Orthognathic Surgery Considerations in the Young Patient and Effects on Facial Growth

Abstract

Management of the growing patient with mandibular and/or maxillary dentofacial deformities presents a unique and challenging situation for orthodontists and surgeons. The surgical procedures required for correction of the deformity may affect the postsurgical growth and alter the dentofacial development. Facial growth may continue or be arrested postoperatively and negate the benefits of surgery performed, resulting in treatment outcomes that are less than ideal. Pediatric and adolescent patients with dentofacial deformities may require surgical treatment during active growth because of functional, esthetic, and psychosocial factors. From individual patient characteristics, the type of deformity, and the indications for early surgical intervention, it is possible to effectively treat many cases during growth. A thorough understanding of facial growth patterns and the effects of surgery on growth are essential, and each case needs to be evaluated individually. This chapter discusses the more common dentofacial deformities, the surgical techniques applicable for each, and the earliest age at which these surgeries can be performed with predictable results. There are, of course, exceptions to these general guidelines based on individual patient characteristics, hormonal or other factors affecting growth, the presenting deformity, co-existing disease, presence of TMJ pathology, other local or systemic factors, and the orthodontist’s and surgeon’s clinical abilities.