Evaluation of the Structural Features of the Face in Orthognathic Surgery

Turkey Medicals – The jaw area is one of the most important parts of the body in every respect. It is the region where many vital functions such as eating, breathing, speech, facial expressions, tasting, feeling, etc. take place.

Anatomically, the double chin covers two-thirds of the face. Orthognathic surgery (Maxillofacial Surgery) is the surgical department where congenital and developmental disorders of this region are performed.

Orthognathic Surgery

Orthognathic surgery is also evaluated by dividing it into one hundred and three sections. Upper face (forehead – base of the head), middle face (upper jaw – maxilla) and lower face (lower jaw).

These three sections are approximately equal in height they are in length. These are the golden proportions on the face described by Lenardo Da Vinci. These measurements, which will be performed on the patient’s face, tell us clinically the proportions and balance of the face in itself it gives an idea about. The head balances like a scale on the neck spine bones in healthy people.

If we evaluate the neck bones like the middle of a scale, the front of the face the weight of the structures in the section and the weight of the back of the head should be approximately equal.

A person with a small lower jaw is expected to have a larger nose, while a person with a large lower jaw has a relatively small upper jaw and a nose that is behind. The back of his head is big the fact that the face of the one is long forward is necessary for the head to developmentally maintain its macro-static balances. In addition, they have racially very different characteristics and facial ratio values that are considered normal also available. The proportions of human facial bones in the Far east are not the same as those in America and Africa.

What are the Structural Features of the Lower and Upper Jaw Bones?

Jaw bones, unlike other bones, have teeth on them and are in close cooperation with them. Taking into account the structural characteristics of the gear and toothless segments, two it is evaluated in a separate section.

The Alveolar Bone of the Jaw – The Part of the Bone That Carries the Teeth

It is a soft bone segment that houses the teeth inside and is connected to the teeth by special bonds in a spongy (spongy) structure that allows minimal movements of the tooth. This is what surrounds the teeth bone can only survive together with teeth, when the teeth are pulled out, it is also gradually melted and pulled out, leaving a bone cavity in place.

When the alveolar bone melts, the soft tissues sag and the person looks older because the support it gives to the face decreases. When there is a tooth loss, the other teeth are replaced correctly in place of the missing tooth buddha it may cause decaying of its bite between the two jaws. In addition, in areas where there is tooth loss, the gingiva (gum) weakens and becomes sensitive, which can cause pain and bleeding.

In orthodontic treatment, such as correcting the tooth alignment with wires attached to the teeth, bringing the tooth that is not in the appropriate place to the appropriate place, burying the teeth, correcting its angle, lengthening or rotating, etc. all of the procedures can be performed thanks to the structural properties and ligaments of this alveolar bone. Orthodontic specialists use these features for the arrangement of teeth and the need for maxillofacial surgery if there is, they will give him a suitable preparatory treatment.

The Basic Bone of the Jaw

It is the basic compact (hard) bone section of the upper and lower jaw. It carries the alveolar bone on it. It provides nutrition, sensation of alveolar bones and teeth with the vessels and nerves it contains provides. It is a hard and durable bone, but in the area where the tooth is missing, it weakens and loses resistance in parallel with the withdrawal and melting of the alveolar bone. The risk of fractures increases in this area.

The bones of the upper jaw (maxilla) and lower jaw(mandible) form support for soft tissues over a large area, as in other parts of the body, and their proper function is it makes them see. They create a bite plan between themselves through the jaw joint (temporo-mandibular joint).

What is My Bite (Occlusion) Disorder?

Normally, the upper jaw teeth should cover the lower jaw teeth and be very slightly in front. All the teeth of the upper and lower jaw are in harmony with each other and all have the same ratio with each other the fact that it’s in contact makes for a good bite. Otherwise, an inappropriate position of even one tooth can deconstruct the entire bite between the two jaws and increase the load on the jaw joint, causing pain may be.

Jaw surgery bite disorders can occur for various reasons. first of all, developmental disorders, traumas, genetic or racial characteristics, wrong habits (finger sucking, for a long time bottle use, etc.), early tooth extractions, lack of timely intervention for teeth that do not come out properly, excessive size of the tongue are common causes. Some bone diseases, benign tumors, vascular diseases (hemangiomas) are less common causes.

The most basic criterion that determines how to treat a bite disorder and whether surgery is required is which bone segment in the jaw the bite disorder originates from.

If the problem is only in the alveolar bone segment and the arrangement of the teeth, then only with orthodontic treatment, the arrangement of the teeth and a good bite (occlusion) can be achieved. But the problem is only the alveolar bone if there is a development delay or excess in the basilar bone, not in the segment and teeth, orthodontic treatment, the arrangement of the teeth, will not be enough to correct the bite. Orthognathic surgery (jaw with surgery), the basilar bone segments of the upper and lower jaw bones should also be made suitable for each other and the face.

What Happens If Patients with Biting Disorders Do Not Receive Treatment?

Many medical problems may occur in patients whose bite is not good. Inability to grind food well, speech disorders, respiratory disorders, premature decay of teeth, gum retractions, mouth odor, dysfunction and pain in the jaw joint may be observed. For example, in a person with a very small lower jaw; significant breathing and sleep problems (sleep apnea) in connection with this heart diseases can be seen. Biting food can be a problem in people whose mouth remains open because their teeth do not close well, as well as oral hygiene will deteriorate, and weight loss when food cannot be chewed well the tendency to buy remains to be seen.

What is Investigated in the Examination of People With Bite Disorders?

In patients who come to jaw surgery due to bite disorder, a detailed facial and oral examination is performed first, dynamic problems are examined during the movements of the jaw joint. Your face is different areas (forehead, eyes and surroundings, cheeks, nose, etc.) asymmetries by proportional evaluation of volume and dimensions between the right and left side (one side of the face is equal to the other side the absence of) is determined. Differences in soft tissue placements are investigated. Especially lip sizes, dynamic positions during laughing are very important.

After evaluating the number of teeth, their individual positions, caries, treatments performed, the size and volume of the tongue during the oral examination, the dental relationship of the lower and upper jaw-biting (occlusion) it is evaluated. In a good bite in jaw surgery, the upper front incisions of the teeth (they are located at about 110 degrees to the upper jawbone) the lower front incisions of the teeth (at about 90 degrees to the lower jawbone they are found) right in front of him and he needs to cover it a little. My normal bite is like this and medically it is called class I (class I) bite.

When examining bite disorders, if the upper teeth are more prominent than the lower teeth, this bite class II (class II) bite disorder (malocclusion) means that the lower teeth are more prominent than the upper teeth if there is a condition that it is in the front, it is called class III (class III) biting disorder. In addition, the teeth are in a similar biting relationship on the sides. The fact that one jaw is narrow is what happens with the other by disrupting the relationship, it can also create a biting problem.

Minimal biting and tooth alignment problems can only be solved orthodontically, while biting disorders related to the upper and lower jaw skeleton (basilar bone), facial and jaw asymmetries of the jaw it should be corrected by surgery.

What are the Imaging Methods for Jaw Disorders?

Some special radiographs (cephalometry, panoramic radiographs) are taken in order to make a more detailed examination in patients who may need maxillofacial surgery. The entire skeletal structure of the head and face and the positions of the teeth are evaluated with these X-rays to investigate whether the problem is in the skeletal structure (i.e. basilar bone) or in the dental (dento-alveolar) complex. With a biting disorder in patients, mostly the problem is both skeletal and dental structure. In the evaluation, the ratios of the bone sizes of the upper, middle and lower face with the base of the head to each other and the soft tissue cephalometric measurements are made taking into account the relationship (especially cheeks and lips).

How is the Preparation for Orthognathic Surgery Done?

Preoperative Preparation After radiology, dental plaster casts of the upper and lower jaw are taken in preparation for maxillofacial surgery to determine the pre-treatment conditions of dental relations. Skeletal and dental according to the problems, orthodontic treatment is started after an appropriate surgical prognosis.

Orthodontic treatment takes an average of 6 months to 24 months. Orthodontics should be started after the age of 12 when the last permanent teeth come out. The ideal timing is 12-18 years old although between, jaw surgery can be performed until decrepit age. Since orthodontic treatment planning is very specific, planning; who knows the preparation for surgery, is experienced in this regard it is very important that it is performed by orthodontists and that the treatment is followed intervals. Poor planning and poor orthodontic treatment can lead to significant problems.

Sometimes patients are not informed enough, sometimes patients with bite disorders at the skeletal, i.e. bone level, due to orthodontists who do not have sufficient experience in preparing for surgery it is tried to correct the teeth only with orthodontic treatment, which leads to insufficient-bad results. Most often, the teeth return to their former positions because the roots of the teeth are overextended, the teeth shaking, gums are pulled, aesthetically insufficient results are obtained and many similar problems are experienced. Treatment with an experienced orthodontist to avoid these problems it is necessary to plan and get an opinion from an experienced plastic surgeon. Orthodontic treatment that is started incorrectly is often not possible to return.

Who Can Orthognathic Surgery (Maxillofacial Surgery) Be Applied to?

Orthognathic surgery operations are usually performed after the age of 17-18, when development is completed. It can be applied to anyone whose jawbone is suitable until old age. For example, breathing while sleeping it can also be applied at a very advanced age in patients who experience sleep apnea.

An acrylic plaque called a biting plaque is made before jaw surgery in patients who have been prepared according to surgical planning and whose orthodontic treatment has been completed. If surgery is performed on one jaw, 1, two if surgery is to be performed on the jaw, 2 bite plates are prepared. These are the ideal positions of the jaws that should be relative to the decussation during surgery and the predicted ideal tooth between each other in order to ensure the relationship – bite (occlusion).

What are the Techniques of Orthognathic Surgery (Maxillofacial Surgery)?

There are three commonly performed surgeries that are classical in orthognathic surgery.

– Lefort I surgery performed for upper jaw disorders,

– Sagittal split surgery performed for lower jaw disorders and

– Genioplasty is a genioplasty surgery performed for jaw end disorders.

All of these surgeries are performed under general anesthesia, each of them takes an average of 1-2 hours. They can be applied separately or bereber. It is enough to stay in the hospital for 1-2 days. Recovery is usually 1 between 3 weeks.

How is Upper Jaw Surgery Performed?

Jaw surgery is performed with an incision made between the upper lip and the upper jaw bone inside the mouth. In skeletal disorders (deformities) of the upper jaw, the upper jaw bone from the base of the nose, the tooth the toothed bone section is freed by cutting (osteotomizing) from the top of the roots. At this time, the upper jawbone is held only by the soft palate and the veins coming from it it is being fed.

The upper jaw bone segment, which becomes mobile in three dimensions; the planned ideal is fulfilled by placing a previously prepared suitable biting plate and placing it on the remaining part of the upper jaw, a new it is determined in position by means of mini-plates (small, perforated metal made of stainless alloy) and screws.

The upper jaw bone can be moved forward or backward according to the requirement, as well as all procedures such as burial, sagging, rotation can be performed. The incision inside the mouth heals by sewing with a melted thread. This if there is a significant deviation of the septum (nose) during the operation, it can be corrected, the low tip of the nose can be slightly relieved. In the same way, it can be suspended in soft tissues.

How is Lower Jaw Surgery Performed?

In skeletal disorders (deformities) of the lower jaw, it is performed to move the lower jaw forward or backward, according to the need. The lower jawbone inside the mouth, behind the teeth on both sides jaw surgery is performed with a 3-4 cm incision made on it.

A nerve that gives sensation to the lower lip and lower teeth passes through the lower jaw bone (mandible) (on both sides). The bone is divided lengthwise from each other as an inner and outer leaf when leaving, this nerve is carefully protected during the operation. The nerve remains in the inner leaves and is checked at each stage if it is damaged. Although it is very rare if the nerve is damaged repair is provided by microsurgical technique (under a microscope).

A biting plate prepared for the lower jaw is placed between the teeth and the ideal location of the lower jaw and the bite is determined, after which the two decoupled bone leaves are placed again in a new position by detecting each other with screws, the integrity of the bone is ensured. Screws are inserted through very small holes of 3-4 mm drilled on both sides of the neck. The tracks around here become indistinct after a whilehe comes and is invisible.

How is Jaw Tip Surgery (mentoplasty) Performed?

Surgery is performed with a decussation of 3-4 cm made between the bone and the lip in the lower jaw. The tip of the lower jaw is cut off (osteotomized) in such a way that the tooth roots are preserved according to the structure of the disorder. In the meantime the jaw end bone segment, which is fed by veins from muscles and becomes mobile, can be moved forward and backward according to the requirement, recessed-sagging or rotation can be performed, the bone muscle again it is detected with mini-plates and screws. The incision inside the mouth is sewn with melting threads, the scars are invisible.

How is the Recovery Process After Orthognathic Surgery (Maxillofacial Surgery)?

In patients who have undergone double jaw surgery, support treatment with serums is performed after surgery, as well as painkillers, antibiotics and treatments to reduce facial swelling. The patient’s intensive the condition that requires him to stay in care is very rare. Nutrition begins with juicy foods on the same day. After the patient’s general condition improves, it is usually 2-4 days after the operation and the upper jaw teeth are fixed to each other with tires and the mouth is closed for 1-3 weeks. This makes bone healing safer.



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President of Organ Transplant Center at MedicalPark Hospital Antalya

Turkey's world-renowned organ transplant specialist. Dr. Demirbaş has 104 international publications and 102 national publications.

Physician's Resume:

Born on August 7, 1963 in Çorum, Prof. Dr. Alper Demirbaş has been continuing his work as the President of MedicalPark Antalya Hospital Organ Transplantation Center since 2008.

Prof. who performed the first tissue incompatible kidney transplant in Turkey, the first blood type incompatible kidney transplant, the first kidney-pancreas transplant program and the first cadaveric donor and live donor liver transplant in Antalya. Dr. As of August 2016, Alper Demirbaş has performed 4900 kidney transplants, 500 liver transplants and 95 pancreas transplants.

In addition to being the chairman of 6 national congresses, he has also been an invited speaker at 12 international and 65 national scientific congresses. Dr. Alper Demirbaş was married and the father of 1 girl and 1 boy.


Eczacibasi Medical Award of 2002, Akdeniz University Service Award of 2005, Izder Medical Man of the Year Award of 2006, BÖHAK Medical Man of the Year Award of 2007, Sabah Mediterranean Newspaper Scientist of the Year Award of 2007, ANTIKAD Scientist of the Year Award of 2009, Social Ethics Association Award of 2010, Işık University Medical Man of the Year Award of 2015, VTV Antalya's Brand Value Award of 2015.


Doctor of Medicine Degree Hacettepe University Faculty of Medicine Ankara, General Surgeon Ministry of Health Turkey EKFMG (0-477-343-8), University of Miami School of Medicine Member of Multiple Organ Transplant, ASTS Multiorgan Transplant Scholarship. Lecturer at Kyoto University. Lecturer at University of Essen, Research assistant at the University of Cambridge .

Professional Members:

American Society of Transplant Surgeons, American Transplantation Society Nominated, Middle East and Southern Africa Council Transplantation Society 2007, International Liver Transplantation Association, Turkish Transplantation Association, Turkish Society of Surgery, Turkish Hepatobiliary Surgery Association.


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Medically Reviewed by Professor Doctor Alper Demirbaş
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