Orthognathic surgery

History
Orthognathic surgery is one of the finest divisions of plastic and maxillofacial surgery. This involves repositioning of facial skeleton and thus overlying integument.

The indications for this type of surgery are many. The first and the foremost being purely aesthetic, meaning there by changing profile for improving looks.

The other indications are midface hypoplasia, treacher Collin syndrome, micro and macrognathia, hemi facial microsomia etc.

The Problem
Even though it is possible to achieve desired result in many such cases, the few problems associated with their problems have been nagging the plastic surgeons.

1. Extensive operation: It takes months of planning and hours of execution and tremendous post operative care to accomplish the desired outcome in such cases. The long operative time along with need for blood transfusion many times, makes this unjustifiable especially if being done for pure cosmetic reasons.
2. Inadequate soft tissue moulding: The soft tissue after osteotomics many a times, does not move as much as one wants to move it making the entire exercise futile with less then ideal gains.
3. Relapse: The relapse rate at a later date because of soft tissue pull is much higher then desirable.
   
   

The Procedure
The procedure can be executed at a relatively young age. And that is the precise reason for the soft tissue growth in such cases.

The distraction devices are fixed under vision and corticotomies are performed. The distraction is started 3 day later and is carried with the rate of 1-2 mm per day. A long period of 6-8 weeks is recommended for consolitation of bone, once distraction is completed and distraction is removed.

The hardware
Many of the cumbersome external devices which were used earlier are now being replaced with internal hidden devices in order to achieve maximum in terms of routine activities.

The future
The innovative scientist plastic surgeons are now working towards distracting the skull bones without nay corticotomy or osteotomy utilizing the unfused sutures for correction of many congenital skull anomalies.

The solution
The answer came in the form of distraction osteogenesis of facial skeleton based on Illizaron principle, surprisingly much later then the technique was accepted as standard form of treatment amongst orthopedicians.

McCarthy, a plastic surgeon from New York who has done pioneer work in distraction osteogenesis was so amazed with the results of his initial experiments that he quoted

" Illizaron was a wonderful man who invented wonderful technique, but he was working on wrong bone."

The complication rate in craniofacial skeleton have been surprisingly low because of better blood supply of the bones. The other things which amazed him was the soft tissue growth in the cases of hemi facial microsomia which was impossible to achieve with traditional osteomies.