Dept. of Oral & Maxillofacial Surgery Dental-maxillofacial Deformities Dept. of Oral & Maxillofacial Surgery School of Stomatology LI Qing-yun
Phase I Phase II Phase III Presurgical treatment Surgical treatment Orthodontics Surgical plan Phase II Surgical treatment Mandible Maxilla Phase III Postsurgical treatment Orthodontics restorative/prosthetic treatment follow-up
Presurgical Treatment Phase Presurgical orthodontics Final surgical planning
Objectives —— Presurgical orthodontics Decompensation dental compensation for skeletal deformity angulation of teeth accentuate the deformity
Objectives —— Presurgical orthodontics Alignment of the arches Compatibility of the arches
Final Surgical Planning Visual Treatment Objective, VTO
Final Surgical Planning Computerized imaging CASSOS
Final Surgical Planning articulator Model Surgery Exact surgical movements (distance, direction) Postoperative occlusion Face-bow
Surgical Treatment Phase Surgeries for maxillary deformity Surgeries for mandibular deformity
Surgeries for maxillary deformity Segmental osteotomy (Anterior / Posterior) Indications: - maxillary protrusion - marked protrusion of maxillary teeth - open bite
Surgeries for maxillary deformity Le Fort I osteotomy (total or segmental) Indications: - maxillary deformities - mandibular deformities
Surgeries for maxillary deformity Le Fort I osteotomy Le Fort II or III osteotomy Indications: - midface deficiency
Surgeries for mandibular deformity Sagittal split ramus osteotomy, SSRO Indications: - mandibular excess - mandibular deficiency - mandibular asymmetry back Ad rotate
Surgeries for mandibular deformity Vertical ramus osteotomy Indications: - mandibular excess - mandibular asymmetry (combined with SSRO) back
Surgeries for mandibular deformity Subapical osteotomy Indications: - bimaxillary protrusion / open bite - leveling the plane of occlusion - uprighting anterior teeth
Surgeries for mandibular deformity Body osteotomy Indications: - mandibular excess (body) combined with ramus procedure or not - open bite / spee’s curve reduction
Surgeries for mandibular deformity genioplasty Indications: - chin deformities
Perioperative complications Airway obstructionedema / bleeding / displacement… … Bleeding Infection Necrosis of teeth / bone Healing Injury of nerve
Postsurgical Treatment Phase Completion of orthodontics Postsurgical restorative/prosthetic treatment Follow-up
Pre treatment
SNA 88° SNB 81° ANB 7°
Post Le Fort I & genioplasty
SNA 84° SNB 81° ANB 3°
Pre treatment
SNA 88° SNB 92° ANB 4°
orthodontic treatment Pre operation & after presurgical orthodontic treatment
SNA 88° SNB 92° ANB -4°
Post Sagittal Split Ramus Osteotomy
SNA 88° SNB 86° ANB 2°
Post treatment
SNA 88° SNB 86° ANB 2°