Preface: Techniques in Orthognathic Surgery ix
Steven M. Sullivan
Le Fort I Osteotomy 1
Steven M. Sullivan
Introduction 1
Surgical technique 1
Complications 13
Summary 13
Le Fort III and Le Fort II Osteotomies 15
David D. Vu and Paul S. Tiwana
Introduction 15
Indications 16
Craniofacial dysostosis 18
Midface deficiency 18
Technique 18
Subcranial Le Fort III osteotomy 19
Modified Le Fort III osteotomy 20
Pyramidal Le Fort II osteotomy 22
The Bilateral Sagittal Split Mandibular Ramus Osteotomy 27
Johan P. Reyneke and Carlo Ferretti
Introduction 27
Step 1—infiltrate the soft tissue with vasoconstrictor 27
Step 2—the soft tissue incision 27
Step 3—buccal subperiosteal dissection 28
Step 4—superior subperiosteal dissection 28
Step 5—exposure of the lingual 28
Step 6—medial ramus osteotomy 28
Step 7—sagittal osteotomy 28
Step 8—buccal osteotomy of the mandibular body 29
Step 9—drill holes for a holding wire 29
Step 10—drill a hole for the condylar positioner 29
Step 11—place reference marks 30
Step 12—lavage 30
Step 13—define the osteotomy 30
Step 14—splitting the mandible 30
The bad split 32
Step 15—stripping the pterygomasseteric sling 33
Step 16—stripping the medial pterygoid muscle and stylomandibular ligament 33
Step 17 33
Step 18—smooth the contact areas of the segments 34
Step 19—place the holding wire 34
Step 20 34
Step 21—mobilize the bone segments 34
Step 22—place the teeth into the planned occlusion 34
Step 23—remove bone from the proximal segment in class III mandibular setback cases 34
Step 24—positioning the condyle 34
Step 25—tightening the holding wires 34
Step 26—placement of the trocar 35
Step 27—drill the holes and for the place of rigid fixation 35
Step 28—remove the intermaxillary fixation and check the occlusion 35
Step 29—intraoperative diagnosis of a malocclusion 36
Step 30—Place intra and extraoral sutures 36
Step 31—place intermaxillary elastics 36
Step 32—apply a pressure bandage 36
Intraoral Vertical Ramus Osteotomy Procedure and Technique 37
Samuel J. McKenna and Emily E. King
Introduction 37
Surgical technique 37
Surgical procedure 38
Potential complications 41
Immediate postoperative care 42
Rehabilitation and recovery 42
Summary 42
Implications of Sequencing in Simultaneous Maxillary and Mandibular Orthognathic Surgery 45
Daniel Perez and Edward Ellis III
The case for mandibular surgery first 45
Planning mandibular surgery first 51
Potential disadvantages of performing mandibular surgery first 52
Computer-Assisted Surgical Simulation for Concomitant Temporomandibular Joint Custom-Fitted Total Joint Reconstruction and Orthognathic Surgery 55
Larry M. Wolford
Introduction 55
Indications for concomitant temporomandibular joint and orthognathic surgery 55
Concomitant temporomandibular joint total joint replacement and orthognathic surgery 56
Surgically Assisted Maxillary Expansion 67
Norman J. Betts
Introduction: nature of the problem 67
Surgical technique 67
Summary and suggestions regarding the correction of transverse discrepancies in adult patients 75
Genioplasty 79
Carlo Ferretti and Johan P. Reyneke
Introduction 79
Surgical technique 79
