How do we plan your jaw surgery?
There are many hours spent behind the scenes planning your jaw surgery. This blog post will give you an insight into what is involved.
There have also been some exciting developments in the area of 3D Jaw Surgery Planning that we would love to share with you.
What happens at your initial jaw surgery consultation?
When you come and meet your Oral & Maxillofacial Surgeon for the first time at Profilo Surgical he will discuss jaw surgery in general terms.
Your surgeon will be able to show you previous cases and what outcomes he has been able to achieve for those with similar concerns as you. He will answer your questions.
Your surgeon will be able to give you an idea of the surgery proposed for you. However without appropriate records this will not yet be a definitive plan.
You have decided to proceed with surgery or investigate further?
Once you have decided to proceed to the planning stage of surgery we will arrange a CT scan for you. This CT scan must be done to our specific protocol so we are able to manipulate the data in preparation for 3D Jaw Surgery Planning.
The data from this scan is used to “segment” the facial bones. This process results in your Oral & Maxillofacial Surgeon being able to move the maxilla (top jaw) and mandible (lower jaw) independent of each other, and the rest of the facial bones. Using these "segmented" images we are able to plan the optimum jaw movements for your individual case.
A CT scan obtained not using our specific protocol may mean we are unable to "segment" your facial bones.
What does 3D Jaw Surgery Planning involve?
The data obtained from your CT scan is then used in the planning stage.
The maxilla is usually moved first into the most ideal position for you. The surgical procedure for this jaw movement is called a Le Fort 1.
Once the maxilla is in the ideal position the mandible is then moved into place. The surgical procedure to move your mandible is a BSSO.
Once your maxilla and mandible have been moved into the ideal position we are able to show you images with the soft tissue present.
The software we use to plan our jaw surgery procedures is Proplan by Materialise.
What do we do with 3D Jaw Surgery Planning?
This is the exciting stuff.
Traditionally Oral & Maxillofacial Surgeons have either used surgical splints or based on clinical judgement when it comes to positioning the jaws during surgery.
Using clinical judgement when deciding where a maxilla should be positioned is very subjective. It is difficult to assess how much movement is achieved in all directions at the same time. It is also very difficult to assess the aesthetics of the movement when a patient is draped in surgery and the facial features are obscured. A discrepancy of millimeters can make a difference in aesthetics and function when completed.
The surgical splint is a piece of acrylic made to fit the surfaces of your teeth, both top and bottom. When it is placed in your mouth the tops of teeth will fit into indentations on the splint.
A surgical splint is accurate when used in moving the maxilla side to side or back and forth. However it is of little help is when the maxilla needs to be rotated (tipped up/down either forwards or backwards or tipped up/down to either the right or left side). Unfortunately a small discrepancy in rotating the maxilla (an impaction movement) will result in a much larger discrepancy at the other side of the maxilla (like opening a door).
By using the Proplan software by Materialise and the SynpliciTi system by OBL we are able to overcome the many deficiencies associated with these traditional forms of jaw surgery. Surgery as a result is more predictable and is easier for the Oral & Maxillofacial Surgeon to perform.
What is SympliciTi System by OBL?
SympliciTi System is a new and innovative plating system custom made for each individual.
Using the Proplan software your Oral & Maxillofacial Surgeon, in consultation with technical support in Malaysia, Belgium, France and the US plan a custom cutting guide and plate for the maxilla (SynpliciTi system by OBL).
The custom cutting guide allows the Oral & Maxillofacial Surgeon to accurately position the maxilla as planned during the Le Fort 1 procedure. This guide is custom made to your individual requirements, it will only lock into position when the maxilla is moved into the correct position.
A custom plate is then placed on the maxilla and held in place with surgical screws. This plate (like the custom cutting guide) will only fit when the maxilla is in the correct position as per the surgical planning.
The mandible can then be repositioned using surgical splints into its planned position.
By using the Proplan software by Materialise and SynpliciTi system by OBL we are able to more accurately perform the proposed jaw surgery than previously. We are able to confidently achieve more difficult and complex movements with greater stability.
The image above shows a traditional plating system in place. There are five plates in place, all separate to each other.
The image above shows the SynpliciTi system by OBL
The plate in the maxilla is a single plate. The increased strength and rigidity of this plating system minimises the potential for relapse of the maxilla.