I. What is orthognathic surgery? What does orthognathic surgery mean? In daily life, we often see some patients with dental and maxillofacial deformities, such as “bulbous teeth” – maxillary protrusion deformity, “envelope” – mandibular protrusion deformity, “bird’s mouth” – small jaw deformity, “discoid face” – discoid face. -mandibular protrusion, “bird’s mouth” – small mandibular deformity, “discoid face” -maxillary recession deformity, “crooked face” – facial asymmetric deformity deformity; “square face” – The “square face” – jaw angle and bite muscle hypertrophy deformity, “high cheekbone” or “low cheekbone”, as well as cleft lip and palate repair and maxillofacial trauma secondary to dental and maxillofacial deformity, etc. Often, the uncoordinated (or ugly) appearance affects the daily life of patients, such as school, work, love and marriage, social interaction, etc., causing them a lot of distress. Orthognathic surgery can improve the appearance and function of patients with these types of deformities, bringing them health and confidence. Orthognathic surgery is a discipline that creates beauty in appearance, and is a new branch of oral and maxillofacial surgery that uses plastic surgery and orthodontics to jointly correct dental and maxillofacial deformities. Modern orthognathic surgery is a new branch of oral and maxillofacial surgery that uses advanced specialized jaw surgical instruments to reassemble the facial skeletal position according to the ideal facial structural relationship and ratio. This surgical technique can not only correct severe dental and maxillofacial deformities and “bring relief” to the patient, but also “add beauty” to the patient’s appearance by improving the facial contour. The following are common dental and maxillofacial deformities and their orthodontic treatment methods: “bulging teeth” orthodontic treatment 1, what is “bulging teeth”? In the medical profession, “bulbous teeth” is essentially a maxillary protrusion malformation or bimaxillary protrusion malformation, which is generally not accompanied by serious functional disorders, but very much affects the aesthetics, and patients seek treatment mainly for the purpose of improving their appearance. 2.How does “protruding teeth” form? What are its clinical manifestations? It is similar to most dental and maxillofacial malformations, and the cause and pathogenesis have not been elucidated, but there are mainly congenital genetic factors and acquired bad habits. The disease has obvious racial characteristics and a tendency to gather in families, and is particularly common in southern provinces such as Guangdong; however, acquired bad habits such as mouth breathing, tongue spitting, biting the lower lip and adult sucking habits are also responsible for the disease. Patients with “teeth flare” often show open lips and teeth, and the lips cannot be closed in the natural state, and the gums are exposed too much when smiling, often accompanied by a receding chin, and when forcing the mouth closed, there is an obvious soft tissue bulge between the lower lip and the chin. In the mouth, the upper and lower front teeth are lip-tilted, often accompanied by crowded unevenness, deep overbite and deep coverage of the front teeth. 3.Can “bulbous teeth” be treated and how to treat it? Not only can “bulbous teeth” be treated, but also can significantly improve the appearance and obtain the unified effect of mouth and jaw function and facial aesthetics. This deformity usually requires a period of orthodontic preparation to align the teeth and then a maxillary recession procedure to correct the deformity. Orthodontic treatment of “Geodontia” The medical name for what is often referred to as “Geodontia” is mandibular protrusion or mandibular hypoplasia. The cause of hypertelorism is related to genetic and environmental factors, of which genetic factors may play a dominant role, and a family history of this condition is often seen in clinical practice. The term “geodesic” is used to describe the abnormal occlusal relationship of these patients. In a normal person, the upper teeth should cover the lower teeth and the upper lip should protrude slightly more than the lower lip. In the case of “encephalic” patients, the bite relationship is the opposite, with the lower teeth biting back on the outer side of the upper teeth, or the upper and lower teeth facing each other cusp to cusp. The chin protrudes forward in a concave shape, and there is poor chewing and pronunciation. This type of deformity is caused by the overdevelopment of the lower jaw and cannot be solved by orthodontic treatment alone. The specific treatment plan will be determined after consultation between the orthodontist and maxillofacial surgeon. Surgical treatment of “small chin” The popular term “small chin” refers to the underdeveloped jaw deformity caused by genetic and environmental factors. The main clinical manifestations are: 1) insufficient height of the lower part of the face, accumulation of soft tissue under the chin, and a “double chin”. (2) The lateral view shows that the mandibular body and mandibular ascending branch are short, and the chin is retracted in the shape of “bird’s beak”; (3) The teeth alignment is disordered, and it is a type II malocclusion, and many patients also have temporomandibular joint disorder syndrome. (4) Due to the reduction in the size of the oropharyngeal cavity and the posterior fall of the tongue, the upper airway is narrowed, which can cause obstructive sleep apnea hypoventilation syndrome (OSAHS) and induce cardiovascular system diseases. Considering the negative impact of micrognathia on the oral physiological function, cosmetic appearance and even the mentality of patients, it is necessary to treat this jaw deformity aggressively. Surgical procedures alone cannot achieve the best functional and morphological results, but must be performed by a combination of oral and maxillofacial surgeons and orthodontists, so that the patient not only has a neatly aligned dentition after surgery, but also has a much improved appearance. The surgical plan depends on the patient’s specific situation, usually requires the use of mandibular branch sagittal bone splitting before migrating the jaw or lengthening the short jaw with distraction osteogenesis, some patients also need to be supplemented with chinplasty to reshape the ideal facial appearance. Correction of “crooked face” The commonly known “crooked face” refers to the asymmetry of the patient’s face, with the midline of the jaw deviating to one side. This type of patient not only has an unorthodox facial appearance, but also has a misaligned bite, low masticatory function and joint problems. There are many causes of “crooked face”, which can be broadly divided into two categories. One type is due to bad habits, such as chewing on one side, holding the chin with one hand for a long time, and unexplained overdevelopment of the condyle on one side, which inhibits the development of the mandible on one side, or overdevelopment on one side, resulting in asymmetrical development of the mandible on both sides and a skewed face. Another type of facial deviation is caused by tumor or ankylosis of the condyle on one side. The treatment for these two types of patients is also different. The first group of patients usually requires a combination of preoperative orthodontics – orthognathic surgery – and postoperative orthodontics to obtain both functional and cosmetic results. Pre-operative orthodontics usually takes about one year, and surgery requires a two-week hospital stay to restore the patient’s facial shape and bite function. Post-operative orthodontics is used to fine-tune the bite and prevent post-operative relapse. In the second category, after the primary disease is removed, the patient’s facial soft and hard tissues should be restored for each patient’s different situation, in order to obtain the basic symmetry of the face under static conditions. Correction of “square face” Square face is caused by enlarged jaw angle and bite muscle. From the front, the lower part of the face is wide and square; from the side, the jaw angle is too sharp and lacks a soft, smooth contour. Men may think that a square face can increase their “masculinity”; however, for a woman, this is obviously not a good thing. The traditional Eastern aesthetic view has always been that a beautiful, soft melon face better reflects the “feminine beauty” of Eastern women. In ancient times, the description of the most beautiful women often have “face like a goose egg” “waist like a willow” said, in modern times, it is generally recognized that China and the Oriental people, especially women’s faces are still oval-shaped (goose egg type) for the most beautiful. Therefore, as people’s pursuit of beauty continues to improve, more and more patients, especially young women, are asking surgeons to correct their square face in order to make their face shape more perfect. As we all know, face shape refers to the morphological contour of the face. Geographical differences, racial differences, gender differences and individual differences can all make the face shape different, and the face shape can also change with age. Anatomically speaking, the shape of the face is determined by the supporting tissues, including bones, cartilage, and teeth, and the overlying soft tissues, including skin, subcutaneous tissues (fat, etc.), and muscles. The bones play the most important role as the orbital frame of the face, and its degree of development and shape become the intrinsic basis of the face shape; these bones are the frontal bone, maxilla, cheekbone, mandible and nasal bone. The skin, subcutaneous fat, and muscles cover the outside of the supporting tissues, and their thickness, tightness, and distribution range also play an important role in the shape of the face. If the part under the ears that is commonly known as the cheek is enlarged and prominent, when viewed from the front, the contours of both sides of the face are vertically downward, intersecting with the lower contour line at nearly right angles, making the lower third of the face appear wide and broad, which is the so-called square face shape. Anatomically speaking, it is mainly due to the overdevelopment of the mandibular angle (part of the jawbone) or the excessive hypertrophy of the bite muscle, both of which can also be present, medically known as mandibular angle hypertrophy (or benign bite hypertrophy). The square face shape is still rough and firm for men, but it loses its beauty for women. Many women suffer from this, they often cover up with their hair, do not want to participate in social activities, and even develop a withdrawn personality. What are the causes of square face? Anatomically speaking, it is mainly due to overdevelopment of the mandibular angle (part of the jawbone) bone, or excessive hypertrophy of the bite muscle, both of which can also be caused, medically known as mandibular angle hypertrophy (or benign bite hypertrophy), the mandibular angle hypertrophy is generally bilateral, unilateral is not uncommon. The cause of jaw angle hypertrophy has two parts: one is the bony hypertrophy of the angle of the mandible; the other is the overdevelopment of the bite muscle protruding from the cheek on both sides. In each patient, the impact of the two causes may be different, either bony or muscular, but from clinical experience, both often occur together. It is often associated with excessive snacking and chewing of gum (or betel nut) during the physical development of adolescents, and can also be caused by grinding of teeth at night. All of these cause excessive exercise of the maxillary muscles (bite muscles, pterygoid muscles, etc.), which stimulates the development of the muscles and bones in the mandibular region and eventually gives the appearance of a “square face deformity”. There are also some patients who are genetically predisposed, and their parents or relatives often also have an enlarged jaw angle. Is there a way to change this face shape? Modern medical plastic surgery has answered in the affirmative, that is, the face shape can be changed to some extent through plastic surgery and it is safe. For the correction of square face, surgical treatment is the most effective and definite method at present. And with the development of modern medical technology and the continuous improvement of surgical instruments, at present, surgeons have been fully able to meet the requirements of patients under the condition of not leaving facial scars, thus relieving patients of their worries and fulfilling their dreams for many years! Second, will orthognathic surgery leave facial scars? Many people worry that such a complex surgery will leave scars on the face. The current orthognathic surgery is done from inside the mouth, so there will not be any surgical scars left on the face. Third, is orthognathic surgery done under general anesthesia or local anesthesia? Is it safe? Orthognathic surgery is generally performed under general anesthesia, and there is no pain during the surgery. The Orthognathic Surgery Center of Guangdong Provincial Dental Hospital has performed more than 1,000 such surgeries since 1990, and there have been no major complications and zero mortality. Orthognathic surgery procedures for dental and maxillofacial patients 1. preoperative psychological assessment: 2. preoperative cephalometric analysis and design: clear diagnosis and treatment plan; 3. preoperative orthodontic treatment: about 1 year; 4. orthognathic surgery: about 2 weeks of hospitalization; 5. postoperative auxiliary orthodontic treatment: 6 months to 1 year; 6. postoperative follow-up assessment The combined orthognathic and orthognathic surgery treatment will bring patients with dental and maxillofacial deformities The combined orthodontic and maxillofacial treatment will bring patients with malocclusion good oral and jaw functions and a coordinated, aesthetic appearance, bringing them a confident smile.