Facial Soft Tissue: The Alpha and Omega of Treatment Planning in Orthognathic Surgery

Abstract

The soft tissues of face are attached to and are draped over underlying hard tissues. Logically, then, it may be expected that there is a mutual relationship which in long run will determine appearance and balance of soft tissues. The dilemma has been that these relationships are not constant overall but appear to vary from site to site. The research on which papers in this Journal have been based has been directed at ascertaining as accurately as possible patterns between relative movements of hard and soft tissues at selected sites. These data may then be applied in a prediction analysis where surgical adjustments of hard tissues are mathematically related to resultant re-arrangement of associated soft tissues. This philosophy has evolved into a prediction system which relies upon a primary determination of most favourable objectives for soft tissue drape. Once that is known, it is practical to secondarily determine those surgical re-adjustments of supporting bony elements which will be required to achieve favoured soft tissue drape and appearance. The prediction system enables Orthodontist to produce a visual treatment objective which will readily identify treatment mechanics required, will determine whether extractions are required and will indicate most favourable extraction plan. Critically, prediction will determine most advantageous pre-operative overjet (or reverse overjet), a signal factor in allowing desired surgical jaw repositioning. The Orthodontist is truly the custodian of this important incisor relationship. This paper presents orthognathic surgical cases in which this prediction analysis has been applied. The records confirm accuracy of treatment planning and demonstrate achievement of favourable aesthetic and functional outcomes. The Orthodontist utilising prediction process will have at hand a treatment plan which will form basis of relevant discussions with Maxillo-Facial surgeon partner, and together team can plan treatment in detail.