Orthognathic Surgery Flashcards
(37 cards)
What is the role of the GDP in orthognathic surgery?
Diagnose need for treatment, refer and be able to explain orthognathic surgery to patients, recognise it when patients are receiving treatment
What are patients typically complaining of when they are being assessed for orthognathic surgery?
Don’t like appearance due to prominence of one jaw and deficiency of the other
Functional deficit- difficulty chewing and biting
Who are the members of the MDT for orthognathic surgery?
consultant in orthodontics
technician
surgeon
psychologist
restorative dentist
SLT (CLP)
hygienist
What is the role of the psychologist in orthognathic surgery?
Early recognition of psychological problems
-> Dysmorphophobia & Neurosis
Understand real motivation for surgery
Help with postsurgical depression and psychological adaptation to the new face
What are the aspects to consider when assessing a patient psychologically for orhtognathic surgery?
Previous psychiatric problems
-> existing disorders (anxiety & depression
sleeping patterns, eating habits)
Systemic symptoms linked to psychiatric issues
-> shortness of breath, abdominal pain, nausea
Is the patient doctor shopping?
What is body dysmorphic disorder?
Obsession over minor defect or non-existent deformity
-> exaggerated response
What is the role of the technologist in orthognathic surgery?
Model surgery planning
Provide occlusal wafer to guide the surgery
Building 3D skull models
Digital Prediction of final occlusion
What is the role of the orthodontist in orthognathic surgery?
Early recognition of dento-facial abnormalities
Comments on quality of occlusion and how this can be improved
Pre/post orthodontic treatment may be required (this must be coordinated and decided on with input with surgeon)
What must be considered when planning orthognathic surgery?
What the soft tissue change is to be
-> how much hard tissue movement would be required to achieve this (teeth are attached and still need to be class 1)
What is assessed when carrying out an EO exam for orthognathic surgery?
Aesthetic proportions
Vertical asymmetry
Lip and Nose morphology
Horizontal asymmetry (Mediolateral)
Antero-posterior relationship
What factors are involved in aetiology of facial deformities?
Family- TCS
Racial- normal in Africa to have prominence of lips (in white populations this is unusual- may be treated)
Congenital- hemifacial microsomia
Untreated trauma
Developmental- happens through life due to over/undergrowth
What is likely to be the cause of increased size of mandible and altered occlusion in middle aged patients?
Acromegaly- excess GH from pituitary adenoma (requires neurosurgery)
What is the difference between a horizontal and vertical asymmetry?
Vertical asymmetry- one side is taller than the other
Horizontal- one side is broader than the other
May split each half into 3 parts to help identify
Deviation of mandible (can be other parts of the face too)
Document this on assessment
What is the difference between a horizontal and vertical asymmetry?
Vertical asymmetry- one side is taller than the other
Horizontal- one side is broader than the other
May split each half into 3 parts to help identify
Deviation of mandible (can be other parts of the face too)
Document this on assessment
How should the lips be arranged in terms of proportion ideally?
Lips- upper 1/3 and lower lip 2/3 of total length
-> At rest we hope to show 2mm of upper teeth (some patients show whole crown length and have gummy smile when smiling)
How do we evaluate the chin position in an orthognathic surgery assessment
Look at degree of deviation and mentalis competence
What is checked in an IO exam prior to orthognathic surgery?
General dental assessment
Occlusal relationship
Central line discrepancy relative to the face
OJ/OB
Crossbite
Occlusal canting
Incisors’ inclination
Crowding and spacing
Tongue size, mobility, speech pattern
Cleft cases and velopharyngeal incompetence
Which special investigations may be utilised for orthognathic surgery?
Radiographs
Study models
Photographs- 2D/3D
What radiographic modalities may be used in orthognathic surgery?
OPT
Lateral Cephs- show relationship of jaw bones
PA cephs- vertical and lateral asymmetry
Periapicals
Occlusal
CBCT- ICAT machine
Why are OPTs useful for orthognathic surgery?
It shows us- impacted teeth, unerupted teeth, infection, root morphology, tooth morphology, shape of bone (trabeculation pattern)
What is CBCT useful for looking at prior to orthognathic surgery?
Can be used for prediction planning
Shows ID nerve, position of impacted teeth
-> Can look at coronal, axial and sagittal slices
What is used to mount study models used in orthoignathuic surgery on articulators?
Facebow registration
What are the uses of study models in orthognathic surgery?
Study occlusion
Orthodontic analysis
Orthognathic surgery planning
Model surgery
Occlusal wafer production for surgery
Assess surgical changes
Assess long-term stability/relapse
Which 2D photographs are taken prior to orthognathic surgery?
2D full face at rest and smiling
Right and left profiles
Teeth in occlusion (anterior and posterior)
1:1 profile photograph
