21.11 - Cleft and craniofacial orthognathic surgery

Abstract

Orthognathic surgery is the term used to describe surgical movement of the maxilla, mandible, and chin to correct occlusion and restore aesthetic skeletal harmony. Computer assisted surgical simulation (CASS) and splint fabrication removed the barriers to surgeons without formal dental training, opening this powerful surgery to plastic surgeons with training in craniofacial surgery. The goal of orthognathic surgery is to establish ideal dental occlusion with the jaws in a position that optimizes facial form and function. It is common for patients who undergo surgical correction of cleft lip and palate in infancy to develop dentofacial deformities, and a significant proportion will have midface retrusion requiring orthognathic surgery. Patients with craniosynostosis and other congenital facial anomalies may also present with restricted midface and lower face development that would benefit from orthognathic surgery. Most commonly, however, orthognathic surgery is performed in patients without a congenital anomaly who present with nonsyndromic skeletal jaw dysplasia, facial asymmetry, abnormal facial proportion, and/or obstructive sleep apnea. This chapter discusses the evaluation, treatment plan, and execution for patients who require orthognathic surgery for commonly encountered conditions.