Medical Uses and Conditions Treated - Corrects gross jaw discrepancies (anteroposterior, vertical, or transverse discrepancies) - Treats skeletofacial discrepancies associated with sleep apnea, airway defects, and soft tissue discrepancies - Addresses skeletofacial discrepancies associated with temporomandibular joint pathology - Fixes disproportionately grown upper or lower jaw causing dentofacial deformities - Treats conditions like micrognathia, overbite, underbite, and long face syndrome - Established treatment option for insufficient growth of the maxilla in patients with an orofacial cleft - Timing of orthognathic procedures is debated to maximize natural growth of the facial skeleton - Patient-reported aesthetic outcomes are generally satisfactory, despite potential complications - Scar tissue formation may impair maxillary growth as a long-term outcome - Comparison between traditional orthognathic surgery and maxillary distraction osteogenesis suggests both procedures are effective, with distraction osteogenesis potentially reducing long-term relapse

Risks and Complications - Complications include bleeding, swelling, infection, nausea, and vomiting - Infection rates can reach up to 7%, but antibiotic prophylaxis reduces the risk - Post-operative facial numbness may occur due to nerve damage - Diagnostics for nerve damage include brush-stroke directional discrimination, touch detection threshold, warm/cold discrimination, and sharp/blunt discrimination - Care must be taken to minimize nerve damage to the inferior alveolar nerve, a branch of the mandibular nerve

Surgical Techniques - Surgery is performed via the mouth, where jaw bone is cut, moved, modified, and realigned - Jaw osteotomy allows for surgical alignment of dental arches and correction of malocclusion - 3D facial diagnostic and design systems have emerged for precise planning - New procedures like IMDO, SARME, GenioPaully, custom BIMAX, and custom PEEK are accessible - Orthognathic surgery is increasingly used for obstructive sleep apnea and facial proportionality correction

Prevalence and Access - Approximately 5% of the UK or US population may require orthognathic surgery for dentofacial deformities - Private health insurance and public hospital funding issues limit access to jaw correction procedures - Certain heavily socialist funded countries report higher rates of jaw correction procedures - Common conditions requiring orthognathic surgery include maxillary prognathisms, mandibular prognathisms, open bites, and temporomandibular joint dysfunction - Increasing self-funding options have made a broader range of jaw correction procedures accessible

Surgery Planning and Techniques - Orthognathic surgery is performed by maxillofacial or oral surgeons in collaboration with orthodontists or plastic surgeons. - It often includes braces before and after surgery, as well as retainers after the removal of braces. - Orthognathic surgery is commonly needed after reconstruction of cleft palate or other craniofacial anomalies. - Careful coordination between the surgeon and orthodontist is essential to ensure proper teeth alignment after the surgery. - Radiographs and photographs are taken to aid in the planning process, and advanced software can predict the patient's facial shape after surgery. - A multidisciplinary team, including oral and maxillofacial surgeons, orthodontists, and speech and language therapists, is involved in the planning process. - Working with a speech and language therapist beforehand can help minimize potential relapse. - A psychological assessment may be required to evaluate the patient's need for surgery and its predicted effect on the patient. - Airway patency is maximised during the planning phase. - Traditional presurgical orthodontic treatment can take up to one year, but new approaches such as surgery-first and clear aligner orthodontia (like Invisalign) are also available.