Jaw malformations (dysgnathia) | Distraction for narrow dental arch | Craniomandibular disorders | Cleft lip, jaw and palate
We specialise in the correction of jaw malformations (dysgnathia) and the consequences of cleft lip, jaw and palate, and we also cover a broad variety of procedures for the treatment of various other conditions. In addition to the well-known methods, we also use new techniques and specially developed surgical methods that enable us to achieve very aesthetically pleasing results. A number of innovations that were developed at our centre have become part of the standard repertoire of modern orthognathic surgery. In practically all of these procedures, surgical access is via the oral mucosa, leaving no visible scars on the face.
There are a variety of different types of malocclusion or misalignments of the teeth, arising from an unfavourable position of the maxilla, the mandible, or a combination of the two. The individual components of the jaw may be too long, too short, too narrow, too wide or asymmetric. This can lead to functional or aesthetic limitations that create the desire or the need for correction.
Combined treatment
Corrective treatment requires teamwork. Since jaw malformations are usually accompanied by misalignment of the teeth, the treatment is carried out in close collaboration with an orthodontist. The specialists will analyse the situation together, based on 3-D x-rays, plaster models and images, and create an appropriate individual treatment plan. In the first phase of treatment, the necessary conditions are created using appropriate braces or other orthodontic appliances, so that the surgical correction can then be carried out. New developments mean that the appliances on offer today are very discreet or even invisible, so there is no need for any cosmetic concerns about the pre-surgical orthodontic phase.
Modern and well-established surgical techniques for the correction of jaw malformations (dysgnathia)
The surgical techniques for the correction of dysgnathia (called osteotomies, meaning procedures involving cutting through the bone) are as diverse as are jaw malformations themselves. Many of these have been in use for decades and have helped countless patients worldwide.
The Le Fort 1 osteotomy allows for the tooth-bearing area of the maxilla below the nose to be cut through and mobilised, for example. If necessary this can be further subdivided (segmented), brought into the correct position and fixed using small screws and plates.
Sagittal split osteotomy also allows for repositioning of the tooth-bearing region of the mandible, which can then be advanced or pushed back as needed to correct the malocclusion.
Using wing osteotomy of the mandibular rim, in a procedure called chin wing osteotomy which was developed at our centre, the profile can also be influenced such that, regardless of dental movement, the best possible result is achieved from both a functional and aesthetic point of view.
If the dental arch lacks space or there is insufficient development of the jaw, growth in the desired dimension can be achieved using suitable apparatus (called a distractor).
Craniomandibular disorders (CMD) are frequent and widespread. They range from occasional localised discomfort to severe and painful conditions. They may be associated with significant restrictions in mobility and the opening of the mouth or with just a faint cracking sound. As the symptoms often radiate, there is an overlap with ear, nose and throat conditions, ophthalmology, neurology, rheumatology and dentistry. Psychological and behavioural factors also play an important role and should also be considered in the assessment of craniomandibular disorders.
Holistic approach
With our broad-based training in medicine and dentistry, as maxillo-facial surgeons we can provide a much-needed overview of possible diagnoses and offer a full range of therapies. After careful clinical examination and a thorough discussion with the patient, the correct diagnosis will be apparent in many cases. If further specialist tests are necessary, these can be arranged quickly and effectively. In most cases, the condition can be treated with an appropriate combination of targeted interventions, and surgery can be avoided.
Conservative treatment
Treatment options range from simple exercises that the patient can easily perform at home, to physiotherapy treatments that aim to resolve the increased tension that is often present in the muscles and ligaments. Restriction of movement due to disc displacement can also be alleviated in this way. Occasionally, the short-term use of medication may be appropriate. If grinding or clenching of the teeth is also present, this can be treated successfully by creating individual splints. Another modern form of treatment is the targeted and longer-term easing of the masticatory muscles with botulinum toxin A. This is used routinely and with good results at our centre.
Surgical treatment
If all conservative measures have been exhausted and distressing symptoms still persist, surgical interventions may be considered. These include simple flushing of the joint (called lavage) under a local anaesthetic, or arthroscopy under general anaesthesia. More rarely, open joint surgery to reattach a displaced disc or the remodelling of a deformed mandibular condyle may be carried out.
Scarring and signs of this congenital malformation can be minimised through various procedures on the nose and lip. The Centre for Maxillo-facial Surgery has extensive experience in the treatment of cleft lip, jaw and palate.
Lip correction
The typical retraction of the upper lip scars and the lack of volume in the area of the vermilion in cleft lip, jaw and palate can be compensated and largely normalised through targeted local flap surgery, together with tissue transplants if needed.