Current Approaches in Orthognathic Surgery

The orthognathic surgical procedures are performed for the correction of abnormalities of the facial skeleton that are present from the birth or arise during growth or acquired secondarily during lifetime. Due to the cover of this book as orthodontics, I would prefer to summarize some commonly used techniques to correct the dentofacial deformities. Even we have published all these techniques at their popular time with our orthodon- tist colleagues; skeletal anchor systems, some basic interdental osteotomies, or complex mechanics that are applying orthopedic corrective forces are currently being used by the orthodontists rather than surgeons. Le Fort I osteotomy in maxilla and sagittal split ramus osteotomies (SSRO) in mandible are commonly used techniques to solve the defor- mity problems of the facial skeleton; therefore, the scope of this chapter is going to be including my personal experience and some technical details with Le Fort I and SSRO. edema, paresthesia, and pain and patient satisfaction and operation times of orthognathic surgical operations performed with conventional drills and piezoelectric surgery. A total of 200 patients with completed skeletal growth and malocclusion due to mastication dysfunc tions were retrospectively evaluated. These patients were divided into two main groups named control group and piezo group. Each group was divided into three subgroups about the type of surgical procedure performed, which are, Le Fort 1 subgroup, bilateral sagittal split ramus osteotomy (BSSRO) subgroup, and bimaxillary subgroup. The evaluation between the groups is made at postoperative 1 day, 1 week, and 1, 3, and 6 months. To evaluate each subgroup, the data acquired from a specific subgroup was compared to the subgroup with the same name in the other main group. After piezoelectric surgery edema, neurosensory dys-function and pain levels were found to be lesser than conventional techniques. Patient satisfaction was found to be higher in piezoelectric surgery patients. When operation times were compared, piezoelectric surgery was discovered to take longer to finish the osteotomy because of its lower cutting efficiency. This study shows that the selective cutting ability of the piezo electric surgery device provides an extremely safe osteotomy for patients by performing a selective osteotomy, thus preserving critical adjacent soft tissues [10]. The piezosurgery begins with the medial aspect of the ramus just over the mandibular foramina, and the cutting tip of the handpiece will be directed 45° angle at posterior start point with around a depth of 2 mm and comes anteriorly. On the ascending ramus, the tip is applied without angulation as deep as possible through the cortex to reach the medullary bone and declines inferiorly on the external oblique linea. If the procedure is a mandibular setback surgery, it is better to extend the osteotomy till the anterior border of the external oblique linea which would help the removal of bony segment for desired positioning of the distal segment similar to Hunsuck-Epker modification. In my experience if a rotational or laterognatic corrective sagittal split osteotomy is going to be performed, the anterior vertical osteotomy