Title: Contemporary orthognathic surgery in the treatment of dentofacial deformities
Abstract:
The number of patients receiving the benefits of orthognathic surgery has grown exponentially. Currently, the indications are not restricted only to occlusal improvement, but also an improvement in facial aesthetics and mainly respiratory improvements. Significant advances in surgical technique contribute to achieving these results, as well as to a better postoperative period. Among them we can mention digital virtual planning and increasingly less invasive techniques for this treatment modality. Preoperative planning is essential for surgical success. Through facial analysis, we plan skeletal movements and these will be responsible for changes in the upper airway and improved facial aesthetics. Large advances of the maxillomandibular complex and accentuated rotations of the occlusal plane are necessary to achieve the best results. This can often define the choice between conventional orthognathic surgery or minimally invasive orthognathic surgery. The choice between these two techniques can also define success in the immediate and longterm postoperative period. Current literature defines the counterclockwise rotation of the occlusal plane performed in orthognathic surgery as the gold standard for the treatment of obstructive sleep apnea. This surgical movement provides an anterosuperior movement for the mandible with significant traction of the suprahyoid muscles and consequently an increase in the area and volume of the pharynx. In addition to choosing the surgical modality, for long-term success it is necessary to evaluate the anatomy of the temporomandibular joints. Patients with anteroposterior deficiency of the maxillomandibular complex, subjected to major advances, need a thorough evaluation of this joint. Previous degeneration of this joint, as well as detachments of the articular disc when not treated prior to orthognathic surgery, can promote a recurrence of the dentofacial deformity through the evolution of wear on the skeletal structure in the area of the joint. Finally, digital virtual planning is one of the greatest contributions to the current state of orthognathic surgery. In addition to being able to carry out all pre-operative studies, we can perform a previous virtual surgery, where all surgical movements are simulated and studied. This, in addition to helping to reduce surgical time, allows us to plan the final and expected result of this surgery. It allows discussing possible changes and expected results with patients and orthodontists, thus making surgery safer and more predictable.
