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Dental-maxillofacial Deformities Dept. of Oral & Maxillofacial Surgery School of Stomatology LI Qing-yun Phase I Presurgical 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 Model Surgery Exact surgical movements (distance, direction) Postoperative occlusion Face-bow articulator 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° 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°