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ORTHOGNATHIC SURGERY

Orthognathic surgery is surgery to reposition the maxilla (upper jaw or jawbone), the mandible (the lower jaw or jawbone), and the dentoalveolar segments (teeth and their sockets) to achieve facial and occlusal balance. One or more segments of the jaw(s) can be simultaneously repositioned to treat various types of malocclusions (bad bite) and jaw deformities. It is also used in treatment of congenital conditions like cleft palate. Bones can be cut and re-aligned, held in place with either screws or plates and screws.

Relationship between the maxilla and mandible

Orthognathic surgery is performed by an oral and maxillofacial surgeon almost always in collaboration with orthodontic treatment, often including braces before and after surgery, and retainers after the final removal of braces. Orthognathic surgery is often needed after reconstruction of cleft palate or other major craniofacial anomalies.

Unless medical conditions necessitate that the surgery be performed earlier, orthognathic surgery is often delayed until after all of the permanent teeth have erupted. To improve the aesthetic results, orthognathic surgery can be combined with soft tissue contouring in adult patients.

TYPES OF ORTHOGNATHIC PROCEDURES
•  Mandibular Sagittal Split Osteotomy
•  Maxillary osteotomy surgery or Le Fort Osteotomy (Le Fort I osteotomy, Le Fort II osteotomy and Le Fort III ostetomy)
•  Genioplasty (chin surgery)

DETAILS OF THE PROCEDURE
Usually surgery is performed under general anaesthetic and using nasal tube for intubation. The surgery might involve one jaw or both the jaws during the same procedure. The modification is done by making cuts in the bones of the mandible and / or maxilla and repositioning the cut pieces in the desired alignment. The surgeon is often able to go through the inside of the mouth without having to cut the skin.

Cutting the bone is called osteotomy and in case of performing the surgery on the two jaws at the same time it is called a bi-maxillary osteotomy (two jaws bone cutting) or a maxillomandibular advancement. The bone cutting is traditionally done using special electrical saws and burs, and manual chisels, and most recently by using ultra-sound waves (though not used on a wide scale). The maxilla can be adjusted using a ” Lefort I” level osteotomy. Sometimes the midface can be mobilised as well by using a Lefort II, or Lefort III osteotomy. These techniques are utilized extensively for children suffering from certain craniofacial abnormalities such as Crouzon syndrome.

The jaws will be wired together (inter-maxillary fixation) using stainless steel wires during the surgery to insure the correct re-positioning of the bones. This in most cases is released before the patient wakes up after the surgery.

COST OF ORTHOGNATHIC SURGERY
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