Preface: Techniques in Orthognathic Surgery ix

Steven M. Sullivan

Le Fort I Osteotomy 1

Steven M. Sullivan

Introduction 1

Surgical technique 1

Complications 13

Summary 13

Le Fort I Osteotomy 1

Steven M. Sullivan

Introduction 1

Surgical technique 1

Complications 13

Summary 13

Le Fort III and Le Fort II Osteotomies 15

David D. Vu and Paul S. Tiwana

Introduction 15

Indications 16

Craniofacial dysostosis 18

Midface deficiency 18

Technique 18

Subcranial Le Fort III osteotomy 19

Modified Le Fort III osteotomy 20

Pyramidal Le Fort II osteotomy 22

The Bilateral Sagittal Split Mandibular Ramus Osteotomy 27

Johan P. Reyneke and Carlo Ferretti

Introduction 27

Step 1—infiltrate the soft tissue with vasoconstrictor 27

Step 2—the soft tissue incision 27

Step 3—buccal subperiosteal dissection 28

Step 4—superior subperiosteal dissection 28

Step 5—exposure of the lingual 28

Step 6—medial ramus osteotomy 28

Step 7—sagittal osteotomy 28

Step 8—buccal osteotomy of the mandibular body 29

Step 9—drill holes for a holding wire 29

Step 10—drill a hole for the condylar positioner 29

Step 11—place reference marks 30

Step 12—lavage 30

Step 13—define the osteotomy 30

Step 14—splitting the mandible 30

The bad split 32

Step 15—stripping the pterygomasseteric sling 33

Step 16—stripping the medial pterygoid muscle and stylomandibular ligament 33

Step 17 33

Step 18—smooth the contact areas of the segments 34

Step 19—place the holding wire 34

Step 20 34

Step 21—mobilize the bone segments 34

Step 22—place the teeth into the planned occlusion 34

Step 23—remove bone from the proximal segment in class III mandibular setback cases 34

Step 24—positioning the condyle 34

Step 25—tightening the holding wires 34

Step 26—placement of the trocar 35

Step 27—drill the holes and for the place of rigid fixation 35

Step 28—remove the intermaxillary fixation and check the occlusion 35

Step 29—intraoperative diagnosis of a malocclusion 36

Step 30—Place intra and extraoral sutures 36

Step 31—place intermaxillary elastics 36

Step 32—apply a pressure bandage 36