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ORTHOGNATHIC MANDIBULAR ORTHOGNATHIC MANDIBULAR SURGERY SURGERY Dr V.RAMKUMAR Dr V.RAMKUMAR CONSULTANT CONSULTANT DENTAL DENTAL &FACIOMAXILLARY &FACIOMAXILLARY SURGEON SURGEON REG NO:4118- REG NO:4118- TAMILNADU- TAMILNADU- INDIA(ASIA) INDIA(ASIA)

7 mandibular osteotomies

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Page 1: 7 mandibular osteotomies

ORTHOGNATHIC MANDIBULAR ORTHOGNATHIC MANDIBULAR SURGERYSURGERY

Dr V.RAMKUMARDr V.RAMKUMAR CONSULTANT CONSULTANT

DENTAL DENTAL &FACIOMAXILLARY &FACIOMAXILLARY SURGEONSURGEON

REG NO:4118-REG NO:4118-TAMILNADU-TAMILNADU-INDIA(ASIA)INDIA(ASIA)

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Symmetrical malformationsSymmetrical malformationsCongenitalCongenital

Mand. PrognathismSevere RetrognathismCondylar Agenesis

AcquiredAcquiredInfl. disease of condyles

Severe Condylar Trauma

Etiology

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EtiologyAsymmetrical MalformationsAsymmetrical Malformations

CongenitalHemihypertrophy of mand.Condylar HyperplasiaCraniofacial Microsomia

AcquiredInfectionsTraumaAnkylosis

Pathological CausesPathological Causes Plexiform Neurofibromatosis

Fibrous Dysplasia

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Quantitative CriteriaQuantitative Criteria

Type of Surgery Bone: soft tissues

Le fort I = 3 : 1 Le fort II = 3 : 2 Le fort III = 1 : 1 Aug Genioplasty = 1 : 1(+/-) Slid. Genioplasty = 1 : 1(consistent)

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Quantitative CriteriaQuantitative Criteria

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The Rule of Fifths The Rule of Fifths

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Mandibular DeficiencyMandibular Deficiency

I. Microgenia = I. Microgenia = Simple retrusion of chin

II. Retrogenia = Retrogenia = Deficient chin profileStevens(1968)

I Degree = < 10 mm II Degree = 10 – 20 mm

III Degree = > 20 mm

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III . Sagittal Mandibular Deficiencies

IV. Mandibular deficiencyLow Angle typeHigh Angle type

Cont…

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Mandibular ExcessMandibular Excess I. Asymmetric Mand Protrusion

With Open biteWithout Open bite

II . Unilateral Condylar HyperplasiaElongation of condylar neckDeviation of chin to normal sideLip line slopes to affected side & cross bite on unaffected side

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Mandibular ExcessMandibular Excess

III . Mandibular HemihypertrophyLower border at lower level than affected sideMarked Convexity or BowingLittle or no displacement of chinNo midline deviation

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GENERAL PRINCIPLESGENERAL PRINCIPLES

Access ( Primarily Intra-oral).Adequate Exposure.Good Postoperative Cosmesis.Good Postoperative Function.Preservation of essential structures.Maintenance of adequate nutrition and waste elimination.

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Mandibular OsteotomiesMandibular Osteotomies

Body osteotomy (ostectomy)Body osteotomy (ostectomy) Sowray-Haskell Sowray-Haskell

modificationmodification Vertical subsigmoid osteotomyVertical subsigmoid osteotomy

Introral (IVRO)Introral (IVRO) ExtraoralExtraoral

Sagittal split osteotomySagittal split osteotomy Obwegeser/Dalpont; Obwegeser/Dalpont;

Bell/Epker; HunsuckBell/Epker; Hunsuck Inverted L-ramus osteotomyInverted L-ramus osteotomy

VariationsVariations Post condylar graftsPost condylar grafts

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Mandibular setback osteotomiesMandibular setback osteotomies

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Mandibular advancement Mandibular advancement osteotomiesosteotomies

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Bilateral Sagittal Split OsteotomyBilateral Sagittal Split Osteotomy Introduced by Trauner & Obwegeser(1957) Obwegeser ( 1964) Modified by Dal Pont(1961) &

Hunsuck(1968) Use of natural plane of cleavage between

buccal and lingual plates Movements possible: Ant, Post & Rotations.

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TechniqueTechniqueIncision & ExposureCorticotomyCorticotomy checkDivision by osteotome ( Wedge action)Nerve identification & preservationRelease of musculatureControl of bleedingFixationClosure Post-op care

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Bilateral Sagittal Split OsteotomyBilateral Sagittal Split Osteotomy

Bony Cuts

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Bilateral Sagittal Split OsteotomyBilateral Sagittal Split Osteotomy

ADVANCEMENT

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The sagittal split osteotomy

Obwegeser/dal Pont

Bell/Epker procedure

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Screw fixation for the sagittal split

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The sagittal split advancement

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Plate fixation

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The reconstruction plate

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Bilateral Sagittal Split OsteotomyBilateral Sagittal Split Osteotomy

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Extraoral vertical subsigmoid Extraoral vertical subsigmoid osteotomyosteotomy

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Vertical Ramus Osteotomy

Coronoidectomy

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Retraction for the extraoral and intraoral V.S.S.

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The inverted L osteotomy

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Bone Grafting

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Incision line – body ostectomyIncision line – body ostectomy

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Ramus Osteotomy

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Angle Osteotomy

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GenioplastyGenioplasty

Indications

Retrogenia

Bird-face appearance

Prominent gonial angle

Shortened vertical ramus height

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ProceduresProcedures

Sliding Horizontal Osteotomy

Double Horizontal Osteotomy

Hinge sliding Osteotomy

Oblique ( advancement) Osteotomy

Jumping Genioplasty

Wedge Osteotomy

Propeller Genioplasty

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ProceduresProcedures

Triple Osteotomy

Quadruple Osteotomy

Genioplasty using Grafts

Kole’s Procedure

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Lower Labial Segmental OsteotomiesLower Labial Segmental Osteotomies

Anterior Mandibular Subapical Osteotomies (AMSO)

AMSO with vertical alveolar osteotomy Vertical alveolar osteotomy Kole’s Procedure Symphyseal Ostectomy Anterior Mandibuloplasty

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Lower Sub-apical

Osteotomy

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IncisionsIncisions

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Bur hole Bur hole MarkingsMarkings

ExposureExposure

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Osteotomy Osteotomy cutscuts

Nerve Bundle Nerve Bundle RepositioningRepositioning

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Kole’s ProcedureKole’s Procedure

Correction of minor degrees of AOB. Class 3 malocclusion Inferior border into defect caused due to

upward movement of ant. segment Chin augmentation Decreased ant. facial height

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