Dental-maxillofacial Deformities

Dental-maxillofacial DeformitiesDental-maxillofacial DeformitiesDental-maxillofacial DeformitiesDental-maxillofacial Deformities

Dept. of Oral & Maxillofacial SurgeryDept. of Oral & Maxillofacial Surgery

School of StomatologySchool of Stomatology

LI Qing-yunLI Qing-yun

Dept. of Oral & Maxillofacial SurgeryDept. of Oral & Maxillofacial Surgery

School of StomatologySchool of Stomatology

LI Qing-yunLI Qing-yun

Phase IPhase IPhase IPhase I Presurgical treatmentPresurgical treatment

• Orthodontics• Surgical plan

• Orthodontics• Surgical plan

Phase IIPhase IIPhase IIPhase II Surgical treatmentSurgical treatment

• Mandible• Maxilla

• Mandible• Maxilla

Phase IIIPhase IIIPhase IIIPhase III Postsurgical treatmentPostsurgical treatment

• Orthodontics• restorative/prosthetic treatment• follow-up

• Orthodontics• restorative/prosthetic treatment• follow-up

Presurgical Treatment PhasePresurgical Treatment Phase

Presurgical orthodontics

Final surgical planning

Presurgical orthodontics

Final surgical planning

Presurgical Treatment PhasePresurgical Treatment Phase

Objectives —— Presurgical orthodontics Objectives —— Presurgical orthodontics

Decompensation

dental compensation for skeletal deformity

angulation of teeth

accentuate the deformity

Decompensation

dental compensation for skeletal deformity

angulation of teeth

accentuate the deformity

Objectives —— Presurgical orthodontics Objectives —— Presurgical orthodontics Alignment of the arches Compatibility of the arches

Alignment of the arches Compatibility of the arches

Final Surgical Planning Final Surgical Planning Visual Treatment Objective, VTO Visual Treatment Objective, VTO

Final Surgical Planning

Computerized imaging CASSOS

Final Surgical Planning Final Surgical Planning

Model Surgery Model Surgery

Exact surgical movements

(distance, direction)

Postoperative occlusion

Exact surgical movements

(distance, direction)

Postoperative occlusion

articulatorarticulator

Face-bowFace-bow

Surgical Treatment PhaseSurgical Treatment Phase

Surgeries for maxillary deformity

Surgeries for mandibular deformity

Surgeries for maxillary deformity

Surgeries for mandibular deformity

Surgeries for maxillary deformitySurgeries for maxillary deformity

Segmental osteotomy (Anterior / Posterior) Segmental osteotomy (Anterior / Posterior)

Indications:

- maxillary protrusion

- marked protrusion of

maxillary teeth

- open bite

Indications:

- maxillary protrusion

- marked protrusion of

maxillary teeth

- open bite

Surgeries for maxillary deformitySurgeries for maxillary deformity

Le Fort I osteotomy

(total or segmental)

Le Fort I osteotomy

(total or segmental)

Indications:

- maxillary deformities

- mandibular deformities

Indications:

- maxillary deformities

- mandibular deformities

Surgeries for maxillary deformitySurgeries for maxillary deformity

Le Fort I osteotomy Le Fort I osteotomy

Le Fort II or III osteotomy Le Fort II or III osteotomy

Indications:

- midface deficiency

Indications:

- midface deficiency

SNA 88°

SNB 92°

ANB 4°

SNA 88°

SNB 92°

ANB 4°

Surgeries for mandibular deformitySurgeries for mandibular deformity

Sagittal split ramus osteotomy,

SSRO

Sagittal split ramus osteotomy,

SSRO

Indications:

- mandibular excess

- mandibular deficiency

- mandibular asymmetry

Indications:

- mandibular excess

- mandibular deficiency

- mandibular asymmetry

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rotaterotate

Surgeries for mandibular deformitySurgeries for mandibular deformity

Vertical ramus osteotomy Vertical ramus osteotomy

Indications:

- mandibular excess

- mandibular asymmetry

(combined with SSRO)

Indications:

- mandibular excess

- mandibular asymmetry

(combined with SSRO)

backback

Surgeries for mandibular deformitySurgeries for mandibular deformity

Subapical osteotomy Subapical osteotomy

Indications:

- bimaxillary protrusion / open bite

- leveling the plane of occlusion

- uprighting anterior teeth

Indications:

- bimaxillary protrusion / open bite

- leveling the plane of occlusion

- uprighting anterior teeth

Surgeries for mandibular deformitySurgeries for mandibular deformity

Body osteotomy Body osteotomy

Indications:

- mandibular excess (body)

combined with ramus procedure or not

- open bite / spee’s curve reduction

Indications:

- mandibular excess (body)

combined with ramus procedure or not

- open bite / spee’s curve reduction

Surgeries for mandibular deformitySurgeries for mandibular deformity

genioplasty genioplasty

Indications:

- chin deformities

Indications:

- chin deformities

Perioperative complicationsPerioperative complications

Airway obstruction

edema / bleeding / displacement… …

Bleeding

Infection

Necrosis of teeth / bone

Healing

Injury of nerve

Airway obstruction

edema / bleeding / displacement… …

Bleeding

Infection

Necrosis of teeth / bone

Healing

Injury of nerve

Postsurgical Treatment PhasePostsurgical Treatment Phase Completion of orthodontics

Postsurgical restorative/prosthetic treatment

Follow-up

Completion of orthodontics

Postsurgical restorative/prosthetic treatment

Follow-up

SNA 88°

SNB 81°

ANB 7°

SNA 88°

SNB 81°

ANB 7°

SNA 84°

SNB 81°

ANB 3°

SNA 84°

SNB 81°

ANB 3°

SNA 88°

SNB 92°

ANB -4°

SNA 88°

SNB 92°

ANB -4°

SNA 88°

SNB 86°

ANB 2°

SNA 88°

SNB 86°

ANB 2°

SNA 88°

SNB 86°

ANB 2°

SNA 88°

SNB 86°

ANB 2°