eMedicine Specialties > Plastic Surgery > Craniofacial

Craniofacial, Orthognathic Surgery: Multimedia

Author: Pravin K Patel, MD, Associate Professor of Surgery, Division of Plastic Surgery, Northwestern University School of Medicine; Chief of Plastic and Craniofacial Surgery, Shriners Hospitals for Children; Head of Craniofacial Surgery, Children's Memorial Hospital
Coauthor(s): David E Morris, MD, Assistant Professor of Surgery, Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois at Chicago College of Medicine; Staff Surgeon, Shriner's Hospital for Children; Andrew Gassman, MD, Resident Physician, Department of General Surgery, Loyola University Medical Center; Linping Zhao, PhD, MSE, Research Specialist and Craniofacial Fellow, Shriners Hospitals for Children, Chicago; Visiting Research Specialist in Biomedical Engineering, Department of Surgery, University of Illinois Medical Center; Adjunct Assistant Professor, Bioengineering Department, University of Illinois at Chicago
Contributor Information and Disclosures

Updated: Feb 2, 2009

Multimedia

Ideal facial proportions believed to be in aesthe...Media file 1: Ideal facial proportions believed to be in aesthetic balance. Such proportions are only guidelines, as ideal proportions change over time, and the ideal result varies with patient expectations.
Ideal facial proportions believed to be in aesthe...

Ideal facial proportions believed to be in aesthetic balance. Such proportions are only guidelines, as ideal proportions change over time, and the ideal result varies with patient expectations.

Profile analysis illustrating the degree of facia...Media file 2: Profile analysis illustrating the degree of facial convexity or concavity from an acceptable orthognathic norm.
Profile analysis illustrating the degree of facia...

Profile analysis illustrating the degree of facial convexity or concavity from an acceptable orthognathic norm.

An overview of the clinical, radiographic, and de...Media file 3: An overview of the clinical, radiographic, and dental evaluation used in planning orthognathic surgery.
An overview of the clinical, radiographic, and de...

An overview of the clinical, radiographic, and dental evaluation used in planning orthognathic surgery.

Analysis of the dentofacial skeleton is based on ...Media file 4: Analysis of the dentofacial skeleton is based on identifiable radiographic landmarks on a lateral cephalometric x-ray.
Analysis of the dentofacial skeleton is based on ...

Analysis of the dentofacial skeleton is based on identifiable radiographic landmarks on a lateral cephalometric x-ray.

Lateral cephalometric analysis of the facial skel...Media file 5: Lateral cephalometric analysis of the facial skeleton based on Steiner analysis. The positions of the maxilla and mandible each are related spatially to the anterior cranial base and to each other. Note that normative values of the facial elements depend on a normal anterior cranial base inclination and length, which typically are altered in craniofacial conditions.
Lateral cephalometric analysis of the facial skel...

Lateral cephalometric analysis of the facial skeleton based on Steiner analysis. The positions of the maxilla and mandible each are related spatially to the anterior cranial base and to each other. Note that normative values of the facial elements depend on a normal anterior cranial base inclination and length, which typically are altered in craniofacial conditions.

Lateral cephalometric analysis of the dentition w...Media file 6: Lateral cephalometric analysis of the dentition within the skeletal framework.
Lateral cephalometric analysis of the dentition w...

Lateral cephalometric analysis of the dentition within the skeletal framework.

Illustration of 2-dimensional (2D) versus 3-dimen...Media file 7: Illustration of 2-dimensional (2D) versus 3-dimensional (3D) planning for orthognathic surgery. All images are of the same patient (with maxillary deficiency and mandibular prognathism). Unlike conventional 2D cephalometric analysis and treatment planning, 3DCT-based analysis provides a more accurate simulation of the surgery and affords analysis in all 3 planes. Note that in the upper images, the osteotomies have been made (left) and then the maxillary and mandibular segments have been moved (right).
Illustration of 2-dimensional (2D) versus 3-dimen...

Illustration of 2-dimensional (2D) versus 3-dimensional (3D) planning for orthognathic surgery. All images are of the same patient (with maxillary deficiency and mandibular prognathism). Unlike conventional 2D cephalometric analysis and treatment planning, 3DCT-based analysis provides a more accurate simulation of the surgery and affords analysis in all 3 planes. Note that in the upper images, the osteotomies have been made (left) and then the maxillary and mandibular segments have been moved (right).

Illustration of the role of presurgical dental de...Media file 8: Illustration of the role of presurgical dental decompensation in a patient requiring mandibular advancement. Dental decompensation is necessary to allow for proper degree of mandibular advancement and for postsurgical stability at the occlusal level. Note that the occlusion is made worse until corrected by skeletal advancement.
Illustration of the role of presurgical dental de...

Illustration of the role of presurgical dental decompensation in a patient requiring mandibular advancement. Dental decompensation is necessary to allow for proper degree of mandibular advancement and for postsurgical stability at the occlusal level. Note that the occlusion is made worse until corrected by skeletal advancement.

Presurgical orthodontic management requires appro...Media file 9: Presurgical orthodontic management requires appropriate dental decompensation, alignment of the dentition within the individual arches, leveling of the curve of Spee, and coordination of the maxillary and mandibular dentition for postoperative stability.
Presurgical orthodontic management requires appro...

Presurgical orthodontic management requires appropriate dental decompensation, alignment of the dentition within the individual arches, leveling of the curve of Spee, and coordination of the maxillary and mandibular dentition for postoperative stability.

Illustration of the transverse maxillary Le Fort ...Media file 10: Illustration of the transverse maxillary Le Fort I osteotomy. The osteotomy is made with a reciprocating saw and completed at the pterygopalatine junction with a curved osteotome.
Illustration of the transverse maxillary Le Fort ...

Illustration of the transverse maxillary Le Fort I osteotomy. The osteotomy is made with a reciprocating saw and completed at the pterygopalatine junction with a curved osteotome.

Variation of midfacial osteotomies to correct dif...Media file 11: Variation of midfacial osteotomies to correct differing degrees of midfacial deformities involving the zygoma.
Variation of midfacial osteotomies to correct dif...

Variation of midfacial osteotomies to correct differing degrees of midfacial deformities involving the zygoma.

Illustration of the sagittal split ramal osteotom...Media file 12: Illustration of the sagittal split ramal osteotomy. Place the horizontal osteotomy superior to the inferior alveolar nerve foramen and continue partially through the body along the oblique line to the region of the second and first molar to complete the vertical osteotomy. Make the osteotomy through the cortex with a reciprocating saw and complete it with an osteotome along the buccal surface.
Illustration of the sagittal split ramal osteotom...

Illustration of the sagittal split ramal osteotomy. Place the horizontal osteotomy superior to the inferior alveolar nerve foramen and continue partially through the body along the oblique line to the region of the second and first molar to complete the vertical osteotomy. Make the osteotomy through the cortex with a reciprocating saw and complete it with an osteotome along the buccal surface.

Illustration of mandibular excess. The patient un...Media file 13: Illustration of mandibular excess. The patient underwent bilateral sagittal split ramal osteotomy and mandibular setback.
Illustration of mandibular excess. The patient un...

Illustration of mandibular excess. The patient underwent bilateral sagittal split ramal osteotomy and mandibular setback.

Illustration of mandibular deficiency. The patien...Media file 14: Illustration of mandibular deficiency. The patient underwent bilateral sagittal split ramal osteotomy and advancement.
Illustration of mandibular deficiency. The patien...

Illustration of mandibular deficiency. The patient underwent bilateral sagittal split ramal osteotomy and advancement.

Illustration of maxillary deficiency with relativ...Media file 15: Illustration of maxillary deficiency with relative mandibular excess. The patient underwent a modified Le Fort I midfacial advancement that included the body of the zygoma.
Illustration of maxillary deficiency with relativ...

Illustration of maxillary deficiency with relative mandibular excess. The patient underwent a modified Le Fort I midfacial advancement that included the body of the zygoma.

Illustration of vertical maxillary excess, aperto...Media file 16: Illustration of vertical maxillary excess, apertognathia, and mandibular retrognathia. The patient underwent Le Fort I anterior-posterior differential maxillary impaction with sagittal split ramal osteotomy and mandibular advancement.
Illustration of vertical maxillary excess, aperto...

Illustration of vertical maxillary excess, apertognathia, and mandibular retrognathia. The patient underwent Le Fort I anterior-posterior differential maxillary impaction with sagittal split ramal osteotomy and mandibular advancement.

More on Craniofacial, Orthognathic Surgery

Overview: Craniofacial, Orthognathic Surgery
Workup: Craniofacial, Orthognathic Surgery
Treatment: Craniofacial, Orthognathic Surgery
Follow-up: Craniofacial, Orthognathic Surgery
Multimedia: Craniofacial, Orthognathic Surgery
References

References

  1. Trauner R, Obwegeser H. The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. I. Surgical procedures to correct mandibular prognathism and reshaping of the chin. Oral Surg Oral Med Oral Pathol. Jul 1957;10(7):677-89; contd. [Medline].

  2. Angle EH. Classification of Malocclusion. Dental Cosmos. 1899;41(3).

  3. Posnick JC, Ricalde P. Cleft-orthognathic surgery. Clin Plast Surg. Apr 2004;31(2):315-30. [Medline].

  4. Bell WH. Modern Practice in Orthognathic and Reconstructive Surgery. Philadelphia, Pa: WB Saunders Co; 1992.

  5. Booth PW, Schendel SA, Hausamen JE. Maxillofacial Surgery. London: Churchill Livingstone; 1999.

  6. Patel PK. Clinics in Plastic Surgery: Orthognathic Surgery. 34. Philadelphia, Pa: Elsevier; 2007:[Full Text].

  7. Epker BN, Stella JP, Fish LC. Dentofacial Deformities: Integrated Orthodontic & Surgical Correction. Chicago, Ill: Year Book Medical Pub; 1998.

  8. Eppley BL, Pietrzak WS, Blanton MW. Allograft and alloplastic bone substitutes: a review of science and technology for the craniomaxillofacial surgeon. J Craniofac Surg. Nov 2005;16(6):981-9. [Medline].

  9. Ferraro JW. Fundamentals of Maxillofacial Surgery. New York: Springer-Verlag; 1997.

  10. Fonseca RJ, ed. Oral and Maxillofacial Surgery. Philadelphia, Pa: WB Saunders; 2000.

  11. Graber TM, Vanarsdall RL. Orthodontics: Current Principles and Techniques. Chicago, Ill: Year Book Medical Pub; 2000.

  12. Kaban LB, Pogrel MA, Perrott DH. Complications in Oral and Maxillofacial Surgery. Philadelphia, Pa: WB Saunders Company; 1997.

  13. Posnick JC. Craniofacial and Maxillofacial Surgery in Children and Young Adults. Philadelphia, Pa: WB Saunders Company; 2000.

  14. Proffit WR, White Jr RP, Sarver DM. Contemporary Treatment of Dentofacial Deformities. St. Louis, Mo: CV Mosby; 2002.

  15. Wolfe SA, Berkowitz S. Plastic Surgery of the Facial Skeleton. Boston, Mass: Little, Brown and Company; 1989.

Further Reading

Keywords

jaw surgery, dentofacial skeletal surgery, facial orthopedic surgery, craniofacial surgery, orthognathic surgery, orthodontics

Contributor Information and Disclosures

Author

Pravin K Patel, MD, Associate Professor of Surgery, Division of Plastic Surgery, Northwestern University School of Medicine; Chief of Plastic and Craniofacial Surgery, Shriners Hospitals for Children; Head of Craniofacial Surgery, Children's Memorial Hospital
Disclosure: Nothing to disclose.

Coauthor(s)

David E Morris, MD, Assistant Professor of Surgery, Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois at Chicago College of Medicine; Staff Surgeon, Shriner's Hospital for Children
David E Morris, MD is a member of the following medical societies: Chicago Medical Society and Illinois State Medical Society
Disclosure: Nothing to disclose.

Andrew Gassman, MD, Resident Physician, Department of General Surgery, Loyola University Medical Center
Disclosure: Nothing to disclose.

Linping Zhao, PhD, MSE, Research Specialist and Craniofacial Fellow, Shriners Hospitals for Children, Chicago; Visiting Research Specialist in Biomedical Engineering, Department of Surgery, University of Illinois Medical Center; Adjunct Assistant Professor, Bioengineering Department, University of Illinois at Chicago
Linping Zhao, PhD, MSE is a member of the following medical societies: American Cleft Palate/Craniofacial Association and American Society of Mechanical Engineers
Disclosure: Nothing to disclose.

Medical Editor

John Persing, MD, Chief, Professor, Department of Surgery, Sections of Plastic Surgery and Neurosurgery, Yale University School of Medicine
John Persing, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Neurological Surgeons, American Association of Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, New York Academy of Sciences, and Society for Neuroscience
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

R Edward Newsome, MD, Program Director and Chief of Plastic Surgery, Henderson Chair in Surgery, Assistant Dean for Graduate Medical Education, Tulane University School of Medicine
R Edward Newsome, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Plastic and Reconstructive Surgery, American Society of Plastic Surgeons, and Louisiana State Medical Society
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
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