Download Introductions of International Medical (Healthcare) Service at Oral

Introductions of International Medical (Healthcare) Service at
Oral & Maxillofacial surgery Department
Special features: Diagnosis and treatments of dentofacial deformity and malocclusion
-- Orthognathic Surgery (OgS)
Orthognathic surgery (OgS) is a procedure of jaw osteotomies by moving upper
and lower jaw bones to correct facial disharmonies and maintain good occlusion. The
indications of orthognathic surgery are dentofacial deformities that may be caused
by developmental defects or cleft conditions, malocclusion caused by traumatic jaw
bone fractures, etc. It has also been proved to have dependable and reliable results
to treat severe obstructive sleep apnea. Clinical signs and symptoms of the
dentofacial deformities and malocclusion mentioned above are buck teeth, open
bite, gummy smile, flattened midface, mandibular prognathism, mandibular
retrognathism, facial asymmetry, etc. Our hospital provides strong and outstanding
medical team with inter-disciplinary collaborative teamwork between oral &
maxillofacial surgery department, orthodontic department, sleep center, and
anesthesiology department. We provide a comprehensive evaluation and treatment,
which goals are improvements in pharyngeal airway space, optimal occlusion,
harmonious facial profile. The breakthrough technology in materials such as titanium
based plates, refined surgery designs have shortened the period of intermaxillary
fixation, during which patient can only have liquid diet; increases patient’s life quality
by a leap, also allow them to recover faster and regain their regular lives with more
confidence ; in some cases, shortened pre-operative orthodontic time is also
possible.
The flow charts of diagnosis and treatments of OgS are as below :
1. Data collection : visit to Oral & maxillofacial or orthodontic department and
after doctor’s examination which ensures that the patient meets the criteria
of dentofacial deformities, we will take extra-oral and intra-oral pictures,
dental impressions, panoramic radiographs, posterior-anterior
cephalometrics, lateral cephalometrics.
2. Data analysis, treatment plans, facial profile predictions: According to the
data collected above, cephalometric analysis, and dental impression models,
the doctor will reach a conclusion, diagnosis, treatment options, facial
profile predictions. If patient also may have or within high risk to have sleep
apnea problems , we will consult sleep center for polysomnography to
confim the severity and classifications of the sleep apnea .
Maxillomandibular advancements (MMA) or a form of orthognathic surgery
is one the most surgical treatments for confimed obstructive sleep apnea
3. Pre-operative preparations: dental extractions, periodontal therapy, dental
fillings for caries, removal or fabrications of prosthesis according to
treatment plans; then start pre-operative orthodontic therapy.
4. Admission and surgery: arrange pre-operative evaluations such as
anesthesiologist examinations and consultation, computer tomography to
help surgeons to individualize surgery according to patient’s anatomy which
reduces patient’s post-operative complication rates. The surgery done by
our professionals are delicate and exquisite, collocated with anesthesiologist
professionals, we use low pressure anesthesia technique which decreases
the blood loss. Most of our patients do not need blood transfusions,
diminishing the hussle of banking blood before surgery and totally cut down
blood transfusion infections to zero. Hospital stay is about 5 days, liquid diet
for one to two weeks, soft diet afterwards.
5. Discharge and follow up: Weekly visit to our outpatient clinic, removal the
intraoral fixation devices after four to six weeks, then the patient will start
post-operative orthodontic treatments. Post-operative three months, six
month, one year follow up is recommended to evaluate the surgical site
healing condition.
Various types of osteomies can be used in orthognathic surgery, which
depends on patient’s anatomy and deformity.
The osteotomies mostly used in our department are as following :
1. Mandibular vertical ramus osteotomy (VRO, Fig. 1) is mostly used in
correcting mandibular prognathism. Mandibular setback and minimal
advancement can be done by using this kind of jaw osteotomy. The risks of
inferior alveolar nerve injury is the low, however the proximal and distal
segments are hard to fixate, therefore prolong the post-operative
intermaxillary fixation period to about six weeks of liquid diet.
2. Mandibular vertico-sagittal ramus osteotomy (VSRO, Fig. 2) is a
combination of vertical ramus osteotomy (VRO) and sagittal split ramus
osteotomhy (SSRO). The risks of inferior alveolar nerve injury is also lower
than SSRO, fixation of the segments are reliable, and shortens the period of
intermaxillary fixation. However, not every patient is congruous with this
kind of ramus osteotomy, which depends on ramus anatomy displayed by
computer tomography taken beforehand.
3. Mandibular sagittal split ramus osteotomy (SSRO, Fig. 3) is compatible with
wide variety of cases of mandibular prognathisms or retrognathism.
Fixation with titanium plates are achievable, dramatically shortening the
intermaxillary fixation period. In some cases, there is no need of postoperative intermaxillary fixation, reducing the inconveniences of liquid diet.
Compared with traditional sagittal split which restrict the amount of
mandible movements, high nerve injury, our professionals has cut the risks
by innovating osteotomy lines and surgical equipments, pre-operative
precise computer tomography evaluation, new piezo-instruments. The
statistics in our hospital showed 37% patients had paresthesia of the lower
lip after the operation, 55% of them resolve by a month, 90% in six months,
most of them experience complete recovery from the lower lip
paresthesia.
4. Sliding genioplasty (Fig.4): is a versatile procedure to correct chin
deficiencies by advancing or reposition in multiple planes to correct
asymmetric conditions. It is procedure to add the finishing touch to the
masterpiece.
5. Le Fort I osteotomy(Fig. 5) : is jaw osteotomy to adjust the maxilla position
horizontally and vertically (roll and pitch), primarily to correct maxillary
dentoalveolar protrusion, gummy smile, depressed maxilla, etc. Besides
that, maxilla position can also be rotated (yaw and roll) to correct
asymmetric conditions; modified Le Fort I osteotomies (two piece, three
piece) can also correct arch forms and dental occlusal relationships,
reducing the post-operative orthodontic period.
6. Maxillary anterior subapical osteotomy (ASO, Fig. 6): using dental
extraction or edentulous space to setback or upward impaction of the
anterior maxilla, correcting the dentoalveolar protrusion and gummy smile.
7. Modified maxilla-mandibular advancement (Modified MMA, Case4 &
Case5): is a combination of segmental Le Fort I osteotomy and
mandibular sagittal split ramus osteotomy (SSRO), advancement of
posterior maxilla and mandible. Besides from correcting malocclusion and
facial profile, it also increases the pharyngeal airway space, a reliable
procedure mostly to treat cases of obstructive sleep apnea.
Fig 1、Mandibular vertical ramus osteotomy
Fig 2、Mandibular vertio-sagittal ramus osteotomy
Fig 3、Mandibular sagittal ramus osteotomy
Fig 4、Sliding genioplasty
Fig 5、Le Fort I Osteotomy
Fig 6、Maxillary anterior subapical
osteotomy