The terms “receding midface”, “geodontia”, “pocket tooth”, maxillary recession, retrognathism, and backbite are sometimes used to refer to the same thing, which is the depression of the middle part of the face. Medically, it is called “midface recession”. Midface recession deformity is caused by the underdevelopment of the upper jaw, resulting in the depression of the entire midface. From the side, the forehead and chin are high, and the nose and upper lip are sunken, resembling a boat. The upper front teeth are retracted inside and there is a large gap from the lower front teeth. [Supplementary] There are further diagnostic classifications for “Geodontia”, “pocket tooth”, and “backbite”: 1) Simple maxillary hypoplasia; 2) Maxillary hypoplasia with mandibular 3. Simple mandibular protrusion. Among them, maxillary hypoplasia with mandibular protrusion is more common. The distinction between these cases is related to the choice of surgical method. (Added 2013-12-1) The main risks are: abnormal facial shape, which seriously affects the aesthetic appearance; inability to eat normally; and unclear speech. In some cases, it can also affect breathing. How to treat? Depending on the age and severity, there are three treatment options 1. Bone traction technique for children aged 6 to 12 years old, 2. Osteotomy traction technique for patients aged 17 years old or older. 3. Orthognathic surgery, for milder deformities, for patients after the age of 17. [Supplementary] These methods are preferred to orthognathic surgery. Because the course of treatment is shorter, recovery is faster, and there is no need to wear a traction head frame. From the high standard requirements of facial aesthetics, it is now more likely to use simultaneous maxillary and mandibular surgery to move the maxilla forward and the mandible back appropriately, which is more likely to achieve a coordinated and beautiful appearance effect. The osteotomy traction technique is suitable for more severe receding maxillary deformities, with the disadvantage of a longer course of treatment (2-3 months of postoperative traction maintenance). To avoid this disadvantage, I now newly adopt a traction-assisted orthognathic surgical approach. (Added 2013-12-1) Each of these three treatment techniques is described in detail below The sutural traction technique for midface recession deformity There are a total of 23 bones that make up the skull and face. These bones are all interconnected by sutures, with the exception of the mandible, which is connected to the skull. In early childhood development, the bones of the skull and face that are connected by the sutures are not yet strong enough to be pulled apart by external forces, which can cause the bones to move. After the bone suture is opened, new bone will be formed to fill the gap and keep the bone block in its new position. The purpose of treatment is achieved. The technique and concept of bone traction osteogenesis was first introduced internationally by Professor Chunming Liu. It is the newest and least invasive treatment technique for children. How to implement the suture traction technique for the treatment of “Diastemas”? The diagnosis can be determined by clinical observation, but the doctor will also take X-rays and a model of the tooth for analysis and a more precise picture. When it is determined that treatment is appropriate, the doctor will recommend hospitalization. Hospitalization The doctor will issue a hospitalization order, and you will be admitted to the hospitalization office and admitted to the ward. Please bring your daily necessities such as toiletries, slippers, and other common items. Pre-surgery preparation: 1. The doctor and nurse will help the child undergo a systematic examination, including physical examination, laboratory tests, electrocardiogram, and chest X-ray. 2. Before the surgery, the doctor will explain to the parents a series of questions about the surgery, including: the purpose of the surgery, the general approach, the schedule, possible complications, and precautions to be taken before and after the surgery. 3. You sign the informed consent form after being fully informed. 4．The nurse performs some specific pre-surgical treatments: penicillin skin test, gastrointestinal preparation, etc. 5．The anesthesiologist will visit the patient the day before surgery and sign the anesthesia informed consent form. Surgery: The nurse administers atropine to the child on the morning of the surgery day. Then pick up to the operating room. The anesthesiologist starts the anesthesia. When the anesthesia is ready, the surgeon begins the procedure. The surgeon places a retractor in the child’s upper jaw. The surgery is minimally invasive and can be completed in one hour. Post-surgical traction: Traction therapy is usually started on the third day after surgery. The surgeon will use a rubber band or traction wire for traction. Regular adjustments will be made. Usually in about 2 months, the receding maxilla can be pulled out. The shape of the face becomes normal and the nose becomes straight. The traction treatment is completed after 3 months of maintenance. Finally, a minor surgery is performed to remove the traction device. Bone traction technique is suitable for patients after the age of 17. The basic treatment steps are as follows: 1. Pre-operative orthodontic treatment. It is also possible to straighten the teeth after the surgery. 2. Hospitalization for surgery to cut the bones in the middle of the face and place the special retractor. 3.Traction starts on the 3rd day after surgery. Traction 1mm forward every day, usually about two weeks to complete the traction. This is the effect can be seen. 4. Continue to maintain traction for 2~3 months, remove the traction device, and the treatment is complete. Outpatient consultation: There are two disciplines responsible for treating these conditions: the oral and maxillofacial specialists and the craniofacial specialists in plastic surgery. The doctor can easily make a preliminary diagnosis and arrange for the next step of examination and treatment. Pre-surgical preparation: This includes: taking x-rays, CT, taking dental models; the doctor will study and develop a treatment plan based on these tests. Orthodontic correction of teeth. It takes 1~2 years. Hospitalization and preoperative preparation: The doctor will agree with you on the date of hospitalization and surgery based on the preliminary preparation. Pre-operative preparation includes: physical examination, laboratory tests, electrocardiogram, chest X-ray; X-ray, CT, taking a dental model; providing an accurate basis for the surgical design; the doctor and the patient agree on the surgical plan together. The doctor explains the possible complications and signs the informed consent form for the surgery. Select and prepare bone fixation materials. General anesthesia is usually chosen, and informed consent for anesthesia is signed. Blood preparation. Blood transfusion may be required. Surgery: The duration of surgery varies depending on the complexity of the procedure. It usually takes 2 to 4 hours. The bones in the middle of the face are first cut as designed and the retractor is placed. Post-operative care: The patient will sleep for a long time after the surgery. This is a normal phenomenon after anesthesia. Watch for smooth breathing, and call the nurse immediately if you find breath-holding. There may be vomiting, head tilted to the side, vomit can come out smoothly to avoid choking into the trachea. Be careful not to pull the gastrointestinal decompression tube and drainage tube. Diet: fasting on the day after surgery, you can feed a little water for 6 hours; you can eat liquid food on the 2nd day, preferably through the gastric tube for 3~5 days. Eat liquid food for 3 weeks, then you can eat food without chewing. 3 months later you can gradually resume normal diet. Rinse your mouth several times a day. Fluids are usually given for 3 to 5 days after surgery. The stitches are removed 7 days after surgery. Traction Traction is usually started 3~5 days after surgery, and the surgeon will do traction adjustment every day. The traction is about 1mm per day and usually 2 weeks to the intended position. Discharge from the hospital and continue to maintain traction for 2 to 3 months. Removal of traction. End of treatment. Orthognathic surgery Orthognathic surgery involves cutting open the receding maxilla, pulling it forward, and fixing it in a normal position with a splint. The biggest advantage of this method is the short treatment time. It is suitable for patients after the age of 17. [Supplementary] For cases of antimandibular, upper and lower teeth gap of 7 or 8mm or more, whether it is simple maxillary recession or simple mandibular protrusion, most cases are suitable for simultaneous maxillary and mandibular surgery to obtain more harmonious cosmetic results. (Added 2013-12-1) Procedure: Outpatient visit: There are two disciplines responsible for treating these conditions: oral and maxillofacial specialists and craniofacial specialists in plastic surgery. The doctor can easily make a preliminary diagnosis and arrange the next step of examination and treatment. Pre-surgical preparation: This includes: taking x-rays, CT, taking dental models; the doctor will study and develop a treatment plan based on these tests. Orthodontic correction of teeth. It takes 1~2 years. Hospitalization and preoperative preparation: Based on the preliminary preparation, the doctor will agree with you on the date of hospitalization and surgery. Pre-operative preparation includes: physical examination, laboratory tests, electrocardiogram, chest X-ray; X-ray, CT, taking a dental model; providing an accurate basis for the surgical design; the doctor and the patient agree on the surgical plan together. The doctor explains the possible complications and signs the informed consent form for the surgery. Select and prepare bone fixation materials. General anesthesia is usually chosen, and informed consent for anesthesia is signed. Blood preparation. Blood transfusion may be required. Surgery: The duration of surgery varies depending on the complexity of the procedure. It usually takes 2 to 4 hours. The bones in the middle of the face are cut as designed, pulled forward, and fixed in their normal position with a bone splice. Post-operative care: The patient will sleep for a long time after the surgery. This is a normal phenomenon after anesthesia. Watch for smooth breathing and call the nurse immediately if you find that you are holding your breath. There may be vomiting, tilt the head to the side, and the vomit can come out smoothly to avoid choking into the trachea. Be careful not to pull the gastrointestinal decompression tube and drainage tube. Diet: fasting on the day after surgery, you can feed a little water for 6 hours; you can eat liquid food on the 2nd day, preferably through the gastric tube for 3~5 days. Eat liquid food for 3 weeks, then you can eat food without chewing. 3 months later you can gradually resume normal diet. Rinse your mouth several times a day. Fluids are usually given for 3 to 5 days after surgery. The stitches are removed 7 days after surgery. You can be discharged from the hospital. After discharge, you should follow up regularly as required by the doctor.