08-09-2011-14H30_PAUL JOHNSON
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Transcript of 08-09-2011-14H30_PAUL JOHNSON
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