ortho - the international C.E. magazine of orthodontics

ortho1_2013 C.E. article_ orthognathic surgery I I 07 _Pre-surgical setup/surgical setup technique Once you have established what you’ll need to do from the surgical treatment objective, you will need to do what we call a pre-surgical setup. Oth- erwise you’ll need to apply the knowledge you’ve gained from the patient, soft-tissue analysis and the surgical treatment objective, and perform a three-dimensional workup to make sure what you have planned will work with the joints, muscles and nervous system. _Surgery Finally, you need to know surgery. I recommend that the orthodontist be in the operating room so you know what the surgeon is doing, and how the surgery goes. It’s very important to know that the surgeongetsthejointsseatedinapassivemanner.If the joint is stressed, then there’s a good chance that we’ll have some surgical relapse. _Joint status Jointanalysiswillincludethreeportions:history, a clinical examination and imaging. Building a history will be similar to traditional patientassessment.Weneedtoknowifthereareany family members who exhibit TMJ problems. If yes, then there’s a good chance the patient will develop significant joint issues that will affect the outcome of treatment. After an oral investigation, a thorough clinical examinationofthejointswillneedtooccur.We’llbe on the lookout for any type of injuries to the mandi- ble.Ifthepatienthashadanyinjurythatinvolvesthe chin, there’s a good chance that the joint may have been damaged. Finally, we need to look into any past treatment. Has the patient had orthodontics before? Has the patient had a lot of restorative dentistry? This is important because all of the above have a tendency to affect joint status. _Clinical examination Next is the clinical examination. Clinical exami- nation includes the following: • range of motion, • symmetry of jaw motion, • palpation, • auscultation, • muscle splinting, • CR position. Fig. 1a Fig. 1b Fig. 1c Fig. 2 Fig. 3 Fig. 1a_Patient profile. (Photos/ Provided by Dr. Theodore D. Freeland) Fig. 1b_Patient frontal. Fig. 1c_Patient oral casting. Fig. 2_Joint degeneration. Fig. 3_Panoramic X-ray of the soft tissue on top of the hard tissue.