Orthognathic surgery

Basic guidelines for the treatment of specific dentofacial deformities

• Mandibular anteroposterior deficiency• Mandibular anteroposterior excess• Maxillary anterioposterior deficiency• Maxillary anteroposterior excess• Maxillary vertical deficincy• Maxillary vertical excess• Open bite deformities• Dentofacial asymmetry

Presurgical orthodontics of VMELevel the mandibular arch before surgery.1

2.Patients with VME often have an excessive reverse curve of spee that should be corrected properatively.

3.The narrow maxilla should be expanded

Surgical treatment of VMETo correct VME, the maxilla must be superiorly repositioned by Lefort I osteotomy. The extent of superior repositioning is governed by upper lip incisor relationship. Exposure of 30% to 40% of the clinical crown of the maxillary incisors beneath the upper lip is esthetically pleasing

Open bite deformitiesData suggest that 1/3 of patients who seek treatment of dentofacial deformities have VME and anterior open bite. A major component of the vertical problem is posterior VME leading to a backward & downward rotation of the mandible

Surgical treatment options 1.Maxillarysuperiorrepositioning(impaction)±genioplasty2.Maxillary superior repositioning+mandibular setback±genioplasty.3.Maxillary superior repositioning +mandibular advancement±genioplasty.4. Maxillary superior repositioning in one piece or in segments+simultaneous expansion of the buccal segments.

Asymmetry