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Jessy's Pufferface, Pre surgical Picture1, Post surgical Picture2 -…

- - - - Aims:
        
        Alignment and levelling
        
        Coordination (ensure arches will be compatible with each other after surgery)
        
        Decompensation
        
        Creation of space for osteotomy cuts if segmental surgery is required
    - - Aims:
        
        Complete any movements not undertaken prior to surgery
        
        Root paralleling at any segmental osteotomy sites
        
        Detailing and settling
    - - To retain teeth in correct position at the end of treatment and prevent relapse
  - - - to stabilize and join the segmented bones
  - - - Swelling
      - Bleeding
      - Limited mouth opening
      - Dietary changes & associated with weight loss in short term
      - Time off work and recovery
      - Changes in facial appearances
      - Changes in nerve sensation
    - - Permanent nerve damage to nerve
        
        Jessy experienced facial nerve damaged that might affect the buccal branches
        
        Compromised motor function
        
        No innervation to the buccinator, levator labii, anguli oris and orbicularis oris
        
        Left-sided facial paralysis
      - Need for reoperation
      - Infection
      - Removal of plates
      - Temporomandibular joints problems
      - Relapse
      - Swallowing problem
      - Ophthalmic complications
      - Reduction in auditory capacity
  - - - Indications:Gummy smile and anterior open bite
        
        Types:
        
        i. Le Fort osteotomy (Le Fort I, II & III)
        
        ii. Maxillary segmental
        
        iii. Surgical assisted rapid maxillary/palatal expansion (SARME/SARPE)
    - - Indications: prognathic mandible (class III skeletal pattern) and retrognathic mandible (class II skeletal pattern)
        
        Types:
        
        i. Bilateral sagittal split osteotomy (BSSO)
        
        ii. Vertical subsigmoid osteotomy
        
        iii. Body osteotomy
        
        iv. Genioplasty - chin repair
    - - i. Bimaxillary surgery
        
        Indications
        
        Retrognathic maxilla and prognathic mandible
        
        Vertical discrepancies (short vs long face, deep bite vs anterior open bite)
        
        Multiplanar discrepancies
      - ii. Distraction osteogenesis
      - iii. Maxillomandibular advancement surgery (MMA)
        
        The bones of upper and lower jaws are repositioned to relieve airway obstruction.
    - - Index of Orthodontic Functional Treatment Need (IOFTN) → identifies patients that would most benefit from combined orthodontics and orthognathic surgical treatment.
  - - - However, fixed appliance alone cannot correct the spacing due to patient's Class 3 Skeletal Pattern.
        
        Therefore, FA was used in combination with orthognathic surgery
        
        To correct the lower dentition spacing and reduce her open bite
- - - - Jessi is 16 years old girl
        -Unable to close her mouth
        -Class 3 skeletal pattern
        -Increase vertical proportion
        -Incompetent lips
        -Class III malocclusion
        -Spacing on tooth 34 and 35, 44 and 45
        -Severe AOB
        -Reverse OJ complicated with macroglossia.
    - - Jessi is 16 years old girl
        -Able to close her mouth
        -Competent lips
        -Class III malocclusion
        -Reduction in spacing on tooth 34 and 35, 44 and 45
        -Reduced anterior open bite
        -No macroglossia
- - - - Arteries
        
        predominantly from
        
        lingual artery; branch of external carotid artery
        
        secondary
        
        tonsillar branch of the facial artery
        
        ascending pharyngeal artery
      - Veins
        
        paired deep lingual veins
        
        single dorsal lingual vein
        
        lingual vein
        
        drain into
        
        internal jugular vein
    - - Motor
        
        Hypoglossal nerve (CN XII)
        
        Intrinsic muscles
        
        Inferior longitudinal
        
        Transverse
        
        Superior longitudinal
        
        Vertical
        
        Extrinsic muscles
        
        Hyoglossus
        
        Styloglossus
        
        Genioglossus
        
        Vagus nerve (CN X)
        
        Extrinsic muscle
        
        Palatoglossus
      - Sensory
        
        Anterior 2/3
        
        Taste
        
        chorda tympani branch of the facial nerve (CN VII)
        
        Sensation
        
        lingual branch of the mandibular (V3) division of the trigeminal nerve (CN V)
        
        Posterior 1/3
        
        Taste
        
        Sensation
        
        Glossopharyngeal nerve (CN IX)
  - - - Provides a representative sample of tissue for diagnostic purposes include the healthy tissue
        
        In this case, incisional and excisional biopsy was chosen, where complete removal of the lesion include the normal tissue for diagnostic purposes was done
    - - Complete removal of a lesion for functional and aesthetic purposes, as well as to confirm the clinical diagnosis
    - - Firm pressure with a circular brush, rotated ten times cause light abrasion
    - - The location must be feasible for the device to approach the mucosal surface perpendicularly
  - - - CT Scan
      - MRI
- - - - Do appropriate slow electrocautery dissection with tension
      - Identification and ligation of the lingual artery & its branches and oversewing with mattress sutures
    - - An attempt should be made to repair them with micro-neurosurgical techniques
      - Effects
        
        loss of sensation/altered sensation
        
        tongue numbness
        
        pain
        
        loss of taste
  - - - swelling
      - redness
      - pain
- - - - Definition
        
        Structural anomalies of blood vessels with normal endothelial cell turnover
      - Clinical Features
        
        Location: tongue and lips (most common)
        
        Appearance: Dark, reddish-purple in colour, smooth surface, flat, or raised lesion of the oral mucosa
        
        Blanch on pressure, usually solitary
        
        Asymptomatic
        
        Present at birth and persist throughout life
        
        Multiple lesions may occur in syndrome: Sturge-Weber Syndrome
    - - Haemangioma
        
        Definition
        
        Benign vascular tumors
        
        Clinical Features
        
        Most common tumor of infancy (F:M, 3:1)
        
        Usually in whites compared to other racial groups
        
        Location – head & neck region (most common)
        
        Present as bright red, non-compressible papule, nodule, plaque
        
        Most haemangiomas will completely resolve by age 9 years old
    - - Definition
        
        Benign proliferation, hamartomatous tumorlike growth of lymphatic vessels
      - Clinical Features
        
        Location: Tongue anterior 2/3 (most common) --> often result in macroglossia
        
        Present as pale, translucent, smooth, nodular elevations
        
        Lesion is superficial and demonstrates a pebbly surface
        
        Primary appear as yellowish & soft. Secondary hemorrhage into lymphatic spaces may cause these “vesicles” to become purple
        
        More likely to result in respiratory difficulties if they grow larger
      - Cystic Variety
        
        Cystic Hygroma
        
        Large diffuse lymphangioma of very dilated lymphatics
        
        Most often lymphangioma seen in the neck area
        
        Can be life-threatening as it can be larger than 15cm