Comprehensive correction of maxillofacial bone deformity-consideration and combined application of orthognathic surgery and facial contouring surgery

Abstract

The maxillofacial skeleton is the basis of the contour of the face. Orthognathic surgery and facial contouring surgery change jaw tissue and affect facial appearance in different manners. Orthognathic surgery is the main method to correct dental and maxillofacial deformities. It changes the shape of the jaw and improves the occlusal relationship by changing the three-dimensional position of the jaw. Facial contouring surgery mainly adopts the method of "bone reduction", which changes the "amount"of the jawbone by cutting a part of the bone tissue to improve the facial appearance, generally without changing oral function. The combined use of orthognathic surgery and facial contouring surgery is becoming increasingly common in clinical practice. This also requires oral and maxillofacial surgeons to have a holistic consideration of the comprehensive correction of maxillofacial bone deformity, and to perform comprehensive analysis of jaw deformities and jaw plastic surgery to achieve the most ideal results. The author's team has been engaged in the clinical work of orthognathic surgery and facial contouring surgery and accumulated rich clinical experience in the comprehensive correction of maxillofacial bone deformity. In this article, the indications, treatment goals, treatment modes, treatment methods, and key points in the surgical operations of comprehensive maxillofacial bone surgery were summarized.

Keywords: dentofacial deformities; facial contouring surgery; facial osteoplasty; maxillofacial bone; orthognathic surgery.

图 1. 常规下颌支矢状骨劈开术中颊侧垂直切骨线的位置，通常位于下颌第一磨牙颊侧（A）；下颌角截骨手术后，行下颌支矢状骨劈开术时颊侧垂直切骨线的位置后移，从而减小近心骨块的体积，同时在近心骨块上打孔增加血液渗透和供应（B）

Fig 1 The position of the buccal vertical bone resection line in the conventional mandibular ramus sagittal split is usually located on the buccal side of the mandibular first molar (A); after the mandibular angle resection, the position of the lateral vertical bone resection line is moved back to reduce the volume of the proximal bone block, and the proximal bone block is perforated to increase blood penetration and supply (B)

图 2. 下颌偏突患者伴发双侧下颌角区域骨量不一致，如红色区域所示（A，B），需要联合采用正颌手术和一侧下颌角区域骨外板劈除术才能获得较好的面部对称性（C）

Fig 2 Patients with mandibular deviation are accompanied by inconsistent bone mass in the mandibular angle area on both sides, as shown in the red area (A, B). It requires a combination of orthognathic surgery and bone plate splitting in one mandibular angle area to get better symmetry of the face (C)

图 3. 下颌支矢状骨劈开术和下颌角区骨外板劈除术同期进行的术中操作

Fig 3 Simultaneous operation of mandibular ramus sagittal bone splitting and mandibular angle area outer plate splitting operation A：下颌支矢状骨劈开术和下颌角骨外板截骨术的骨切开线；B：截骨下颌角区骨外板；C：行下颌支矢状骨劈开术，并采用双皮质螺钉进行坚固内固定。

图 4. 上颌LefortⅠ型骨切开术与颧骨颧弓内推术同期进行时的坚固内固定

Fig 4 The rigid internal fixation of the maxillary Lefort Ⅰ osteotomy and the zygomatic and zygomatic arch internal thrusting at the same time