Orthognathic Surgery

Principles, Planning and Practice

Farhad B. Naini, Daljit S. Gill, Farhad B. Naini, Daljit S. Gill

• Publisher: Wiley-Blackwell
• Year: 2016
• ISBN:
  9781118649947
• Edition: 1
• Topic: Medicine
• Subtopic: Orthodontics

ORTHOGNATHIC SURGERY

Orthognathic Surgery: Principles, Planning and Practice is a definitive clinical guide to orthognathic surgery, from initial diagnosis and treatment planning to surgical management and postoperative care.

• Addresses the major craniofacial anomalies and complex conditions of the jaw and face that require surgery
• Edited by two highly experienced specialists, with contributions from an international team of experts
• Enhanced by case studies, note boxes and more than 2000 clinical photographs and illustrations
• Serves as an essential reference for higher trainees and practicing clinicians in cranio-maxillofacial surgery, orthodontics, plastic and reconstructive surgery and allied specialties

Chapter 1
Introduction: Orthognathic Surgery – A Life's Work

Hugo L. Obwegeser

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• Introduction
• Historical remarks
• How did the sagittal splitting procedure come into being?
• Trauner’s inverted L-shaped osteotomy of the ramus
• My first successful sagittal splitting of the mandibular ramus
• My final technique for many years
• International reaction
• Transoral chin correction
• The mobilization of the maxilla – its history
• Operative technique for mobilization of the maxilla
• Modifications of the procedures
• New procedures
• Segmental alveolar osteotomies
• Problems of maxillary anomalies in secondary cleft deformity cases
• The Le Fort III + I osteotomy
• The correction of hypertelorism
• Recurrence
• Special instruments
• Concluding remarks
• Acknowledgements
• References

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Introduction

Dr Farhad B. Naini has asked me to write an introduction to this definitive textbook on Orthognathic Surgery. I am very grateful for the honour. My intention is to compose a commentary on the development of orthognathic surgery. Firstly, however, I must express my gratitude to my teachers. It is due to them that I developed the ability to produce new ideas (Figure 1-1). I initially received general surgical training for six months in the military services and an equivalent period in a country hospital in my native town. Following this I had the privilege to train for two years with Hermann von Chiari at his Viennese Institute for Pathology and Microbiology. I then spent six years training in dentistry and maxillofacial surgery with my teacher Richard Trauner at the Maxillofacial Unit of the Dental School of the University of Graz. I spent another five months training in plastic and reconstructive surgery with Sir Harold Gillies in Basingstoke, London, and later six months with Eduard Schmid in Stuttgart. Norman Rowe and Paul Tessier were very good friends and colleagues of mine, and we learned from each other. All I know I owe to my teachers.

Fig. 1-1 My teachers (anticlockwise): Professor Hermann von Chiari, Chief of the Institute of Pathology and Microbiology of the University of Vienna. Professor Richard Trauner, Chief of Dentistry and Maxillofacial Surgery, University of Graz, Austria. Professor Eduard Schmid, Chief of the Klinik für Gesichtschirurgie, Marienhospital, Stuttgart. Sir Harold Gillies, International founder of Plastic and Reconstructive Surgery, Basingstoke, England. Mr Norman Rowe, Chief of Department of Oral Surgery, Basingstoke, England. Dr Paul Tessier, Chief of the Department of Plastic Surgery, Military Hospital, Paris.

Historical remarks

The wish to correct deformities of the maxillomandibular complex is an old desire. It was mainly mandibular anomalies that led to a desire for the development of corrective surgery. V.P. Blair (1907),¹ F. Kostečka (1934),² and others developed ideas and techniques to cut the body or the ramus of the mandible for repositioning into a planned new occlusion. Their procedures did not satisfy my teacher Richard Trauner, as the results had too many problems. He suggested that we needed to develop another osteotomy that would produce broad contacting bone surfaces and as such have better prerequisites for early bony union and reduce the likelihood for relapse.

How did the sagittal splitting procedure come into being?

Due to my teacher's request it was my obligation to develop an idea for a procedure that would fulfil his intentions. As I very much disliked skin incisions in the visible regions of the face for surgery on the facial skeleton, I had to find a transoral procedure. I took a cadaveric mandible and turned it around in my hands in order to view it from every direction. By doing so I realised that the vertical splitting of the ramus would produce the ideal situation in relation to the desired goal. However, how could it be split without damaging the mandibular nerve in its canal? In order to find that out I decided to make horizontal cuts about every five millimetres in the ramus. The resultant findings proved very promising. No instrument should touch the area of the mandibular canal. It became obvious that I had to cut the lingual cortical plate of the mandible just above the entrance of the mandibular nerve into the mandible. Another cut of the lateral cortical plate had to be placed somewhere close to the angle, either above or in front of it, but towards the angle in order to correct an unpleasant angle anomaly. That would provide enough raw bone surface contact for fast bony union, independently of whether the mandible would be repositioned in a posterior or an anterior position, or even when a rotation of the mandible was necessary (Figure 1-2).

Fig. 1-2 Drawings of my sagittal splitting technique (from: Obwegeser, 1957).³

Trauner's inverted L-shaped osteotomy of the ramus

My chief, Richard Trauner, liked my idea. He himself had the intention to perform his idea, an inverted L-shaped osteotomy of the ramus. Trauner's technique required both a transoral and a transfacial approach. The first patient in whom we attempted to produce our ideas was an edentulous young lady, on 17 Febru...