Orthognatic Surgery: The Princess of Maxillofacial Surgery
In spite of Maxillofacial Surgery apparently seeming to be confined to a limited area of intervention – head and neck – the truth is that its specifications are extensive. Maxillofacial Surgery can be performed with a view towards recovery and rehabilitation of various functions; respiratory, phonetic, pain, aesthetics and chewing:
■ Mouth – cysts, impacted teeth, bone atrophy of the jaws, benign and malignant tumours;
■ Face – jaws and soft structures of the face, e.g. congenital alterations and development of the face such as malformations, protruding jaw, receding chin, facial asymmetry, as well as all types of traumatology;
■ Neck – salivary gland disorders (paratoid, sub-maxillary) such as tumours, calculus, inflammations;
■ Aesthetic surgery of the face and neck.
Among the various craniomaxillofacial surgical techniques, one that has developed most in recent years is Orthognatic Surgery. This involves treatment protocols with the object of altering the position of the jaws (dentofacial deformities), bad positioning of the teeth (dental occlusion) and also facial aesthetics and airways (breathing).
Treatment for dentofacial deformities must be carried out by a highly specialised and diverse team of health professionals: Maxillofacial Surgeon, Orthodontist, Physiotherapist and Speech Therapist. The aim of these professionals is to guarantee a symmetric facial appearance, better functioning of the teeth and stability of the temporomandibular joint (jaws), as well the functionality of the breathing passages, one of the conditions being obstructive sleep apnoea.
In aesthetics, Orthognatic Surgery is mostly used in corrective surgery of the nose, eyebrows, lip line, protruding teeth and gums. These factors are responsible for and together determine the “facial features”.
More than anything else, what we want to do is rehabilitate the functional defect which is the patient’s reason for having consulted us. However, we always look to re-establish individual facial aesthetic, and not confine ourselves to restoring average or normal features as seen by the general population. In other words, we work to improve aesthetics and function, but stay true to the identity and personality of those who seek us out.
About 25% to 30% of the population has a variable degree of facial alteration, of which 50% will, eventually, seek Orthognatic Surgical treatment, says Dr. David Sanz. Up until a short time ago, these surgical procedures were quite traumatic, undertaken almost exclusively in extreme cases. Nowadays, due to surgical technique evolution and anaesthetics, together with the modern equipment available, this type of surgical procedure has resulted in shorter hospital stays and a quicker post-operative recovery. This has meant that a greater number of people are now resorting to this type of surgery, including those merely wanting to improve their appearance.
It is also important to explain that despite the nonexistence of a fixed protocol, equal and ideal for all cases, the majority of cases need to previously undergo orthodontic treatment (braces), which facilitate the correct positioning of the teeth before surgery. In other cases, surgery is the first step followed by orthodontic treatment, if necessary.
The most common indications for Orthognatic Surgery are jaw and/or mandibular facial skeletal deformities with malocclusions resulting in chewing difficulties.
As previously mentioned, orthodontics has an important role to play in Orthognatic Surgery before, during and after surgery. Its main goals are:
■ To increase surgical safety through Bolton Analysis and by treating maxillary and dental discrepancies;
■ Simplifying the surgical procedure by identifying the correct positioning of the teeth beforehand;
■ Correct dental problems before surgery in order to obtain the best surgical results;
■ To guarantee the best possible tooth containment.
The HPA Health Group has a team of maxillofacial surgeons, specialist in different skills and in various areas of intervention, namely Orthognatic Surgery.
By Dr David Sanz
Dr. David Sanz is Maxillofacial Surgeon at Hospital Particular do Algarve, Alvor and Gambelas and member of the European Association for Cranio-Maxillo-Facial Surgery. President of the Portuguese Society of Temporomandibular Disorders and Orofacial Pain