Oral Maxillofacial Surgery Orthognathic Surgery Term Paper

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Orthognathic Surgery is a procedure used for patients that have jaws that do not meet properly, which often coincides with teeth that do not seem to fit correctly with their jaws. This procedure is often used in conjunction with orthodontics, which straighten the teeth in preparation for the jaw surgery. People who require orthognathic surgery often have incorrectly positioned jaws, or an improper bite. Often the upper and lower jaws grow at different rates, which can lead to problems that affect speech, chewing, long-term oral health, as well as appearance. Also, jaw alignment can also be influenced by injury to the jaw and birth defects. Orthognathic surgery basically repositions the jaw (Center for Oral and Facial Surgery of Chattanooga, 2000). This type of surgery is also used for patients that require jaw repositioning in order to allow for the reconstruction of the dentition using implants (Jones, 2002).

More specifically, orthognathic surgery involves the "surgical manipulation of the elements of the facial skeleton to restore proper anatomic and functional relationship in patients with dentofacial skeletal anomalies (Patel, 2001). The historical roots of orthognathic surgery date back to 1846, and the ability to effectively reposition the mandible preceded the ability to reposition the maxilla (Patel, 2001). Therefore, patients with primary maxillary deformities would somewhat ineffectively undergo mandibular surgery because it was the only option. Orthognathic surgery, as a distinct, specialized procedure, did not emerge until the possibility of effectively repositioning the maxilla in a consistent manner was demonstrated by Obwegeser in 1965. In 1970, Obwegeser was the first to report simultaneous repositioning of the maxilla and mandible (Patel, 2001). The general goal of orthognathic surgery is to straighten the jaw. Patel (2001) explained how defining a straight jaw compared to a jaw that is not straight requires determination of the degree that a jaw deviates from a specified population norm. Furthermore, repositioning the jaw in order to achieve the restoration of the orthognathic form of a particular face is dependent on individual aesthetic characteristics of each patient.

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Careful, meticulous analysis of the soft tissue using clinical examination, photographs, skeletal evaluation with standardized radiographs, and dental evaluations are required for the correction of maxillofacial deformities (Patel, 2001). The orthognathic surgeon must work closely with the orthodontist, dentist, and other professionals in the formulation of an effective treatment plan (Patel, 2001). Successful outcomes from orthongnathic surgery depend on several factors that are present prior to, during, and after the procedure (Patel, 2001).

Anomalies that require orthognathic surgery are usually a result of differential growth of the upper and lower facial skeleton, which leads to an abnormal relationship between the upper and lower jaws (Patel, 2001). This differential growth may be due to genetic predisposition or congenital anomalies, such as some syndromic conditions (Patel, 2001). In addition, traumatic events, such as injury, can also lead to discrepancies in the relationship between the upper and lower jaws, which may result in the disturbance of normal subsequent growth. Other factors that may be involved in anomalies requiring orthognathic surgery include surgical resection, neoplastic growth, and iatrogenic radiation (Patel, 2001). The most common conditions requiring orthongnathic surgery are developmental anomalies (Patel, 2001).

Assessment to determine the necessity of orthognathic surgery should be focused on the evaluation of the relative size and position of all facial skeletal elements, as….....

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