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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