Orthognathic surgery to reposition the maxilla, mandible, or chin is the mainstay treatment for patients who are too old for growth modification and for dentofacial conditions that are too severe for either surgical or orthodontic camouflage.
Today’s orthognathic surgical treatment for dentofacial deformity consists of standard orthognathic procedures to correct jaw deformity, as well as adjunctive procedures to improve hard and soft tissue contours. These adjunctive procedures include an osseous versus alloplastic genioplasty, septorhinoplasty, and suction lipectomy of the neck.
A collaborative approach between the orthodontist and maxillofacial surgeon is imperative to successfully devise and execute a comprehensive treatment plan with predictable outcomes.
Orthognathic surgery to treat jaw discrepancy and malocclusion may be viewed variably by insurance carriers. Often, “medical necessity” is difficult to establish and substantiate. For some patients, the out-of-pocket cost of combined orthodontic and orthognathic treatment is prohibitive. The treating professionals should be aware of this relevant issue when devising and recommending a specific treatment plan.
Typically, most patients will solicit surgical evaluation based primarily on the recommendation of the treating orthodontist. The patient may present to the surgeon, having already implicitly selected a preferred treatment option based on the treatment focus of the orthodontist. In general, orthodontic camouflage approaches to achieve a specific occlusal relationship with disregard to skeletal discrepancy, facial aesthetics, and degree of dental compensation should be discouraged. This is especially true in a patient who places high value on overall facial aesthetic improvement.
Key principles of surgical care and overall patient care include psychologic preparation of the patient; good preoperative and postoperative nutrition; preservation of blood supply to the mobilized teeth and jaw segments; protection of bone, neurovascular structures, and teeth; appropriate postoperative wound management; fixation of bony segments; proper control of occlusion; and rehabilitation to full jaw function.