the jaws and the teeth.
  • Often, these abnormalities cause difficulty
    associated with chewing, talking, sleeping and
    other routine activities.

26
Orthognathic surgery
  • Corrects these problems and, in conjunction with
    orthodontic treatment, will improve the overall
    appearance of the facial profile.

27
?????????
  • ???????????
  • (1) Eliminating or reducing dental
  • compensation for the skeletal deformity
  • (2) Obtaining alignment of teeth and
  • establishing anteroposterior incisor
  • position
  • (3) Obtaining reasonable arch compatility

28
Evaluation of patients with dentofacial deformity
  • ???????
  • ???????
  • ????
  • ????

29
????
  • ???????????
  • ???????????????????

30
???????
  • ?????,???????????,??????????,??????????,????????

31
???????
  • ?????????,???????
  • ??????????????

32
Presurgical orthodontic consideration
  • ????????,???????????????????????????????????,?????
    ???????

33
?????
  • ????????????????,????????????????
  • ?????????,??????
  • ???????,??????????????

34
Objectives of orthodontic treatment
  • ??????????????,????????,??????????,????????

35
?????
  • ??????
  • ??????

36
Indicate a need for orthognathic surgery
  • Difficulty chewing or biting food
  • Open bite
  • Unbalanced facial appearance
  • Facial injury or birth defects
  • Receding chin, Protruding jaw
  • Sleep apnea (breathing problems when sleeping
    such as snoring, difficulty breathing, etc.)

37
Common Types Of Orthognathic Deformities
  • Apertognathia, or "Open Bite
  • Retrognathia
  • Prognathia "

38
Apertognathia, or "Open Bite
39
  • An "open bite" exists if thereis space between
    the upperand lower teeth when themouth is
    closed.


40
Maxillary excess
  • Facial skeleton grows long (vertically)
  • "gummy smile"
  • A deficient (small) lower jaw and a long and
    retruded chin.
  • presence of blocked nasal airflow and a
    mouth-breathing (respiratory) habit that is
    ongoing during childhood

41
Maxillary excess
42
Apertognathia, or "Open Bite
43
Retrognathia or "Over Bite
44
Retrognathia
  • With diminished forward projection of the lower
    face, there is loss of support for the overlying
    soft tissues of the cheeks, neck and chin. This
    results in an obtuse (flat) neck-chin angle, with
    submental fullness (double chin)
  • .

45
ASO(ant. Subapical osteotomy)
46
Mandibular deficiency
                                    
                                    
47
Retrognathia or "Over Bite
48
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Prognathia
  • lower jaw is overdevelopedand protrudes out
    beyond the upper jaw.

50
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51
?????????????
  • ??????????(extraoral approach),??????????(intraora
    l approach),???????????????????( sagittal split
    ramus osteotomy,SSRO ) ????????????( intraoral
    vertical ramus osteotomy, IVRO )?

52
??????????
53
?????????????
  • (1) ?????????????????????????
  • (2) ??????????
  • (3) ????????????????????,?????????????
  • (4) ?????????????
  • (5) ???????????
  • (6) ????????????

54
  • (7) ????????,?????????
  • (8) ??????
  • (9) ????????????????,??????????????????
  • (10) ????????????
  • (11) ???????????,??????????????

55
  • (12)??????????????, ???????,????????????????????
  • (13) ??????????????
  • (14) ?????????????????
  • (15) ????(double jaw)?????????????
  • (16) ????????????????????????

56
?????????????
  • (1) ???????
  • (2) ??????????
  • (3) ?????????????????,???????????????(shift)
  • (4) ??????????????

57
Prognathia????????
58
???????????
  • (1) ?????????????????????,??????????????
  • (2)????????????????,?????????(rigid or
    semirigid)???,?????????
  • (3) ????????,???????????????,??????????????????

59
???????????
  • (1) ????????????????
  • (2) ????????
  • (3) ??????????????
  • (4) ??????????,????????,???????????????(elastic
    band ),??????????

60
Mandibular excess
  • mandibular excess (prognathism), emphasis should
    be given to the overall appearance of the face
    with less concern about specific ceph-alometric
    (x-ray) measurements.

61
Mandibular excess
  • The orthodontist's goal will be to remove all
    dental compensations (poor positioning of the
    teeth) while the surgeon's objective is to
    reposition the jaws to achieve a functional
    occlusion and to enhance facial aesthetics.

62
Mandibular excess


                                                       
                                                       
                                                       
63
Asymmetric Mandibular Prognathism
  • The extent of deformity will be dependent on the
    timing of the unilateral (one sided) condylar
    overgrowth in relation to any further (residual)
    growth of the facial bones.

64
Asymmetric Mandibular Prognathism
65
Genioplasty
 
66
?????????
  • ????,????????????,?????????,???????????,??????????
    ????????,??????????????

67
???????
  • ??????
  • ?????????????

68
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??????????
70
Segment osteotomy
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77
?????? ??????

                                     
  • ??????????????????,??3??,?????????????????????????
    ????????,????????????,???????,???????????????????
    ???????,????????
  • ?

78
  • ??????,?????????30?,????????,??????????,??????????
    ????,??????????????,???????????????????
  • ???????????????????????,?????,??????????????????
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