Orthognathic surgery –

Orthognathic surgery – maxillary deformities , maxillary repositioning procedures and complications

Presented by : Dr. ShwetaModerator : Dr. Anuradha Navaneetham

Maxillary deformities

Vertical Transverse Anteroposterior

Facial disproportion

Symmetrical disproportion maxillary enlargement

maxillary deficiency Asymmetrical disproportion

Maxillary enlargement

Dentoalveolar protrusion Panmaxillary enlargement Vertical maxillary excess

Maxillary deficiency

Supra-apical maxillary hypoplasia Vertical maxillary deficiency Nasomaxillary hypoplasia Lateral maxillary deficiency Total midface hypoplasia Crouzen’s syndrome Apert’s syndrome

Middle face assymetries

Cleft lip and cleft palate syndrome Localized maxillary pathology Secondary maxillary assymetries Hemifacial atrophy Hemifacial hypoplasia Hemifacial hypertrophy

Dentoalveolar protrusion

Panmaxillary enlargement

Vertical maxillary excess

Vertical maxillary excess

long lower facial height lip incompetence excessive incisor display at rest excessive gingival display on smile

Vertical maxillary deficiencies

Short lower facial third Diminished maxillary incisor display

at rest Diminished incisor display on smile

Supra-apical maxillary hypoplasia

Nasomaxillary hypoplasia group 1

Nasomaxillary hypoplasia group 2

Nasomaxillary hypoplasia group 3

Nasomaxillary hypoplasia group 4

Lateral maxillary deficiency

Total mid face hypoplasia Post trumatic

cleft

Mid third assymetries

Special groups

History

1859 Von Langenbeck 1867 Cheever 1901 Le Fort 1927 Wassmund 1934 Axhausen 1942 Schuchardt 1949 Moore and Ward 1965 Obwegeser

Surgical options

Total maxillary osteotomies Segmental alveolar maxillary

osteotomies

Total maxillary osteotomies

Lefort I Lefort II Lefort III

Segmental alveolar maxillary osteotomies

Anterior maxillary osteotomies Posterior maxillary osteotomies Combined procedures

Superior repositioning Inferior repositioning Anterior repositioning Posterior repositioning

Surgical technique

Surgical exposure, osteotomy cuts, pterygomaxillary dysjunction

Mobilization & advancement Fixation Bone grafting

Lefort I osteotomy

Indications

Low mid face hypoplasia Maxillary hyperplasia Cant in occlusion Cleft patients Open bite

Soft tissue changes

Exposure

Maxillary mobilization

Stage I Stage II Stage III

Practical points

Lefort I osteotomy

Variation I : with midline narrowing Variation II : with midline widening Variation III : with superior

repositioning Variation IV : with inferior

repositioning

Lefort II osteotomy

Indications

Nasomaxillary hypoplasia Group I Group II Group III Group IV

Profile changes

Exposure

Practical points

Lefort II osteotomy

Variation I : with inferior repositioning Variation II : with naso-orbital

maxillary advancement of converse Variation III : kufner’s modification Variation IV : with lateral extensions

Le fort II variation 2

Lefort II variation 3

Le fort III osteotomy

Lefort III osteotomy

Variation I : with inferior repositioning Variation II : with transverse frontal

crescent Variation III : lefort III + I

Anterior segmentl osteo.

Corticotomy with interradicular osteotomy

Anterior maxillary osteotomy wassumand method wundrer’s method cupar’s method

Posterior segment osteotomies

Kufner

Perko – Bell approch

Thank you