Contemporary Aspects of Orthognatic Surgery

Abstract

Ortognatska kirurgija se tijekom prošlih 50 godina razvila jednom od standardnih zahvata čeljusne kirurgije. Na osnovama rada Obwegesera, koji je uveo sagitalnu osteotomiju ramusa mandibule početkom 50-tih godina, danas se ova metoda smatra “Gold standardom” mandibularnih ortognatskih zahvata u cijelome svijetu. Luhrov uvod sprava osiguranja centrične pozicije kondilusa tijekom čitavog zahvata ranih 80-ih godina daje dodatnu podršku modernom pristupu sveobuhvatne funkcionalne rehabilitacije pacijenata s disgnatijama. Iako je Wassmund već 20-ih godina uveo LeFort-I-osteotomiju, trajalo je daljnjih 50-ak godina dok je ta tehnika bila prihvaćena u čeljusnoj kirurgiji. Najvažniji razlog tome je ležao u strahu od teških krvarenja do kojih može doći tijekom zahvata. Uvođenjem kompletnog sustava za osiguranje kondilarne pozicije tijekom maksilarne i mandibularne osteotomije pri bimaksilarnim zahvatima, kao i ciljanom korištenju distraktora u određenim indikacijama, u današnje vrijeme kirurgija je u stanju rješiti i najteže slučajeve disgnatia. S iskustvom dužim od 20 godina, te nakon više od 2000 ortognatskih zahvata u našoj klinici, pokušavamo dati široki pregled o razvitku kirurških tehnika te kliničkih rezultata na tom području. Ovaj napredak ne bi bio moguć bez primarne i kontinuirane terapije specifično obrazovanog specijalista ortodoncije tijekom primarne terapije, uključujući interdisciplinarne indikacije za zahvat, ortognatske pripreme pacijenata te postoperativne terapije. Radi toga naglašavamo ortognatsku terapiju te tehničke preduvjete za kirurški zahvat.Orthognatic Surgery within the past half decade has become a standard procedure in cranio-maxillo-facial surgery. Based upon the elementary works by Obwegeser introducing the sagittal split ramus osteotomy in the early 50ies, today this procedure has became the gold standard in mandibular orthognathic procedures worldwide. The introduction of devices to ensure the centric condyle position throughout the entire surgery by Luhr in the early 80ies gives another impact to the modern understanding on a complete functional rehabilitation after dysgnathia. Even though the LeFort-I Osteotomy already was introduced by Wassmund in the 20ies it took almost another 50 years until this procedure became accepted in surgery, mainly based on the fear of severe bleeding that may occur during surgery. By introducing compund condyle positioning device to ensure the exact condyle position troughout both procedures of maxillary and mandibular osteotomy respectively, during combined bimaxillary osteotomies as well as the targeted use of distraction devices, today we are able to solve even severest dysgnathia problems. At the Department of Crani-Maxillo-Facial Surgery of the University of Würzburg during the past two decades and far more than 2000 orthognatic surgery cases we are trying to present a broad overview over the development of the latest surgical techniques and clinical results This progress is not possible without the primary and consistent treatment by a specifically skilled orthodontist during primary treatment including the interdisciplinary indication for surgery, the orthognathic preparation of the patient as well as the postoperative treatment. Therefore special emphasis will be put onto the orthognathic treatment, as well as on the technical prerequisites fo rthe surgical procedure