Facial Deformity Correction Surgerys
Sometimes by birth or growth some people present with elongated or shortened jaws. This creates an unsightly appearance and needs correction. They may also present with protruding teeth. In addition to a cosmetic deformity , it may also affect chewing (functional apsect) and also decrease the confidence of the person (Psychological aspect)In certain patients the deformity may not be confined to only the teeth but affect the jaws (underlying bone) as well.
Small dental abnormalities can be corrected with orthodontics alone (using fixed and removable appliances). More serious skeletal problems require surgery together with orthodontics to move all or part of the upper jaw, lower jaw or both into a more normal position. In these cases the patient will need both orthodontics and orthognathic surgery (Corrective jaw surgery) to correct the bone as well as the teeth.
Treatment usually involves orthodontic treatment followed by surgery and then some final orthodontics. Surgery is undertaken under general anaesthesia. The operation may take from one hour in simple procedures to several hours with more complicated surgical procedures. Surgery is usually done from inside the mouth leaving no visible external scars. Surgery may be done in the upper jaw( maxillary Le Fort ) or lower jaw (mandible BSSO– bilateral sagittal split osteotomy) or chin ( genioplasty) alone or it may even be a combination of all three procedures depending on the complexity of the deformity.
A 20 year old girl came to us with gross maxillary ( upper jaw ) protrusion and wanted correction. Detailed examination was done with all the needed x-rays and models and it was decided to go for a joint orthodontic– orthognathic surgical approach. She was initially started on orthodontics and then 8 months later went for surgical correction under general anesthesia. The entire procedure(Le Fort I maxillary osteotomy, BSSO mandibular osteotomy and genioplasty) was done from inside the mouth with no scars on the face. As you can see from the pictures, the results are spectacular and the patient was very satisfied with the outcome. She also had a big jump in her confidence and has a positive body language now.
Post op photographs showing correction done by orthodontics and a bi-maxillary orthognathic surgery. (Le Fort I + BSSO + genioplasty) In addition to looks and function, the confidence of the patient has vastly improved.
A 21 year old boy presented with complains of a protruding lower jaw growth and inability to bite and chew food properly. X-rays, models and clinical examination revealed gross mandibular excess (lower jaw excess) due to growth. It was decided to go for a joint orthodontic—orthognathic surgical approach for best results. The orthodontics was strated to remove any dental compensation that occurs with any skeletal problem and he was prepared for surgery. Under general anesthesia , the mandible(lower jaw) was osteotomised and moved into the correct position via a BSSO (Bilateral sagittal split osteotomy). The entire procedure was done from inside the mouth (intraoral approach) and he had no scars on the face . The patient's appearance and the ability to chew food also greatly increased.
Pre-operative Photos showing decreased lower Jaw growth on one side
The entire surgical procedure is done completely from inside the mouth with no scars on the face.
In addition to the cosmetic benefit, the ability to chew food has greatly increased
Parry-Rhombergs syndrome is otherwise known as progressive hemifacial atrophy. It is characterized by shrinkage and degeneration of both the hard and soft tissues of the face. The cause is unknown. It is thought it may be due to any of the following reasons- an autoimmune disorder, decreased blood supply to the face during growth or hereditary reasons. It usually becomes worse as the child grows and then finally “burns” out after puberty. As this complex syndrome has both soft tissue and hard tissue deficiencies, staged reconstruction is the way forward. Initially the hard tissue correction is done and this is followed by soft tissue correction.
A 22 year old girl was came to us with decreased growth on the right side of her face. Careful clinical examination and CT scans confirmed a diagnosis of Parry Rhomberg syndrome. She underwent a course of pre-surgical orthodontics followed by orthognathic surgery—Le-Fort I level osteotomy for her maxilla to correct the cant, an asymmetrical bilateral sagittal split osteotomy to correct her mandibular deficiency. As these procedures were done intraorally there were no scars on her face. This was followed by soft tissue correction via free fat grafting from her thigh and abdomen to complete her treatment.
Pre-operative Photos showing decreased lower Jaw growth on one side
The hard tissue correction was done completely intraorally via a Le Fort I osteotomy of the upper jaw, asymmetrical BSSO of the mandible (Lower jaw) and this was followed up with free fat grafting.