Surgical modification of long-face problems

Abstract

Long-face individuals make up approximately one fourth of the dentofacial deformity group who seek surgical treatment, almost 20% more than would have been expected from the presumed population incidence. Just fewer than 25% of patients who undergo surgical treatment are in the long-face group, and this group is slightly more likely to accept and receive surgical treatment than their proportion of the surgical population. When the severity of vertical deformity is so great that reasonable correction cannot be obtained by growth modification or camouflage, the combination of orthodontics and orthognathic surgery may provide the only viable treatment option. Because many long-face patients will also present with an anteroposterior problem involving prominent incisors and a receding chin, it is often easy to dwell on the Class II aspect of the problem and ignore the vertical contribution. Should a camouflage treatment plan be implemented by extracting maxillary first premolars and retracting the maxillary incisors, quite unacceptable esthetics may result because the nasolabial angle will increase. The option of vertical maxillary impaction now allows the orthodontist to avoid the negative facial esthetics that were once considered an inevitable consequence in improving the dental occlusion. Careful planning involving both the orthodontist and the oral maxillofacial surgeon now provides patients with an option that results in both desirable esthetics and good occlusion.