Aesthetic Considerations in Orthognathic Surgery Mr Paul Johnson Guildford, England XX1 COBRAC Vitoria-ES 2011
Is Orthognathic Surgery Cosmetic Surgery?
Yes and No
Orthognathic Surgery The Treatment of Dentofacial Deformity
Aims Correction of dentofacial deformity To give a functional occlusion To achieve the best aesthetic result
Paradox Indication is usually occlusal Result usually judged by the aesthetic outcome
Mandibular Procedures Maxillary Procedures Chin Rhinoplasty Cheek implants
• Bilateral Sagittal Split • Le Fort 1 • Sliding Genioplasty
Pertaining to beauty
A quality which delights the senses
Place Time Fashion
Beauty is in the eye of the beholder But are their any rules?
Treatment planning So how do you decide what the correct operation is?
Cephalometric analysis. Yes but what is really important?
Cephalometics •Skeletal pattern •Incisor angulation •Face Height •Maxillary Mandibular Plane Angle
Think aesthetics Starting point End point What to do What not to do
Assess the patient. Consider the immediate effects of planned movements. Consider long term effects.
Chapter 4. Evaluation Of Facial Soft Tissues David Sarver, William Profitt, James Ackerman
Clinical assessment of facial form • • • • •
Facial balance. Thirds and fifths Lips Chin\Nose balance Nose Cheekbones and inferior orbital rims.
Facial thirds and fifths
The Lips • Lip growth lags behind skeletal growth. Therefore lip competence cannot be assessed until growth complete. • Lip thickness greater in females than males. • Lip thickness decreases with age. • Lip balance.
Upper lip â€“ incisor relationship Incisal show with the upper lip at rest 0 â€“ 4 mm. Female > male If > 4mm vertical maxillary excess If < 0mm vertical maxillary insufficiency But must assess in conjunction with mandibularmaxillary plane angle and facial thirds. Beware of the short upper lip and short clinical crowns.
Chin â€“ nose balance
Nasal aesthetics Nasolabial angle Alar width Paranasal fullness
Nasolabial Angle 100-120 degrees Female > male
So What effects do osteotomies have on facial appearance?
Advancement • Pogonium forward • Pogonium downward (if curve of Spee maintained) • Labio-mental angle becomes more obtuse • Improved soft tissue support over jaw and neck
Mandibular Setback • Chin point back • Labiomental angle more acute • Decreased soft tissue support
Nasal Aesthetics and Le Fort 1 • • • • • • •
Nose forward Nose tip angulation Nares exposure increased Upper lip forward and flattened Subnasale forward Columella forward Increased alar width
Adverse Aesthetics following treatment of AOB by maxillary impaction. The ‘Miss Piggy’ deformity
Facial Age Changes Loss of soft tissue volume and skin elasticity and gravitational effects. Loss of lip fullness Loss of curve of upper lip Loss Increase Increase in upper lip length Loss of face height Decrease in upper incisor show Increase in lower incisor show Nasal tip moves inferiorly and nasolabial angle becomes more acute Deepening of nasolabial grooves and marionette lines
Compensation for Age Changes Leave soft tissues oversupported. – Maintains upper lip support – Decreases nasolabial fold development and marionette lines
Conservative maxillary impaction. – Maintains incisal show
Clinical Assessment Nasal hump Zygomatic insufficiency Acute nasolabial angle Undersupported upper lip Oversupported lower lip
Orthodontic Plan Decompensation Alignement Coordination
Surgical Plan Maxillary advancement Cheek implants Rhinoplasty
Bird-face deformity BirdPost distraction
Conclusions Think aesthetics in orthognathic surgery Anticipate age changes
Is orthognathic surgery cosmetic? Yes and no.
Mr Paul Johnson
Published on Oct 18, 2011
XX1 COBRAC Vitoria-ES 2011 Mr Paul Johnson Guildford, England Is OrthognathicSurgery Cosmetic Surgery? Cosmetic Surgery? Yes and No The Trea...