Orthognathic (jaw) surgery to correct the size and shape of the jaw is often performed in conjunction with orthodontic alignment of the teeth to restore optimal facial harmony. The maxilla (upper jaw), the mandible (lower jaw), or both jaws may require surgical correction to treat jaw deformities resulting from either developmental problems or following severe trauma. Orthognathic surgery not only improves facial appearance, but also ensures the teeth meet correctly and functions properly.
The Skeletal foundation of the human face serves to a large extent as the invisible determinant of the perceived facial appearance. Aesthetic surgery performed on facial soft tissue alone without dual consideration for skeletal structural abnormalities that may be co-existent or at least partially responsible for the patient’s undesired facial appearance will consistently fall short of achieving the best possible outcome. Correction of facial skeletal disproportions and disharmony necessitates a keen aesthetic sense and a respectful awareness of the impending soft tissue changes that can translate from making alterations to the underlying skeletal base.
Where dental occlusion and skeletal stability were once the surgical priorities in orthognathic surgery, the field has evolved such that most patients who present for orthognathic surgery do so out of aesthetic discontentment, and aesthetic considerations have come to dictate the goals of surgery. Advancements in surgical technique, a paradigm shift in surgical planning away from rigid cephalometric measurements to that guided by the surgeon’s aesthetic sense, and improved patient care has realized more consistent and favorable outcomes in aesthetic orthognathic surgery.
An increasing number of patients, especially young women, are presenting for correction of dentofacial deformities. Conditions that are particularly common include mandibular prognathism, bimaxillary protrusion, and facial asymmetry. Optimal management of these patients requires a partnered approach, with equal contribution and shared responsibility from both the surgeon and the orthodontist. Effective collaboration between the surgeon and orthodontist is essential to attaining a balanced outcome that incorporates both facial and dental ideals.
The Le Fort I osteotomy of the maxilla (upper jaw), bilateral sagittal split of the mandible (lower jaw), anterior segmental osteotomy of the maxilla and/or mandible, and the osseous genioplasty are the most commonly performed orthognathic procedures. Dr Goh’s famillarity with their utility is fundamental to minimizing potential complications and attaining optimal aesthetic and functional outcome.