Orthognathic surgery is one of the most powerful, life-changing facial interventions.
It consists of the repositioning of the maxilla, mandible and chin. ORHTO means alingment and GNATHIC comes from the Greek word for the jaw.
Beyond facial aesthetics, the primary goal is to improve: breathing; dental occlusion; and correct mastication. So, do not take orthognathic surgery as only a vain procedure to serve aesthetic trends. It is definitely a functional surgery, rather than just a mere cosmetic intervention.
The face is our most unique and distinguishable feature.
Several genetic and environmental factors play together for the final adult facial morphology.
For example, air passage through the nose is a very important stimulus for mid-face development. Children without correct nasal breathing may not develop correct maxillary and mid-third facial size. Also, the mandible may tend to grow downward.
The spectrum of facial imbalances range from a mismatch of proportions of rather normal facial structures (which account for the majority of the cases) up to some pathologies, such as: cleft palate, craniosynostosis or hemifacial microsomia, moving into a broader field called: craniofacial surgery.
To achieve a well-balanced face, there are proportions of facial soft tissues and skeleton landmarks that must be taken into consideration.
These proportions are the result of big anthropometric data, collected during the second half of the last century that have been getting more matured including: x-rays, photographic and computerized analysis.
The first big data assessed the caucasian population, but there are several recent publications studying its applicability in other populations. These guidelines help to achieve what is believed to be a harmonious face for each individual, when considering an orthognathic surgery.
It is also believed that a well-balanced face skeleton can preserve a younger profile, compared to those with insufficient or poorly defined features. Whether those anthropometric guidelines translate directly into good facial aesthetics and attractiveness, will remain an open answer.
The canons of beauty have evolved and have been reinvented several times, from the Greek Hellenic scholars, up to the modern media pop culture. Comparing the current anthropometric guidelines and the results from beauty contests, showed that the definition of a good looking face does not exactly match mathematical models. Actually attractiveness includes other components such as expressiveness, beyond the mere static facial framework.
In sum, to quote the famous Irish novelist Margaret Hungerfort: beauty is in the eye of the beholder. This means that expectations of subjective definitions of beauty results must be addressed cautiously, before a jaw surgery.
Orthognathic surgery is one of the facial intervention with more impact, not only in the facial morphology, but also in head and neck functions, in particular: breathing.
A bimaxillary surgery is a total upper airway surgery, with clear advantages. A maxillomandibular advancement compared to other interventional techniques, procudes higher rates of cure and success in obstructive sleep apnea patients, carefully selected after sleep studies and airway imaging.
To provide the full functional and morphological balance, the surgical plan might include, not only orthognatic surgery, but other interventions, either at the same surgical time or at a delayed time, such as: septoplasty, rhinoplasty or cheek surgical modulation.
There are dozens of different treatment protocols, but the most common one is as follows:
Postoperative reactions tend to vary but the general timeline goes as follows:
Remember this is just a general timeline and do not take it for granted that this will be just like that for you.
For example, smokers and patients with chronic illnesses tend to have longer recovery time.
The main and most concerning side effect of jaw surgery is the chin numbness. Not all patients are affected. Complete damage of the nerve is a non-negligible risk, but recent imaging technology and piezo instruments, that use ultrasound cutting technology, tend to reduce this risk.
Orthognathic surgery produces highly stable results. However, there can be a regression, usually of some millimeters, rarely to the same preoperative position.
Why this? Because the muscle system will try to pull the skeleton back to its previous position. This risk will be reduced when using high quality fixing material, correct planning and surgical technique and if the patient complies correctly with the treatment plan.
Here are some of scientific papers mentioned throughout the video and other worthmentioning:
Galantucci L., et al. Is principal component analysis an effective tool to predict face attractiveness? A contribution based on real 3D faces of highly selected attractive women, scanned with stereophotogrammetry
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