Cover -- Title page -- Copyright page -- Contents -- List of authors -- Foreword -- Preface -- 1: Psychological considerations for the orthognathic patient -- 1.1 Psychological issues associated with facial appearance -- 1.2 Psychological assessment -- 1.2.1 Patient perception of the presenting clinical problem -- 1.2.2 Patient expectation of treatment -- 1.2.3 Patient motivation for treatment -- 1.2.4 Patient's psychological status -- 1.2.5 Outcome from psychological assessment -- 1.3 Advice on management of patients following assessment -- 1.4 Red flag and amber flag patients -- 1.4.1 Red flags -- 1.4.2 Amber flags -- 1.5 Psychological therapeutic input to patients during treatment -- 1.5.1 Pre-surgical orthodontics -- 1.5.2 Surgical planning stage - patient preparation for surgery -- 1.5.3 Psychological input following surgery -- 1.6 Conclusion -- 1.7 References -- 2: Dentofacial assessment -- 2.1 Introduction -- 2.2 General assessment -- 2.2.1 Patient's concerns -- 2.2.2 Medical, dental and social history -- 2.2.3 History of dentofacial dysmorphology -- 2.2.4 Stature and body form -- 2.3 Facial assessment -- 2.3.1 Lateral view -- 2.3.2 Frontal view -- 2.3.3 Bird's eye view -- 2.3.4 Worm's eye view -- 2.4 Intra-oral assessment -- 2.4.1 Dental arches -- 2.4.2 Teeth in occlusion -- 2.4.3 Soft tissues -- 2.5 Diagnostic records -- 2.5.1 Protocol for collection of basic records -- 2.5.2 Role of diagnostic records -- 2.6 Cephalometrics for orthognathic patients -- 2.6.1 Gross inspection -- 2.6.2 Qualitative analysis -- 2.6.3 Quantitative analysis -- 2.6.4 Superimposition -- 2.7 Special investigations -- 2.7.1 Condylar hyperplasia -- 2.7.2 Acromegaly -- 2.8 Summary -- 2.9 Recommended further reading -- 3: The treatment planning process -- 3.1 Introduction -- 3.2 Three fundamental planning steps -- 3.2.1 Envisaging the desired aesthetic changes.

3.2.2 Deciding on the required jaw movements -- 3.2.3 Planning orthodontics to allow the required jaw movements -- 3.3 Four keys to dento-skeletal planning -- 3.3.1 Upper incisor and maxillary position -- 3.3.2 Occlusion and mandibular position -- 3.3.3 Maxillo-mandibular complex rotation -- 3.3.4 Chin position -- 3.4 Final surgical planning -- 3.4.1 Final planning steps -- 3.4.2 Photo-cephalometric prediction -- 3.4.3 Model surgery -- 3.5 Summary (Figure 3.8) -- 3.6 Recommended further reading -- 4: The role of orthodontics -- 4.1 Introduction -- 4.2 Pre-surgical orthodontics -- 4.2.1 Factors affecting incisor decompensation -- 4.2.2 Control of incisor decompensation -- 4.2.3 Vertical tooth movements -- 4.2.4 Transverse tooth movements -- 4.2.5 Orthodontic preparation for segmental surgery -- 4.2.6 Progress monitoring -- 4.3 Peri-operative orthodontics -- 4.3.1 Fixed appliance preparation for surgery -- 4.3.2 Inter-maxillary fixation -- 4.3.3 The occlusal wafer -- 4.3.4 Orthodontic procedures in theatre -- 4.4 Post-surgical orthodontics -- 4.4.1 Post-surgical healing phase -- 4.4.2 Post-surgical tooth movement -- 4.4.3 Retention -- 4.5 Surgery before orthodontics -- 4.5.1 Advantages -- 4.5.2 Disadvantages -- 4.6 Surgery without orthodontics -- 4.7 Complications of orthodontic treatment -- 4.7.1 Iatrogenic tooth damage -- 4.7.2 Loss of periodontal support -- 4.8 Summary -- 4.9 Recommended further reading -- 5: Orthognathic technical procedures -- 5.1 Introduction -- 5.2 Clinical assessment -- 5.2.1 Patient planning sheet -- 5.2.2 Master impressions -- 5.2.3 Occlusal registration -- 5.2.4 Face bow recording -- 5.3 Articulator and face bow selection -- 5.3.1 Plain line articulator (simple hinge) -- 5.3.2 Semi-adjustable articulators and face bow recordings -- 5.4 Face bow recordings -- 5.5 Face bow points and planes of reference.

5.5.1 Auricular average value face bow -- 5.5.2 Condylar face bow -- 5.6 Errors in face bow registrations used for orthognathic model surgery -- 5.7 Face bow with orbital pin replaced with a bull's eye spirit level -- 5.8 Orthognathic articulator and face bow -- 5.8.1 Face bow -- 5.8.2 Articulator -- 5.9 Preparing the casts for articulation -- 5.9.1 Articulating the casts -- 5.9.2 Marking out the casts -- 5.9.3 Marking and measuring the casts for vertical movements -- 5.9.4 Marking and measuring the casts for antero-posterior movements -- 5.9.5 Repositioning the casts -- 5.9.6 Occlusal re-positioning wafer -- 5.10 Recent advances in model surgery -- 5.11 Suggested further reading -- 6: Prediction planning -- 6.1 Introduction -- 6.2 Prediction planning for orthognathic surgery -- 6.3 Methods of prediction planning -- 6.3.1 Model planning -- 6.3.2 Soft tissue profile prediction planning -- 6.3.3 Computerised prediction -- 6.3.4 Factors affecting the accuracy of prediction planning -- 6.3.5 Hard tissue and soft tissue ratios -- 6.3.6 Summary -- 6.4 The two-dimensional planning process -- 6.4.1 Acquisition of lateral cephalogram -- 6.4.2 Acquisition of the lateral profile photograph -- 6.4.3 Superimposition of lateral cephalogram and profile photograph (Matching) -- 6.4.4 Planning -- 6.4.5 Simulation -- 6.4.6 Surgical planning sheet -- 6.5 Three-dimensional prediction software -- 6.6 The three-dimensional planning process - acquisition of different imaging modalities -- 6.6.1 CBCT -- 6.6.2 Three dimensional stereophotogrammetry -- 6.6.3 Planning -- 6.7 Navigation surgery -- 6.7.1 Summary -- 6.8 References -- 7: Basic orthognathic surgical procedures -- 7.1 Introduction -- 7.2 Le Fort I osteotomy -- 7.2.1 Indications -- 7.2.2 Surgical technique -- 7.2.3 Le Fort I segmental osteotomies -- 7.2.4 Complications -- 7.3 Anterior maxillary osteotomies.

7.3.1 Indications -- 7.3.2 Surgical technique -- 7.3.3 Complications -- 7.4 Sagittal split ramus osteotomy (Figure 7.12a) -- 7.4.1 Indications -- 7.4.2 Procedure (Figure 7.12a) -- 7.4.3 The condylar segments -- 7.4.4 Complications -- 7.5 Vertical Subsigmoid Osteotomy (VSSO) (Figure 7.14) -- 7.5.1 Indications -- 7.5.2 Procedure -- 7.5.3 Complications -- 7.6 Mandibular body osteotomy -- 7.6.1 Indications -- 7.6.2 Procedure -- 7.6.3 Complications -- 7.7 Inverted L ramus osteotomy (Figure 7.16) -- 7.7.1 Indications -- 7.7.2 Procedure -- 7.7.3 Complications -- 7.8 Anterior mandibular osteotomies -- 7.8.1 Lower anterior segmental osteotomy -- 7.8.2 Anterior mandibulotomy (Figures 7.18a, 7.18b) -- 7.8.3 Complications -- 7.9 Genioplasty -- 7.9.1 Indications -- 7.9.2 Procedure -- 7.9.3 Complications -- 7.10 Medical preoperative/intraoperative considerations and general postoperative care -- 7.10.1 Informed consent -- 7.10.2 Blood tests -- 7.10.3 Operative considerations -- 7.10.4 General postoperative care -- 7.11 Distraction osteogeneis -- 7.11.1 Mandibular distraction osteogenesis -- 7.11.2 Maxillary distraction -- 7.11.3 Compression bifocal and multifocal distraction osteogenesis -- 7.12 Further reading -- 8: High level osteotomies -- 8.1 Introduction -- 8.2 Indications -- 8.2.1 The Le Fort II osteotomy (Figures 8.1a, 8.1b) -- 8.2.2 The Le Fort III osteotomy -- 8.3 Timing of surgery -- 8.4 Special investigations -- 8.5 Le Fort II surgical procedure -- 8.6 Le Fort III surgical procedure -- 8.6.1 Indications -- 8.7 Advantages and disadvantages of subcranial Le Fort III osteotomy -- 8.8 Complications related to anatomy of area -- 8.9 Other facial deformities -- 8.9.1 Treacher Collins Syndrome -- 8.9.2 Craniofacial (hemifacial) microsomia -- 8.10 Further reading -- 9: Case reports -- Case 9.1 Class II, division 2 malocclusion -- Presentation.

Initial combined plan -- Final surgical plan -- Treatment outcome (Figures 9.1.4-9.1.7) -- Case 9.2 Vertical maxillary excess -- Presentation -- Initial combined plan -- Final surgical plan -- Treatment outcome (Figures 9.2.3-9.2.6) -- Case 9.3 Class III malocclusion -- Presentation -- Initial combined plan -- Final surgical plan -- Treatment outcome (Figures 9.3.4-9.3.7) -- Case 9.4 Mandibular asymmetry with 3D planning -- Presentation -- Initial combined plan -- Final surgical plan -- Treatment outcome (Figures 9.4.5-9.4.8) -- Case 9.5 Anterior open bite -- Presentation -- Initial plan -- Final surgical plan -- Treatment outcome (Figures 9.5.4-9.5.7) -- Case 9.6 Class II, division 1 with hypodontia -- Presentation -- Initial combined plan -- Final surgical plan -- Treatment outcome (Figures 9.6.4-9.6.7) -- Index.