Seminar 13 orthognathic surgery maxi/ dental implant courses by Indian dental academy

The infratemporal space is exposed by reflecting temporalis inferiorly. The medial canthal tendon are detached and tucked with suture.

Osteotomy begins just below the fronto nasal suture and passed medialy to divide ethmoid bone and through the medial wall of orbit it enters the orbital floor. The infraorbital neurovascular bundle is dissected out of bone and osteotomy is continued laterally to reach in the inferior orbital fissure. Now the lateral orbital wall is exposed and osteotomy begins at area of deficiency. This is connected to the anterior end of inferior orbital fissure. Now the pterygomaxillary junction is exposed through intraoral incision. Using chisel pterygoid plate is separated from maxilla. This is extended superiorly to inferior orbital fissure. The nasal septum is separated through the osteotomy site is the frontal region. The cut passes through perpendicular plate of ethmoid and vomer. At this level bleeding is less and chance of damage to olfactory fibres are less.

Mobilisation of maxillary malar complex is now done by using disimpaction forceps. By gentle rocking movements the segment is gradually moved to the required position.

Bone grafts are placed at lateral orbital rim and glabellar region and secured with wires. Onlay grafts are also placed for augmenting the infraorbital rim, frontal area etc; Medial canthal ligaments are replaced by non absorbable suture in a figure of 8 manner. Miniplates are applied at frontozygomatic osteotomy site, the fronto nasal osteotomy, and between zygomatic arch and zygoma. Before placing the miniplates inter maxillary fixation is applied in a slightly over corrected position. After rigid fixation this is removed. The bicoronal flap is now closed 2-3 suction drains are applied.