1-4. We shortened the long face, reduced the excessive incisor show and the gummy smile, made the junction between the upper lip and nose more acute and aesthetically pleasing. All this was done with an impaction Le Fort I osteotomy: In more simple terms we separated the upper jaw / nasal complex and repositioned it further up and forward. Nothing was done to the teeth or gums per se. The change is all from the superiorly repositioned jaw / nasal complex.
5. Simultaneously with the access afforded with the Le Fort I osteotomy we adjusted the inferior turbinates of the nose, the nasal septum and the base of the nose to allow better breathing and a more aesthetically pleasing nose.
6. By reducing as described in 1-4 the length of the face, the lips have less tension in them when closing, giving a more natural appearance and creating less strain.
7-8. The lower jaw was brought forward by doing a Bilateral Sagittal Split Osteotomy to the mandible, thus bringing the lower incisors forward to touch with the upper incisors, allowing normal biting and chewing.
9-10. The chin was brought forward with a sliding genioplasty and also moved to the right to make the face more symmetrical.
All of the above was done in one operation, the duration of which was roughly three hours. The patient stayed in hospital for two nights.
Before the surgery was done, the patient had braces placed (orthodontics) in order to position the teeth in the appropriate position so as to allow the optimal movement of her jaws. She was discussed jointly with the Orthodontist before commencing braces so that the optimal plan could be made as to the extraction pattern of teeth and brace work to be done.
This case serves very well in demonstrating that if patients are considering orthognathic surgery, they do not have braces put on until a surgeon reviews them and a joint discussion is held with the orthodontist well in advance.
Orthodontics is not required for all cases, for example if a genioplasty is considered or correction of some asymmetries, rhinoplasties, TMJ problems or bimaxillary advancements for many sleep apnoea cases. Each case is assessed individually.
