Orthognathic surgery in East Paris

Maxillofacial Surgery Pr Meningaud

What is orthognathic surgery?

Orthognathic surgery treats abnormalities in the relationship between the bony bases of the upper jaw (maxilla) and lower jaw (mandible). The most popular image is that of the prognathic person with a forward chin. For the specialist, the reality is much more complex, and there are many anomalies, each with its own specific name: endognathy, progeny, retromadibulia, brachygnathy, laterognathy, etc.

Orthognathic surgery in East Paris

Maxillofacial Surgeon Paris Est Créteil

Is orthognathic surgery covered by social security?

Orthognathic surgery itself is covered at 100% by social security. However, many orthognathic surgeons operate in sector 2 and may therefore charge a higher fee. This may be reimbursed by a mutual insurance company, but it all depends on the contract you have taken out. If in doubt, don’t hesitate to ask the surgeon for a quote, so that you can check with your health insurance company. Osteotomies for purely cosmetic purposes are not covered.

Which surgeons are qualified to perform orthognathic surgery?

Orthognathic surgery is, by its very nature, maxillofacial surgery, and by definition all maxillofacial surgeons are qualified by the Conseil de l’ordre in maxillofacial surgery. However, some otolaryngologists are qualified in maxillofacial surgery. The easiest way to find out more is to contact the departmental medical association to which the doctor belongs.

What is the usual hospital stay for orthognathic surgery?

The usual length of stay varies according to the type of surgery. They range from 24 hours to 7 days

Professor Jean-Paul Meningaud

Orthognathic surgery at Paris Est

The usual bone healing time is 4 weeks. This process can take longer in the event of infection. These are very rare. Finally, in exceptional cases, there may be a lack of consolidation, known as pseudarthrosis. Note that the term maxilla is a pleonasm. The maxilla is necessarily superior, as opposed to the mandible.

Genioplasty is an operation designed to modify the shape of the chin. Essentially, it consists of an osteotomy of the basilar part of the mandibular symphysis, followed by osteosynthesis in an advanced, retracted, elevated or lowered position. Backward or “ovalization” genioplasty can be performed using a shaping osteotomy, i.e. grinding with a ball burr. When indicated, this technique considerably reduces the risk of complications. Lowering genioplasties require the interposition of a bone graft, which slightly increases the potential rate of complications. Genioplasty does not alter the dental articulation (unlike orthognathic surgery). However, genioplasty can be combined with orthognathic surgery.

There are different types of genioplasty:

  • retrograde
  • verticaladv
  • ancement
  • symmetrization

Respiratory distress syndrome

This is caused by obstruction of the upper airways. It can occur in two circumstances. It may be caused by a compressive hematoma of the floor of the mouth. In the case of osteotomy, faulty fixation of the genioplasty may be the cause, with abrupt recoil of the fragment on which the tongue muscles are inserted. This is why this procedure is not so trivial, and needs to be carried out in a suitable environment, with appropriate post-operative monitoring. This is an exceptional complication.

Dental mortification

These are essentially caused by an osteotomy line passing in contact with the incisor and canine apices. If the line appears to be too close to the roots at the time of surgery, the practitioner should monitor tooth vitality in the months that follow, so as to propose bio pulpectomy and root canal treatment of the teeth concerned before tooth mortification. This complication is virtually non-existent in the hands of a specialist.

Asymmetry

Asymmetry is the result of an asymmetrical osteotomy or fixation.

Labial anaesthesia

This is caused by dissection of the chin nerves. It is very common when it is limited to hypoesthesia (incomplete loss of sensitivity). It regresses within a few weeks or months.

On the other hand, if left unrepaired, a sectioned chin nerve can lead to permanent anaesthesia of a half-lip. The section is the result of surgical error. Depending on his or her skills, the surgeon should be able to repair it immediately, or notify the patient when he or she wakes up and refer him or her to a specialist for microsurgery. This complication is virtually non-existent in the hands of a specialist. Should it nevertheless occur, the prognosis is good after prompt microsurgery.

Recurrence

Recurrence is often due to faulty mounting, with the osteotomized fragment tilting progressively downwards and backwards. It should not be confused with the melting of edema in the weeks following surgery.

Osteitis

This is an infection of the bone. It is very rare, as the face is very well vascularized. It is favoured by various causes, which are often combined: vascular terrain, significant de-periostealization (both vestibular and lingual of the osteotomized fragment), smoking, leaking sutures, postoperative trauma, need for bone grafting.

In theory, it is possible, but not advisable. These procedures are performed under general anaesthetic. The intubation probe cannot be placed in the nose when rhinoplasty is performed. Oral intubation will prevent control of the dental articulation. A very theoretical alternative would be to perform a tracheotomy or submental intubation. In practice, this is only justified in the management of facial fractures (severe traumatology). Another alternative would be to perform orthognathic surgery first, then re-intubate the patient by mouth during the procedure to perform the rhinoplasty, and finally perform the inter-maxillary blockade on awakening. In fact, it may be preferable for the surgeon to concentrate on each of these two (extremely delicate and meticulous) procedures in two separate operative phases. What’s more, orthognathic surgery modifies the profile and, in some cases, the shape of the nose, so it’s best for the patient and surgeon to discuss the nose project again after orthognathic surgery.

The same does not apply to rhinoplasty combined with genioplasty (isolated modification of the chin shape), which can be performed under the same anaesthetic.

We differentiate between

anomalies of the maxillary bases;alveolar anomalies;anomalies of arch relationships, static and kinetic;anomalies of tooth position.

LINGUISTIC CONSTRUCTION

The structure to be defined is designated by a radical of Greek origin.

This radical is preceded by a prefix that specifies the situation in space, and a qualifier that indicates the level. Example:

LOWER PRO GNATHY

prefix radical level

Prefixes :

in the anterior-posterior direction :

PRO: too far forward,

RETRO: too far back;

in the vertical direction:

INFRA: too far up in relation to the occlusal plane,

SUPRA: too far down;

in the transverse direction :

ENDO: inside the “normal” situation,

EXO: outside the “normal” situation.

Terminology for soft tissues

Lips:

procheilia: lips too far forward;retrocheilia: lips too far back;

Chin:

progenia: very prominent chin;retrogenia: recessed chin.

TERMINOLOGY FOR MAXILLARY ANOMALIES

(Bone bases and alveolar processes):

The term maxilla refers to the upper jaw;the term mandible refers to the lower jaw.

Bone base anomalies: the radical GNATHIE is used:

Topographical anomalies:

anteroposterior: pro- or retrognathia vertical: infra- or supra gnathia: affecting both anterior and posterior sectors. These terms are no longer widely used;transverse direction concerns the maxilla only:endognathy: the maxilla is too narrow;exognathy: the maxilla is too wide.

Volume anomalies

Laterognathy: this term is used more specifically for the mandible (anatomical anomaly);Micrognathy/macrognathy: indicates an overall reduction or increase in the volume of one of the maxillae.Brachygnathy: decreased anteroposterior length.Dolichognathy: increased anteroposterior length.

These features also modify sagittal relationships. These terms are mainly used to describe major craniofacial syndromes.

Alveolar anomalies

Anterior-posterior direction (anterior sector only): pro-alveolus: vestibulo-version of a group of teeth and the alveolar bone supporting them; retro-alveolus: linguo-version.

Vertical direction (anterior sector): supra-alveolus: anterior alveolar arch too low in relation to the occlusal plane; infra-alveolus: anterior alveolar arch too high.

Transverse direction (for lateral sectors only):endo-alveolus: lingual version of a group of lateral teeth and the alveolar bone supporting them;exo-alveolus: vestibular version.

TERMINOLOGY OF INTER-ARCH RELATIONSHIPS (OCCLUSAL RELATIONSHIPS)

a) overbite (only in the anterior sector): excess incisal overlap, overbite ;

b) infraclusion :

anterior sector: absence or insufficiency of incisal overlap;posterior sector: absence of occlusal contacts in a group of teeth.

Synonyms: anterior gap = anterior underbite; lateral gap = lateral underbite..

The term BEANCE is increasingly used, as it is more concise.

Terminology for tooth position anomalies

The arch curve is used as a reference, the horizontal plane is represented by the occlusal plane, and the description is given in vestibulo-lingual, mesio-distal and vertical directions. The radical VERSION indicates an abnormal inclination of the long axis of the tooth.in the vestibulo-lingual direction:vestibulo-version: localised to 1 or 2 teeth;linguo-version: localised to 1 or 2 teeth;in the mesio-distal direction:mesioversion;distoversion;in the vertical direction:infraposition (or…TOPIE): tooth too high in relation to the occlusal plane;supraposition (or…TOPIE): tooth too low. It’s best to avoid the radical…GRESSION, which implies an idea of displacement. Egression = supraposition, ingression = infraposition.

Rotation :

axial rotation, around the tooth’s longitudinal axis;

SOME COMMONLY USED TERMS

Dental crowding: characterises incorrect alignment of teeth, with dento-dental disharmony (DDD) or dento-maxillary disharmony (DDM). Labial hollowness or inocclusion: the lips do not meet in the resting position (+ 3 mm).Malocclusion: abnormal meshing of the teeth, in maximum intercuspidation. Dysmorphosis: morphological anomaly, defined in relation to the usual norms of a given population.Ectopy: situation of a tooth far from its usual location.

Kinetic relationships

These anomalies appear during the closing movement of the mandible, the only mobile bone in the face, and correspond to a marked shift between the position of maximum tooth contact and the highest and rearmost position of the condyles (centric relationship+++): in the antero-posterior direction: proglide; in the lateral direction: latero-slip or latero-deviation: the latter term illustrates the deviation of the incisal middles during the closing movement.