oral surgery
Orthognathic surgery
Reconstruction of craniomaxillofacial deformities
Based on skeletal growth potential
Surgerical movement of jaw structiures
Correct MANDIBULAR discrepencies
Sagitall ramous osteostmies
Sagittal split osteostomie *****************
Most common
RIF increased popularitie
Correct variety of mandibular deformities
Distraction osteogenesis **
Genioplasty **
Dramatic facial change with relaltively minor surgery
Morphology of bony chin and overlaying soft tissue must be corrected
Integrity of attached gingiva important
Can alter lip morphology and competence
Transoral vertical ramus
Adj
V shaped mandibles
Less neurosenosry loss
Possibility more stable
Dis
Experience, segment positioning problems, RIF more challenging possible limited to MMF
MAXILLARY DEFORMITIES
Le Fort I
Segmental consideration of max deformities
Surgical assisted rapid palatal expansion
Indications: transverse deficiency, arch length discrpency, no other vertical or AP abnormalities
ADJ: good stability, can be done outpatient/ in office
Segmental Le Fort
Other segmental options
Rationale
Transverse discrepancy
Vertical abnrormalities
Extraction space
Tooth angulation
Asymmetry
Dental arch form
Skeletal
Cleft lip and palate
I. Embryology
A. Failure fusion of MEDIAL MAXILLARY and NASAL PROCESS
B. Exam of 5-6 wk embryo reveals facial prominences
1. Nasomedial, nasolateral, maxillary, mandibular
2. Smaller units likely represent growth centers
II. Prevalence CL/P
A. CL +/- CP 1:700 live births
B. NA: 1:280
C. Asian: 1: 425
D. AA: 1:1700
E. Cleft palate alone 1:2000, less common
III. Genetics and etiology
A. Multifactorial, not a single gene disease
B. Genetic factors: chromosome 1, 17, 22
C. Environmental: retinoic acid, phenytoin, ethanol, maternal hypoxia
D. Folic acid deficiency induced
E. Syndromic association: 10-15% with CL/CP, up to 50% with CP
F. Associated conditions
1. Pierre
Reconstruction of craniomaxillofacial deformities
Based on skeletal growth potential
Surgerical movement of jaw structiures
Correct MANDIBULAR discrepencies
Sagitall ramous osteostmies
Sagittal split osteostomie *****************
Most common
RIF increased popularitie
Correct variety of mandibular deformities
Distraction osteogenesis **
Genioplasty **
Dramatic facial change with relaltively minor surgery
Morphology of bony chin and overlaying soft tissue must be corrected
Integrity of attached gingiva important
Can alter lip morphology and competence
Transoral vertical ramus
Adj
V shaped mandibles
Less neurosenosry loss
Possibility more stable
Dis
Experience, segment positioning problems, RIF more challenging possible limited to MMF
MAXILLARY DEFORMITIES
Le Fort I
Segmental consideration of max deformities
Surgical assisted rapid palatal expansion
Indications: transverse deficiency, arch length discrpency, no other vertical or AP abnormalities
ADJ: good stability, can be done outpatient/ in office
Segmental Le Fort
Other segmental options
Rationale
Transverse discrepancy
Vertical abnrormalities
Extraction space
Tooth angulation
Asymmetry
Dental arch form
Skeletal
Cleft lip and palate
I. Embryology
A. Failure fusion of MEDIAL MAXILLARY and NASAL PROCESS
B. Exam of 5-6 wk embryo reveals facial prominences
1. Nasomedial, nasolateral, maxillary, mandibular
2. Smaller units likely represent growth centers
II. Prevalence CL/P
A. CL +/- CP 1:700 live births
B. NA: 1:280
C. Asian: 1: 425
D. AA: 1:1700
E. Cleft palate alone 1:2000, less common
III. Genetics and etiology
A. Multifactorial, not a single gene disease
B. Genetic factors: chromosome 1, 17, 22
C. Environmental: retinoic acid, phenytoin, ethanol, maternal hypoxia
D. Folic acid deficiency induced
E. Syndromic association: 10-15% with CL/CP, up to 50% with CP
F. Associated conditions
1. Pierre