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Orthognatische chirurgie
| In orthognathic surgery, the aim is to use operative measures to achieve proper occlusion (the manner in which teeth and molars of the upper and lower jaw fit on each other) and an aesthetically pleasing face. While tastes do differ, there is such a thing as good taste. In plastic (aesthetic) surgery, a number of guidelines have been set up describing what an aesthetically pleasing face should look like. It has to be noted that there are quite a few cultural differences in this area.
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| For example, we can divide an aesthetically pleasing face into 3 vertical and 5 horizontal equal proportions. In profile, the face should roughly resemble the image presented here.
In order to achieve this result, we can make cuts in the bone at the locations shown in the first picture, realign the pieces as necessary, and fix them in place with mending plates and screws.
| After about 6 weeks, the bone pieces will have grown together in their new positions. Until that time, the patient will have to subsist on soft foods, as he or she otherwise runs the risk that the bone pieces will not grow together properly.
As a rule, the mending plates and screws may be left in place after this period. Sometimes they will need to be surgically removed because they bother the patient. | Other than moving bones around as described, bone or other materials (synthetic bone, donor bone, Gore-Tex) may be applied subdermaly in the facial area. Synthetic and donor bone will in time be transformed into own bone, and Gore-Tex will be encapsulated. In some cases, bone will be removed, a rhinoplasty be done, fat be sucked away (liposuction), etc. in order to achieve an aesthetically satisfying result. |  |
Immediately following the operation, the patient?s face will be seriously swollen and blue. The corners of the mouth will feel stretched, the mouth can only be opened a small amount, there are a number of numb spots (particularly on the lower lip), but the amount of pain is usually surprisingly limited. The first two weeks are a very unpleasant time for the patient. Eating is difficult, and some patients have trouble sleeping. It is not uncommon for the patient to wonder if he/she made the right decision in having the operation, and they generally remain indoors. After about 2 weeks, however, patients have recovered sufficiently to take part in normal social activities. Full recovery can take up to half a year. In general, the patient can return home the day following the operation. The first outpatient check takes place after 1 week. After the third and sixth week another checkup takes place. After about half a year, once the orthodontist has completed treatment, final photographs and x-rays are made and the patient is, in principal, done with the treatment. | Prior to the operation, 2 tooth arcs must be created using orthodontic techniques which will then be located and fixed into place properly during the operation. If the upper jaw is clearly too narrow, it may sometimes be necessary to use trans-palate dystraction (TPD) to widen the upper jaw. This means an additional operation. A special turnbuckle has been developed that helps separate the two halves of a surgically split upper jaw. |  | The turnbuckle is set against the hard palate, and has the important advantage that it does not bother or barely bothers the patient (see www.titamed.be )
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