Orthognathic Surgery for Patients with Maxillofacial Deformities

For best function and aesthetics, the teeth of the maxilla (ie, upper jaw) should fit in a precisely defined position with the teeth of the mandible (ie, lower jaw). The mandible articulates with the temporal bone to form the temporomandibular joint.

Growth discrepancies of either jaw can lead to problems such as an “open bite” in which the teeth do not touch.

Maxillofacial abnormalities that compromise a patient's airway (A) often can be improved by surgery (B).

Angle's classification and the effect of the occlusion on the shape of the face: class I occlusion (A), class II malocclusion (B), and class III malocclusion (C).

Cephalometric tracing showing how maxillofacial surgery is planned.

The surgeon performs the procedure in advance on anatomically accurate plaster models to relate the mandible with the maxilla: lateral view (A), frontal view (B).

The surgeon makes osteotomies (ie, incisions) between the teeth in the plaster maxillary cast to create a precise occlusal fit.

During more extensive midface, craniofacial, or nasal procedures, the surgeon passes a reinforced endotracheal tube through a submental incision, which avoids the need for tracheostomy or repositioning of the tube later in the procedure.

The plate and screws illustrate a technique for rigid fixation used during mandibular advancement surgery to span the gap created when the lower jaw is brought forward.

The LeFort I (A), II (B), and III (C) osteotomy locations.

Cranial bone graft site.

Lateral preoperative (A) and postoperative (B) photographs of a patient who has undergone LeFort I orthognathic surgery.

Genioplasty is performed to give facial balance and to reposition the mentalis muscle to improve lip elevation and advance the suprahyoid muscles in cases of sleep apnea. Illustration of the proposed procedure (A) and postoperative x-ray with hardware in place illustrating how the chin, lips, and nose are aligned (B).

Preoperative (A and B) and postoperative (C and D) views of a patient who has undergone malar augmentation, maxillary and mandibular surgery, and rhinoplasty.

The three stages of distraction osteogenesis: latency, activation, and consolidation (A); Panorex x-ray of an internal distraction device applied to the mandibular rami before activation (B); and Panorex x-ray of a distraction procedure during activation, with the yellow arrows indicating the vectors of distraction (C).

A patient shown before distraction osteogenesis (A), with distraction device applied (B and C), and after a successful distraction osteogenesis procedure of the midface using an external device (D).

The first postoperative night can be difficult for the patient as he or she deals with discomfort, swelling, and learning to handle secretions using suction.

Postoperative placement of orthodontic rubber bands (ie, elastics) used to control the patient's bite during the healing process.

Although recovery is different for each patient, there are similarities. This graph plots the average intensity of swelling, bruising, energy, pain, and mood levels that patients experience during the first two postoperative weeks.