08-09-2011-14h30_paul johnson
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XX1 COBRAC Vitoria-ES 2011 Mr Paul Johnson Guildford, England Is OrthognathicSurgery Cosmetic Surgery? Cosmetic Surgery? Yes and No The Treatment of Dentofacial Deformity Deformity OrthognathicSurgery Aims Correction of dentofacialdeformity To give a functional occlusion To achieve the best aesthetic result To achieve the best aesthetic result Paradox Indication is usually occlusal Result usually judged by the aesthetic outcomeTRANSCRIPT
Aesthetic Considerations in Orthognathic SurgeryOrthognathic Surgery
Mr Paul JohnsonGuildford, England
XX1 COBRACVitoria-ES 2011
Aims
�Correction of dentofacial deformity
�To give a functional occlusion
�To achieve the best aesthetic result�To achieve the best aesthetic result
•Skeletal pattern•Incisor angulation•Face Height •Maxillary Mandibular
Cephalometics
•Maxillary MandibularPlane Angle
� Assess the patient.� Consider the immediate effects of planned movements.effects of planned movements.� Consider long term effects.
Mosby 2003
Chapter 4. Evaluation Of Facial Soft TissuesDavid Sarver, William Profitt, James Ackerman
Clinical assessment of facial form
• Facial balance. Thirds and fifths• Lips• Chin\Nose balance• Nose• Nose• Cheekbones and inferior orbital rims.
The Lips
• Lip growth lags behind skeletal growth. Therefore lip competence cannot be assessed until growth complete.
• Lip thickness greater in females than • Lip thickness greater in females than males.
• Lip thickness decreases with age.
• Lip balance.
Upper lip – incisor relationship
Incisal show with the upper lip at rest
� 0 – 4 mm. Female > male
� If > 4mm vertical maxillary excess
� If < 0mm vertical maxillary insufficiency
But must assess in conjunction with mandibular-maxillary plane angle and facial thirds.
Beware of the short upper lip and short clinical crowns.
Advancement
• Pogonium forward
• Pogonium downward (if curve of Speemaintained)
• Labio-mental angle becomes more • Labio-mental angle becomes more obtuse
• Improved soft tissue support over jaw and neck
• Nose forward• Nose tip angulation• Nares exposure increased
Nasal Aesthetics and Le Fort 1
• Nares exposure increased• Upper lip forward and flattened
• Subnasale forward• Columella forward• Increased alar width
Facial Age ChangesLoss of soft tissue volume and skin elasticity and gravitational effects.
�Loss of lip fullness�Loss of curve of upper lipIncrease in upper lip lengthLoss of curve of upper lip
�Increase in upper lip length�Loss of face height�Decrease in upper incisor show�Increase in lower incisor show�Nasal tip moves inferiorly and nasolabial angle becomes more acute
�Deepening of nasolabial grooves and marionette lines
Compensation for Age Changes
�Leave soft tissues oversupported.– Maintains upper lip support
– Decreases nasolabial fold development and marionette linesmarionette lines
�Conservative maxillary impaction.– Maintains incisal show
Clinical AssessmentNasal humpZygomatic insufficiencyAcute nasolabial angleUndersupported upper lipOversupported lower lip
Orthodontic PlanDecompensationAlignementCoordination
Surgical PlanMaxillary advancementCheek implantsRhinoplasty
Conclusions
�Think aesthetics in orthognathic surgery
�Anticipate age changes�Anticipate age changes