Orthognathic Surgery of the Mandible

Abstract

Orthognathic surgery performed in conjunction with orthodontic treatment is commonly performed to correct skeletal irregularities and realign the maxillomandibular relationship to improve occlusal function and facial esthetics. A thorough understanding of soft tissue esthetics, skeletal and occlusal relationships, and surgical techniques is required to obtain successful results. Surgical techniques have evolved greatly throughout history, as technological advances such as virtual surgical planning have become available and widely used to obtain predictable movements with minimized complications. The aim of this article is to review the orthognathic surgical procedures of the mandible, with particular attention to the indications, contraindications, preoperative assessment, surgical technique, and possible complications encountered.

Keywords

orthognathic surgery - sagittal split osteotomy - prognathism

Publikationsverlauf

Artikel online veröffentlicht:
29. September 2021

• References

• 1 Obwegeser HL. Orthognathic surgery and a tale of how three procedures came to be: a letter to the next generations of surgeons. Clin Plast Surg 2007; 34 (03) 331-355
• 2 Naran S, Steinbacher DM, Taylor JA. Current concepts in orthognathic surgery. Plast Reconstr Surg 2018; 141 (06) 925e-936e
• 3 Awad M, Capasso R. Skeletal surgery for obstructive sleep apnea. Otolaryngol Clin North Am 2020; 53 (03) 459-468
• 4 Choi S-H, Hwang C-J, Baik H-S, Jung Y-S, Lee K-J. Stability of pre-orthodontic orthognathic surgery using intraoral vertical ramus osteotomy versus conventional treatment. J Oral Maxillofac Surg 2016; 74 (03) 610-619
• 5 Greaney L, Bhamrah G, Sneddon K, Collyer J. Reinventing the wheel: a modern perspective on the bilateral inverted ‘L’ osteotomy. Int J Oral Maxillofac Surg 2015; 44 (11) 1325-1329
• 6 Camacho M, Liu SY, Certal V, Capasso R, Powell NB, Riley RW. Large maxillomandibular advancements for obstructive sleep apnea: an operative technique evolved over 30 years. J Craniomaxillofac Surg 2015; 43 (07) 1113-1118
• 7 Hernández-Alfaro F, Guijarro-Martínez R. On a definition of the appropriate timing for surgical intervention in orthognathic surgery. Int J Oral Maxillofac Surg 2014; 43 (07) 846-855
• 8 Villegas C, Uribe F, Sugawara J, Nanda R. Expedited correction of significant dentofacial asymmetry using a “surgery first” approach. J Clin Orthod 2010; 44 (02) 97-103 , quiz 105
• 9 Yang L, Xiao Y-D, Liang Y-J, Wang X, Li J-Y, Liao G-Q. Does the surgery-first approach produce better outcomes in orthognathic surgery? A systematic review and meta-analysis. J Oral Maxillofac Surg 2017; 75 (11) 2422-2429
• 10 Costa F, Robiony M, Politi M. Stability of sagittal split ramus osteotomy used to correct Class III malocclusion: review of the literature. Int J Adult Orthodon Orthognath Surg 2001; 16 (02) 121-129
• 11 Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning. Part I. Am J Orthod Dentofacial Orthop 1993; 103 (04) 299-312
• 12 Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning–Part II. Am J Orthod Dentofacial Orthop 1993; 103 (05) 395-411
• 13 Chen Z, Mo S, Fan X, You Y, Ye G, Zhou N. A meta-analysis and systematic review comparing the effectiveness of traditional and virtual surgical planning for orthognathic surgery: based on randomized clinical trials. J Oral Maxillofac Surg 2021; 79 (02) 471.e1-471.e19
• 14 Harding J, Hartsfield Jr JK, Mian AS. et al. Accuracy of mandibular proximal segment position using virtual surgical planning and custom osteosynthesis plates. Int J Oral Maxillofac Surg 2021; S0901-5027 (21)00135-1
• 15 Yong CW, Tan TS, Lim RSK, Lim AAT. Surgical cutting guide for orthognathic anterior segmental subapical surgery. Br J Oral Maxillofac Surg 2021; 59 (01) 125-126
• 16 Borba AM, Borges AH, Cé PS, Venturi BA, Naclério-Homem MG, Miloro M. Mandible-first sequence in bimaxillary orthognathic surgery: a systematic review. Int J Oral Maxillofac Surg 2016; 45 (04) 472-475
• 17 Böckmann R, Meyns J, Dik E, Kessler P. The modifications of the sagittal ramus split osteotomy: a literature review. Plast Reconstr Surg Glob Open 2015; 2 (12) e271
• 18 Orloff G, Hale LTCR. Mandibular osteotomies in orthognathic surgery. J Craniofac Surg 2007; 18 (04) 931-938
• 19 Caldwell JB, Hayward JR, Lister RL. Correction of mandibular retrognathia by vertical L osteotomy: a new technic. J Oral Surg 1968; 26 (04) 259-264
• 20 Leung YY, Wang R, Wong NSM. et al. Surgical morbidities of sagittal split ramus osteotomy versus intraoral vertical ramus osteotomy for the correction of mandibular prognathism: a randomized clinical trial. Int J Oral Maxillofac Surg 2021; 50 (07) 933-939
• 21 McKenna SJ, King EE. Intraoral vertical ramus osteotomy procedure and technique. Atlas Oral Maxillofac Surg Clin North Am 2016; 24 (01) 37-43
• 22 Spiessl B. The sagittal splitting osteotomy for correction of mandibular prognathism. Clin Plast Surg 1982; 9 (04) 491-507
• 23 Agnihotry A, Fedorowicz Z, Nasser M, Gill KS. Resorbable versus titanium plates for orthognathic surgery. Cochrane Database Syst Rev 2017; 10: CD006204
• 24 Al-Moraissi EAM, Al-Hendi EA. Are bicortical screw and plate osteosynthesis techniques equal in providing skeletal stability with the bilateral sagittal split osteotomy when used for mandibular advancement surgery? A systematic review and meta-analysis. Int J Oral Maxillofac Surg 2016; 45 (10) 1195-1200
• 25 Al-Moraissi EA, Ellis E. Stability of bicortical screw versus plate fixation after mandibular setback with the bilateral sagittal split osteotomy: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2016; 45 (01) 1-7
• 26 Agbaje JO, Salem AS, Lambrichts I, Jacobs R, Politis C. Systematic review of the incidence of inferior alveolar nerve injury in bilateral sagittal split osteotomy and the assessment of neurosensory disturbances. Int J Oral Maxillofac Surg 2015; 44 (04) 447-451
• 27 Westermark A, Bystedt H, von Konow L. Inferior alveolar nerve function after mandibular osteotomies. Br J Oral Maxillofac Surg 1998; 36 (06) 425-428
• 28 Sousa CS, Turrini RNT. Complications in orthognathic surgery: a comprehensive review. J Oral Maxillofac Surg Med Pathol 2012; 24 (02) 67-74
• 29 Nesari S, Kahnberg K-E, Rasmusson L. Neurosensory function of the inferior alveolar nerve after bilateral sagittal ramus osteotomy: a retrospective study of 68 patients. Int J Oral Maxillofac Surg 2005; 34 (05) 495-498
• 30 Essick GK, Phillips C, Turvey TA, Tucker M. Facial altered sensation and sensory impairment after orthognathic surgery. Int J Oral Maxillofac Surg 2007; 36 (07) 577-582
• 31 Kang MG, Yun KI, Kim CH, Park J-U. Postoperative condylar position by sagittal split ramus osteotomy with and without bone graft. J Oral Maxillofac Surg 2010; 68 (09) 2058-2064
• 32 Te Veldhuis EC, Te Veldhuis AH, Bramer WM, Wolvius EB, Koudstaal MJ. The effect of orthognathic surgery on the temporomandibular joint and oral function: a systematic review. Int J Oral Maxillofac Surg 2017; 46 (05) 554-563
• 33 Wolford LM, Reiche-Fischel O, Mehra P. Changes in temporomandibular joint dysfunction after orthognathic surgery. J Oral Maxillofac Surg 2003; 61 (06) 655-660 , discussion 661
• 34 Steenen SA, Becking AG. Bad splits in bilateral sagittal split osteotomy: systematic review of fracture patterns. Int J Oral Maxillofac Surg 2016; 45 (07) 887-897
• 35 Steenen SA, van Wijk AJ, Becking AG. Bad splits in bilateral sagittal split osteotomy: systematic review and meta-analysis of reported risk factors. Int J Oral Maxillofac Surg 2016; 45 (08) 971-979
• 36 Proffit WR, Turvey TA, Phillips C. The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: an update and extension. Head Face Med 2007; 3: 21