Dr. David Sanz

Maxillofacial Surgeon
 

Dr.  José Carlos Fernandes

Maxillofacial Surgeon

Orthognatic Surgery
The princess of maxillofacial surgery

HPA Magazine 7

In spite of Maxillo-Facial Surgery apparently seeming to be confined to a limited area of intervention – head and neck – the truth is that the specifications of its reach are extensive, with a view towards recovery and rehabilitation of masticatory, respiratory, phonatory functions, pain and aesthetics:
· Oral Cavity – cysts, impacted teeth, bone atrophy in the jaws, benign and malignant tumours;
> Face – jaws and soft structures of the face, e.g. congenital alterations and development of the face such as malformations, protruding jaw, receding chin, facial asymmetry, as well as all types of traumatology;
> Cervical area – salivary gland disorders (paratoid, sub-maxillary) such as tumours, calculus, inflammations;
> Aesthetic surgery of the face and neck.

Among the various craniomaxillofacial surgical techniques, one that has developed most in recent years is Orthognatic Surgery. This involves treatment protocols for the alterations of the positon of the maxillaries (dentofacial deformities), manifested by the position of the teeth (dental occlusion), facial aesthetic and airways (respiration).
Treatment for dentofacial deformities must be carried out by a highly specialised team of of diverse health professionals: Maxillo-Facial Surgeon, Orthodontist, Physiotherapist and Speech Therapist. These professionals will guarantee a result with a more symmetrical facial aesthetic, better functioning of the dental structures and stability of the temporomandibular joint (joint between the mandibular and maxilla), as well the functionality of the airway, with obstructive sleep apnoea being one of its indications.
The aesthetic parameters most used are: the nose, eyebrows, smile line, exposure of teeth and gums, which are factors that together determine the “personality of the face. 
As Dr. José Carlos Fernandes highlights, "more than anything else, what we want to do is rehabilitate the functional defects for which the patients consulted us. However, we always look to re-establish the individual facial aesthetic, and not confine ourselves to restoring average or normal values of the population. In other words, we work to improve the aesthetic and function, but stay true to the identity and personality of those who seek us out". 
"About 25% to 30% of the population has a variable degree of facial alteration, of which 50% will, eventually, seek Orthognatic Surgical treatment", says Dr. David Sanz. 
"Up until a short time ago, these surgical procedures were quite traumatic, undertaken almost exclusively in extreme cases. Nowadays, the evolution of surgical techniques and anaesthetics, as well as the materials, allow for a shorter hospital stay and post-operative recovery, justifying the realisation of this type of surgery for a greater number of people, including those merely wanting to improve their appearance". 
According to Dr. Sanz "it is also important to explain that despite the nonexistence of a fixed protocol, equal and ideal for all cases, the majority need to previously undertake orthodontic treatment (using braces), which facilitates the correct positioning of the teeth before surgery. In other cases, it is possible to advance directly with the surgery and resort to orthodontia later, if necessary".
The most common indications for Ortognatic Surgery are maxilla and/or mandibular facial skeletal deformities with masticatory malocclusions:
· Transversal Discrepancies;
· Asymmetry;
· Anteroposterior discrepancies: relation between maxilla/mandibular incisors and anteroposterior relations of the maxilla/mandibular molars;
· Vertical discrepancies: Presence of a vertical facial deformity or an Open Bite (without space between the anterior teeth;

As previously mentioned, orthodontia has an important role to play in Orthognatics before, during and after surgery, and its main goals are:
· To increase the safety of the surgery through treatment of the maxillary discrepancies and Bolton analysis;
· Simplification of the surgery by prognosis of the position of the teeth;
· Optimisation of the surgical gesture by previous elimination of dental discrepancies;
· To guarantee the best possible retainer.
In this way, the orthodontist and the surgeon must work in close harmony in the diagnosis and planning of the orthodontic-surgical approach, for which the first decision includes the option of the treatment to follow: exclusively orthodontic, orthodontic-orthopaedic or orthodontic-surgical. For children, exclusively orthodontic treatment can modify or influence growth, thus reducing the need for surgical treatments. In adults, when growth is complete, orthodontic-surgical treatment is often the best and only option.
The HPA Health Group has a team of maxilla-facial surgeons with different skills in various areas of intervention in this specialty, namely orthognatic surgery.