Orthognathic surgery is a discipline that uses the combination of surgery and orthodontics to treat dental and maxillofacial deformities. Maxillofacial malformations can be divided into: 1. anterior-posterior developmental abnormalities of the jaw: such as maxillary protrusion, maxillary recession, mandibular protrusion, mandibular recession, etc.; 2. vertical developmental abnormalities of the jaw: such as open and closed, long face, short face, etc.; 3. lateral developmental abnormalities of the jaw: such as wide face deformity, bite hypertrophy, mandibular angle hypertrophy, etc.; 4. chin deformities: such as chin underdevelopment or overdevelopment; 5. facial asymmetric deformities: such as hemifacial short deformity, unilateral jaw overdevelopment, half jaw angle hypertrophy, progressive half facial atrophy deformity, etc. Orthognathic surgery is a relatively mature technique that has been used in conjunction with orthodontics to provide aesthetic and functional results for patients with malocclusion. Orthognathic surgery mainly refers to the correction of severe bony malocclusion after growth and development is completed with surgical methods. Surgical correction requires the cooperation of orthodontists and oral and maxillofacial surgeons to ensure that the bite relationship and jaw deformity are well corrected. Orthognathic surgery is generally performed through an incision in the mouth, using tools such as a chainsaw, electric drill and bone cutter to cut open the jaws in accordance with medical principles and a preoperative design, and then move them to the appropriate position for fixation. Because of the small operating field of view and mostly sharp operation, we should pay attention to the occurrence of the following situations in the surgical operation and postoperative period: 1. Postoperative airway obstruction: Routine postoperative tracheal intubation is left overnight, and the airway is assessed early the next morning, and most patients are safely extubated, and if the swelling will obviously affect the airway, the tracheal intubation can continue to be retained. In addition, intraoperative and postoperative application of hormones in appropriate amounts can prevent laryngeal edema and reduce maxillofacial edema. 2. Bleeding and nerve injury: Intraoperative injury to larger vessels, such as the internal maxillary artery, palatine aorta and inferior alveolar nerve vascular bundle, can lead to severe bleeding. The operator is required to understand the anatomical course of blood vessels, and to master the precise and accurate design of osteotomy line and the direction and depth of bone knife entry during osteotomy. A small amount of bleeding can be taken as local compression, filling, or placing gelatin sponge, spraying ephedrine and other measures. 3, tooth, bone segment necrosis and poor bone healing: bone segment necrosis or poor bone segment healing is mostly due to excessive stripping of soft tissue. Therefore, the separation and exposure of the bone surface should not be too large in scope. The transverse osteotomy line is too low and leads to root truncation and pulp necrosis. The root length and the location of the root tip should be estimated and the bone should be osteotomized about 4-5 mm above and below. Poor fixation and insufficient contact with the broken end of the bone can also affect the healing of the bone segment. Generally, interosseous fixation plus intermaxillary fixation is used to ensure good fixation of the bone segment. 4, postoperative occlusal disorder, deformity recurrence: postoperative occlusal disorder and deformity recurrence are mostly due to poor fixation, preoperative orthodontic in place, and no stable occlusal relationship. Therefore, preoperative orthodontic fight to make the postoperative reconstruction of the bite, can be stable in a state. At the same time, patients should have regular postoperative follow-ups to adjust the bite immediately. In addition, secure interosseous fixation, intermaxillary fixation and bone grafting in the bone gap left after osteotomy movement is also one of the methods to prevent the recurrence of deformity.
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