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Chapter-20 Midface Deformity

BOOK TITLE: Surgical Correction of Facial Deformities

Author
1. Mani Varghese
ISBN
9788184488791
DOI
10.5005/jp/books/11121_20
Edition
1/e
Publishing Year
2010
Pages
6
Author Affiliations
1. Mar Baselios Dental College , Kothamangalam (Kerala), India, Govt Dental College and Hospital, Calicut
Chapter keywords

Abstract

Retrusion or hypoplasia of the mid-face, without deformity of the cranial vault, is dealt with in this chapter. The deformities are mainly of the maxilla, zygoma and/or nasal bones. These patients require advancement at the subcranial level. Like in other cases orthodontic technique may have to be instituted pre and post-surgically. The goal of pre-surgical orthodontic treatment is to put the teeth in the desired position so that post-surgically optimal occlusal relationship is achieved. Depending on the structures that are to be advanced, osteotomy has to be designed. When the deformity includes the maxillae, malar bones and nasal bones, Le-Fort III osteotomy is advised. If the malar bones are not involved, only Le-Fort II will suffice. If the nasal complex is not involved, modified Le-Fort 111 is the surgery of choice. Surgical decision is made depending on the deformity. Prediction tracing is done. Pre-surgical orthodontic/orthopedic treatment has to be decided and instituted in consultation with an orthodontist. In many of the craniofacial synostosis syndrome deformities, there is premature fusion of the craniofacial sutures. In such cases, orthopedic expansion movements may be difficult and combined orthodontic and surgical expansion has to be considered. After the pre-surgical orthodontic movement is achieved cephalometric study and prediction tracings are repeated. Feasibility model surgery is also done. Next step is the construction of occlusal splint for stabilization. Mid-face deformity correction is mainly for hypoplasia; hence advancement is the aim of surgery. As there is a tendency for relapse, in all cases of advancement, occlusal splint is often constructed in such a way that the occlusion is over-corrected to class I1 relationship.

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