1,721,213 research outputs found
Le Fort III Osteotomy and Variations
No full textIn 1942, Gillies performed a Le Fort III reosteotomy for the first time on a patient with a Le Fort III fracture that had healed in malposition. Similar to the maxillary osteotomies, years passed before Tessier took up this technique in 1967 and separated the entire midface (high-level midface osteotomy) from the skull base and displaced it anteriorly or inferiorly, changing not only occlusal discrepancies but also the position of the bulbi and the nasal skeleton. This also resulted in a significant widening of the posterior airway. In bimaxillary corrections of today, the mandibular osteotomy is rarely performed simultaneously with a LeFort III osteotomy. This is due to the fact that the high-level midface osteotomies are usually performed at an early age and further growth must be awaited for any necessary correction at the LeFort I level or even in the mandible. In adulthood, a LeFort III osteotomy may be indicated in cases of malignant exophthalmia, for example, in which a setback correction of the mandible must be performed at the same time in order to correct the occlusion
Clinical Anatomy in Bimaxillary Osteotomies
No full textTo perform bimaxillary osteotomies, explicit knowledge of the anatomy of the maxilla, midface to skull base and that of the lower third of the face is essential. Obwegeser described osteotomy and relocation of the maxilla in 1965 and simultaneous bimaxillary osteotomy for correction of dysgnathia in 1970 (Obwegeser, Schweiz Monatsschr Zahnheilkd 75:365–371, 1965; Obwegeser, Schweiz Monatsschr Zahnheilkd 80:347–356, 1970). The downfracture method as it is used today was mainly studied and described by Bell et al. (Int J Adult Orthodon Orthognath Surg 3(1):23–52, 1988), Bell (Modern practice in orthognathic and reconstructive surgery. WB Saunders, Philadelphia, 1992), Moloney and Worthington (J Oral Surg 39(10):1278–1282, 1981), Obwegeser (Plast Reconstr Surg 43(4):351–365, 1969), and Spiessl (New concepts in maxillofacial bone surgery. Springer, Berlin, 1976). Today, the Le Fort I osteotomy is a standard procedure for the correction of maxillary or bimaxillary malocclusion. In the anatomy of the mandible, the course of the inferior alveolar nerve and the bone structures in the area of the gonion angle play the most important role. Measurement points and anatomical orientation aids serve to transfer the virtual reality of computerized planning to the surgical site
The Development of Bimaxillary Osteotomies of the Mandible and Maxilla/Midface:Introduction
No full textThe skeletal position of the jaws is genetically determined. Typical positional relationships of the jaws include classifiable occlusal forms and externally recognizable, almost typifying esthetic features of each face. Classification was essential for the development of systematic treatment concepts in order to enable structured treatments in the first place, which must also be communicated internationally. In addition to the statements in the Volumes I and II on malocclusions of the mandible and maxilla, cleft malformations extend the spectrum of growth disorders in the midface. The underdevelopment of the maxilla and midface, which is common in cleft patients, were also the reason for surgical corrective approaches in the midface region. In the presence of prognathism in the mandible, the combination of osteotomies in the midface/upper jaw and mandible was obvious. Today, at established centers in orthognathic surgery, the majority of orthognathic patients are treated with bimaxillary procedures
Segmental Osteotomies in the Maxilla
No full textThe last five decades have seen decisive advances in orthognathic surgery in terms of surgical techniques and outcomes in the treatment of dysgnathic maxillofacial malocclusions and deformities. However, despite brilliant technical innovations, the basic surgical principles have remained unchanged. The most common midface osteotomy techniques currently used to correct growth-related sagittal, vertical, and transverse deviations, as in syndromal and nonsyndromal maldevelopments, in various modifications, involve premaxillary segmental osteotomies and variably designed total Le Fort osteotomies in the Le Fort I, II, and III levels of the jaws. Although the monobloc osteotomies described by Tessier (Ann Chir Plast 12:273 1967) are also part of corrective surgery of the face, they are not part of standard orthognathic surgical procedures. Osteotomies must be performed in a safe way and preferably by intraoral approach to avoid scars on the face and at the same time provide adequate exposure to the skeleton. Essential structures must be preserved, the airway must remain free, and provision for appropriate nutrition postoperatively should be considered
Posterior Maxillary Segment Osteotomy-PMSO-Indications
No full textPosterior maxillary segment osteotomies distal to the canine/first premolar offer the possibility of closing the open bite by impaction of the posterior lateral maxillary segments in cases of vertical growth excess and presence of an open bite with sagittally correct conditions. Transverse crossbite situations can also be closed with the aid of posterior maxillary segment osteotomy. There are one-stage and two-stage procedures, although only one-stage procedures are used today. The posterior segment osteotomy technique can also be used in conjunction with a Le Fort I osteotomy
AMO:Wunderer Technique
No full textThe anterior maxillary osteotomy (AMO) is employed primarily to reposition the anterior dento-osseous segment posteriorly (setback). It is also used to move the segment superiorly or inferiorly as indicated. Wunderer formed a vestibular pedunculated anterior maxillary segment, while foregoing Wassmund’s palatal tunneling and palatal perfusion by forming a palatal mucosal flap. This significantly improved the overview of the palatal osteotomy zone, which was anatomically difficult to see
Anterior Maxillary Osteotomy:Management After Surgery
No full textAnterior maxillary osteotomies (AMOs) are technically demanding. Intensive support of the patient in the postoperative phase is crucial for success. Above all, masticatory overload must be avoided. Furthermore, wound healing disorders are not uncommon and, in conjunction with inappropriate behavior, can jeopardize the success of treatment
IVRO and Inverted-L-Osteotomy in the Mandible
No full textIVRO: Vertical osteotomies in the ascending ramus of the mandible are accessed via transoral approach. The osteotomy is performed from the lateral mandibular side and should be located dorsal to the lingula on the lingual side in order not to injure the neurovascular bundle of the mandibular canal. If angulated saws, burrs or Piezo surgery are not available an extraoral approach must be considered. The inverted L-osteotomy represents a variant of vertical osteotomies in the ascending mandibular ramus. It can be used when vertical displacements in particular do not play a role. Attention must be paid to the function of the temporal muscle. Inverted L and vertical ramus osteotomy can also be used when anatomic reasons prohibit BSSO. A longer period of intermaxillary fixation must be accepted
Immediate and Late Complications
No full textDespite all surgical advances in the field of orthognathic surgery, serious intra- as well as postoperative complications can occur with bimaxillary osteotomies. The standard use of 3D imaging in preoperative planning of orthognathic procedures has led to a better understanding of the anatomy, so that the incidence of these complications has decreased to low levels. The overall complication rate is reported to be 4%, with some studies in the literature reporting an overall complication rate of 6–9%. Immediate and indirect complications of orthognathic surgery include vascular complications (hemorrhage, arterio-venous fistulae), aseptic necrosis and loss of teeth, maxillary sinusitis, sensory deficits, nasal septal deviations, changes in the position of the nose, loss of tooth vitality/sensitivity, undesirable bad fractures of the mandible, but also towards the base of the skull and in the pterygoid region, ophthalmologic complications, maxillary mal-positioning, bony nonunion, maxillary instability, and relapse
Le Fort I Osteotomy - Development of Total Maxillary Osteotomies
No full textThe last five decades have seen decisive advances in orthognathic surgery in terms of surgical techniques and outcomes in the treatment of dysgnathic maxillofacial malocclusion and deformities. However, despite brilliant technical innovations, the basic surgical principles have remained unchanged. The most common midface osteotomy techniques currently used to correct growth-related sagittal, vertical, and transverse deviations, as in syndromal and nonsyndromal maldevelopments, in various modifications, involve Le Fort osteotomies in the Le Fort I, II, and III levels of the jaws and midface. Segmented and multisegmented maxillae are an option for transversal and vertical corrections. In the vast majority of midface osteotomies, the Le Fort I osteotomy is used. It is a safe and versatile procedure when performed correctly
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