Mandibular Osteotomy for Long Lower Jaw Correction
Patients born with a cleft deformity undergo a lengthy rehabilitation process. The cleft deformity can give rise to a myriad of issues for them. All these issues have to be addressed surgically. They however lead a life of complete normalcy after rehabilitation.
One of the most noticeable complications is regarding upper jaw growth. Upper jaw growth is affected in patients with a cleft palate. The lack in normal upper jaw growth results in a skewed relationship between the jaws.
Development of a hypoplastic upper jaw is very common in patients with a cleft palate. This gives rise to the appearance of a long lower jaw. In reality, the lower jaw could be of normal size in comparison to the hypoplastic upper jaw.
A long lower jaw in relation to an underdeveloped upper jaw can lead to several problems. Primary among them is the functional aspect. Both speech and the ability to eat is affected. Patients with cleft deformity often undergo extensive speech therapy.
Another aspect of this long lower jaw is the cosmetic issues for the patient. A long lower jaw gives rise to a concave profile. Correction of this can either involve lower jaw reduction or upper jaw advancement.
Cosmetic jaw surgery has evolved over the decades. The facial biometrics are obtained for the patient. A decision is then made to reach the optimal treatment plan for cosmetic jaw surgery. This can either be upper jaw advancement or lower jaw reduction.
Orthognathic surgery is otherwise known as corrective jaw surgery. Used in conjunction with orthodontic treatment, it corrects jaw problems involving the upper and lower jaws. This involves the jaw bones, the jaw joint and the upper and lower teeth.
The right treatment plan for mandibular prognathism results in long term benefits. This should be performed only after completion of jaw growth. Return to work or school post-surgery is within a few days. A correct bite is established through this surgical procedure.
Resolution of obstructive sleep apnea requires lower jaw advancement. The surgical procedure of these surgeries involve intraoral incisions. There is no visible scar tissue from this surgery.
Upper jaw advancement could be performed through a variety of surgical technique. The most common technique is the Le Fort I advancement. Distraction osteogenesis is utilized when the degree of advancement is very high.
Lower jaw reduction is most commonly performed through mandibular osteotomy. The bilateral sagittal split osteotomy is the treatment of choice. This surgery is best performed by cosmetic jaw surgeons with the necessary experience.
Our hospital is a superspecialty craniomaxillofacial surgery center. We perform surgeries ranging from complex impactions to craniofacial surgery. Cosmetic jaw surgery is one of the specialty features at our hospital.
Many disease conditions often result in extensive destruction of jaw bone. These result in large bony defects of the jaws. Trauma is another cause for extensive bony destruction of jaw bone. Cosmetic jaw surgery is used to reconstruct such deformities of the jaw bone.
We primarily use rib bone grafts for cosmetic jaw surgery. Rib bone grafts are ideally suited for reconstruction of the jaws. They can be crafted to the correct shape and size to fit into the bony defect. There is also ready consolidation of the graft with surrounding alveolar bone.
This young woman was born with a unilateral cleft lip and palate defect. She had undergone corrective surgery in her infancy. As seen commonly with cleft patients, she now has a hypoplastic upper jaw.
Her lower jaw is now prognathic in relation to her upper jaw. She also has a missing incisor at the site of the alveolar cleft. The patient was referred to our hospital for management of her multiple problems.
Treatment planning was explained to her and she provided consent to undergo treatment. Fixed orthodontic treatment was initiated to correct her dental occlusion. She was then scheduled to undergo bilateral sagittal split osteotomy of her lower jaw.
Attention was first turned to her missing upper incisor tooth. A dental implant was placed at the site. Six months would be allowed to elapse for osseointegration of the implant. A shade matched ceramic crown would be fixed upon her return.
Bilateral bone cuts were then made in her mandible. Caution was taken to avoid any injury to her inferior alveolar nerve. The mandible was setback by 8 mm bilaterally. This resulted in establishment of normal relationship between her jaws.
The surgical site was then stabilized with titanium plates and screws. Facial esthetics was dramatically improved following the surgery. The patient also reported improved ability with eating and speech.
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