Join me for Lucy’s lecture looking at 3 aspects of orthognathic surgery; 3D planning, body dysmorphia and obstructive sleep apnoea.
Digital workflow
o CBCT
o Scanned models
o Digital surgical planning
o Surgical cuts planned
o Customised plates
o Re-assess planned Vs delivered changes
Video assessment
o Soft tissues in animation
o incisal show, rest, smiling
CBCT assessment
o Can assess maxilla relative to cranial base – not possible with plan views
o Detailed assessment of maxillary cant
o Apex of roots visible
o Cuts can be planned away from roots
o ID nerve position and plan around them
o Cutting guides
o Screw holes for guide and plates
o Bone depth measured and appropriate screw selected
Post operative assessment
o End CBCT superimpose plates and planned position
Advantages
o Diagnosis – especially asymmetry
o Planning
o Execution – more controlled surgery
o Stability – of union due to predictable bone thickness
o Safety – nerve
o Teaching
o Communication
o Post op analysis
Shared decision making
o NICE guidelines on SDM
o Involvement in surgical planning for patients
Disadvantages of 3D planning
o Cost – 2-3k per patient
o Soft tissue analysis unpredictable
o Airway analysis unpredictable
o 60 minutes additional time per case in planning
o Plates not adaptable
Lucy – what has she learned
o Change maxillary impaction points
Airway consideration
o Effects of mandibular set back
o Sleep study
o Mandibular advancement splint
o Repeat sleep study
o Plan bimaxillary advancement
o Mallampati – visual assessment, most OSA patients grade 4 – due to base of tongue
o Caution of large maxillary set back
Body dysmorphia BDD
o Believe they look abnormal or are deformed when they are not
o Likely dissatisfied with treatment outcomes
o 1.7-2.4% in population, greater in those seeking treatments
o Effect of Covid, worsening of BDD Quittkat 2020
o Zoom dysmorphia – people living in isolation with greater awareness of appearance
o Patients working from home = seeking more treatment
o Symptoms of BDD worsened with working from home
o Screening of BDD for orthognathia surgery
o BDD screening questionnaire
o Preoccupation, level of distress, impaired social function
o Lucy has learned
o Difficult conversation
o Beware of multiple surgeries
o Don’t offer less evasive treatment, will still remain dissatisfied
