West Coast Oral Surgery
Face and Jaw Reconstruction
Oral and maxillofacial surgeons treat a wide variety of
congenital, pathologic, and trauma-induced facial deformities. Modern surgical
techniques and materials allow oral and maxillofacial surgeons to optimize
function and esthetics of the face and jaws.
Modern surgical techniques of the face and jaws were developed
during World War II, the Korean War, and the Vietnam War. It was during this
period of time that oral surgeons and plastic surgeons were called upon to treat
the devastating facial injuries of our war heroes. During the often desperate
attempts to reassemble or reconstruct these injuries to the face and jaws, new
surgical techniques were born.
Surgeons can now disassemble the
bones of the face and skull and place them in their normal anatomic positions.
The advent of titanium plates and screws allows rigid fixation of the newly
positioned bones allowing surgeons to achieve greater anatomic movements that
were not possible prior to the advent of these devices.
The most common reconstructive
procedure of the face performed by oral and maxillofacial surgeons falls under
the category of orthognathic surgery. Orthognathic surgery is designed to
properly align the jaws relative to each other and to the skull.
In most cases, discrepancies in the
alignment of the dental arches can be treated with orthodontics (braces).
However, in some cases surgery is needed to correct these discrepancies. These
discrepancies are usually inherited. The following table illustrates problems
with jaw growth that require surgical correction.
hypoplasia with anterior-posterior discrepancy: the upper jaw has not
grown far enough forward resulting in an underbite.
||Lefort I osteotomy
with anterior advancement: a horizontal bone cut is made above the roots
of the upper teeth and the upper jaw is moved forward. Movements greater
than 6 mm often need additional bone grafting.
hyperplasia (vertical maxillary excess): the upper jaw has grown down too
far resulting in a "gummy" smile.
||Lefort I osteotomy
with superior repositioning: a horizontal bone cut is made above the roots
of the upper teeth and a horizontal segment of bone is removed. The upper
jaw is then repositioning upwardly and held with titanium plates and
discrepancy: the arch form of the upper jaw is constricted relative to the
Lefort I osteotomy: a standard Lefort I osteotomy is performed
and additional cuts are made in between the teeth and in the palate to
widen the upper jaw. Sometimes the application of an orthodontic palatal
expander is necessary to achieve the desired amount of widening.
hypoplasia with anterior-posterior discrepancy: the lower jaw has not
grown far enough forward leading to an overbite.
osteotomy: an oblique bone cut is made through the vertical portion of the
lower jaw (ramus) allowing forward advancement of the lower jaw. The bones
are then held together using titanium screws.
hyperplasia: the lower jaw has grown too far forward resulting in an
||Sagittal split or
vertical ramus osteotomy: bone cuts are made in the vertical portion of
the lower jaw allowing posterior repositioning of the lower jaw.
between upper and lower jaw is too great to be corrected with single jaw
surgery alone. Upper and lower jaw surgery is necessary using methods
|Microgenia: the chin
had not grown far enough forward.
||A horizontal bone
cut is made below the roots of the front teeth of the lower jaw allowing
the chin portion of the lower jaw to be separated and moved forward. The
chin bone is then held forward using a specially designed titanium plate.
One question that patients have when undergoing
jaw surgery is whether or not they will have to be wired shut. Wiring patients
shut after orthognathic surgery is infrequent due to the application of rigid
internal fixation using titanium plates and screws.
Oral and maxillofacial surgeons will also
participate in varying degrees to correct skull deformities (craniofacial
surgery) and to repair congenital deformities such as cleft lip and cleft
palate. The degree of participation by the oral and maxillofacial surgeon in
these types of surgery will depend on their own level of experience and