Minimally Invasive (MI) Orthognathic Surgery: A Systematic Step-by-Step Approach

✍ Scribed by Gwen R.J. Swennen (editor)

• Publisher: Springer
• Year: 2023
• Tongue: English
• Leaves: 194
• Category: Library

✦ Synopsis

This comprehensive and visually engaging color atlas and manual serves as an invaluable resource for orthognathic and orthofacial surgeons seeking detailed information on the various aspects of minimally invasive (MI) orthognathic surgery. The initial two chapters lay the foundation for a groundbreaking and innovative approach to MI orthognathic surgery, drawing from a wealth of 25 years of experience. The authors delve into the rationale behind this novel concept, aiming to enhance surgical efficiency and minimize patient morbidity. They present an in-depth exploration of the new surgical algorithm, which encompasses a systematic, step-by-step standardization of MI orthognathic techniques. The development of specialized MI orthognathic instruments and the introduction of innovative surgical codes, sequences, and templates are thoroughly elucidated. Subsequently, the following five chapters meticulously outline the "step-by-step" MI surgical techniques for the five primary orthognathic surgical procedures. These descriptions are accompanied by detailed illustrations, ensuring a comprehensive understanding of each technique. In the closing chapter, the book delves into the essential conditions required for successful MI orthognathic surgery, providing a thorough exploration of these necessary prerequisites. This book serves as a practical and user-friendly guide, offering clear and straightforward "step-by-step" instructions suitable for residents in training, junior surgeons, as well as experienced practitioners. Orthognathic and orthofacial surgeons will find "Minimally Invasive (MI) Orthognathic Surgery" to be an outstanding companion in their routine surgical practice.

✦ Table of Contents

Foreword
Foreword
Preface
Acknowledgments
Contents
Contributors
1: Background and Introduction to Minimally Invasive (MI) Orthognathic Surgery
General Considerations About Minimally Invasive (MI) Surgery
Minimally Invasive (MI) Orthognathic Surgery
Background of MI Orthognathic Surgery
MI Orthognathic Surgical Techniques
Surgical Efficiency toward Decreasing Operation Time in Orthognathic Surgery
Minimally Invasive (MI) Orthognathics Algorithm
References
2: A New Concept Toward Minimally Invasive (MI) Orthognathic Surgery
Step-by-Step Standardization of “MI Orthognathic Surgical Techniques” to Increase Surgical Efficiency
Optimization of Vascular Blood Supply and Decrease of Interstitial Edema and Swelling to Improve Postoperative Recovery
Development of Dedicated “MI Orthognathic Instruments” and “MI Orthognathic Surgical Codes” to Allow a less Invasive Approach and to Create a Common Language among the Surgical Team
Orthognathic Instrument Codification Using “MI Orthognathic Surgical Codes”
Novel Orthognathic Instruments to Fulfil “MI Philosophy” Principles
Modified Conventional Orthognathic Instruments to Fulfil “MI Philosophy” Principles
The Rationale behind the “Intelligent Handgrip”
Creation of Dedicated “MI Orthognathic Surgical Sequences” and “MI Orthognathic Sequence Template Bars” to Facilitate Instrumentation Table Organization and Increase Surgical Efficiency
MI Orthognathic Surgical Sequences
MI Orthognathic Sequence Template Bars
Dedicated Storage of “MI Orthognathic Instruments and Sequence Template Bars” to Optimize Gathering, Cleaning, and Sterilization Processes Toward a Time-Efficient and Cost-Effective Clinical Routine
References
3: Minimally Invasive (MI) Chin Osteotomy
General Considerations Regarding the “MI Chin Osteotomy” Surgical Procedure
“MI Chin Osteotomy” Instruments and “MI Chin Osteotomy” Surgical Instrumentation Table Organization
Patient and Operating Room Preparation Toward the “MI Chin Osteotomy” Surgical Procedure
The “10 Step-by-Step MI Chin Osteotomy” Surgical Technique
Step 1—MI Soft Tissue Approach to the Chin
Step 2—MI Access toward the Bony Chin
Step 3—MI Exposure of the Bony Chin
Step 4—Marking the Skeletal Chin Midline toward the Lower Dental Midline
Step 5—Marking a Horizontal Reference Line in the Midline
Step 6—MI Exposure of the Unilateral Bony Chin by Subperiosteal Tunnelling
Step 7—MI Chin Osteotomy
Step 8—Completion of the MI Chin Osteotomy
Step 9—MI Mobilization of the Bony Chin after Osteotomy
Step 10—MI Repositioning and Rigid Fixation of the Chin in its 3D Virtual Planned Position
References
4: Minimally Invasive (MI) Le Fort I  Osteotomy
General Considerations Regarding the “MI Le Fort I Osteotomy” Surgical Procedure
“MI Le Fort I Osteotomy” Instruments and “MI Le Fort I Osteotomy” Surgical Instrumentation Table Organization
Patient and Operating Room Preparation Toward the “MI Le Fort I Osteotomy” Surgical Procedure
The “10 Step-by-Step MI Le Fort I Osteotomy” Surgical Technique
Step 1—MI Soft Tissue Approach to the Le Fort I Osteotomy
Step 2—MI Subperiosteal Dissection of the Medial Pillar of the Maxilla
Step 3—Marking Landmarks for Vertical Repositioning of the Maxilla
Step 4—Degloving of the Nasal Floor and Septum Release
Step 5—MI Exposure of the Maxilla by Subperiosteal Tunnelling
Step 6—MI Le Fort I Corticotomy
Step 7—MI Osteotomy of the Medial and Lateral Maxillary Pillars
Step 8—MI Down Fracture and Pterygomaxillary (PTM) Dysjunction Followed by Mobilization of the Osteotomized Maxilla
Step 9—Remodelling of the Nasal Floor, Nasal Septum, and Removal of Potential Premature Bone Contacts
Step 10—MI Repositioning and Fixation of the Maxilla in its 3-Dimensional (3D) Virtual Planned Position
References
5: Minimally Invasive (MI) Sagittal Split Osteotomy
General Considerations Regarding the “MI Sagittal Split Osteotomy” Surgical Procedure
“MI Sagittal Split Osteotomy” Instruments and “MI Sagittal Split Osteotomy” Surgical Instrumentation Table Organization
Patient and Operating Room Preparation toward the “MI Sagittal Split Osteotomy” Surgical Procedure
The “10 Step-by-Step MI Sagittal Split Osteotomy” Surgical Technique
Step 1—MI Soft Tissue Approach to the Sagittal Split Osteotomy of the Mandible
Step 2—MI Access Toward the Buccal Corticotomy of the Horizontal Mandibular Ramus
Step 3—MI Buccal Corticotomy of the Horizontal Mandibular Ramus
Step 4—MI Retromolar Degloving
Step 5—MI Access toward the Lingual Corticotomy of the Vertical Mandibular Ramus
Step 6—MI Lingual Corticotomy of the Vertical Mandibular Ramus
Step 7—MI Completion of the Sagittal Split Osteotomy
Step 8—MI Mobilization of the Mandibular Segments after Sagittal Split Osteotomy
Step 9—“Trivector Seating” of the Mandibular Proximal Segment
Step 10—MI Rigid Fixation of the Sagittal Split Osteotomy
References
6: Minimally Invasive (MI) Maxillary Expansion
General Considerations Regarding the “MI Maxillary Expansion” Surgical Procedure
“MI Maxillary Expansion” Instruments and “MI Maxillary Expansion” Surgical Instrumentation Table Organization
Patient and Operating Room Preparation Toward the “MI Maxillary Expansion” Surgical Procedure
The “10 Step-by-Step MI Maxillary Expansion” Surgical Technique
Step 1—MI Endonasal Approach to the Le Fort I Corticotomy
Step 2—MI Exposure of the Hemimaxilla by Subperiosteal Tunnelling
Step 3—MI Subperiosteal Dissection of the Inner Part of the Lateral Nasal Wall
Step 4—MI Le Fort I Corticotomy
Step 5—MI Osteotomy of the Medial and Lateral Maxillary Pillars
Step 6—MI Intraoral Approach toward the Midline Le Fort I Osteotomy
Step 7—Marking the Skeletal Maxillary Midline toward the Upper Dental Midline
Step 8—MI Maxillary Midline Osteotomy and Mobilization
Step 9—MI PTM Dysjunction/Septum Release if Required
Step 10—Placement and/or Activation of a Maxillary Expansion Apparatus (Bone-Borne, Teeth-Borne, or Hybrid Teeth/Bone-Borne)
References
7: Minimally Invasive (MI) Mandible Constriction/Expansion
General Considerations Regarding the “MI Mandible Constriction/Expansion” Surgical Procedure
“MI Mandible Constriction/Expansion” Instruments and Surgical Instrumentation Table Organization
Patient and Operating Room Preparation toward the “MI Mandible Constriction/Expansion” Surgical Procedure
The “5 Step-by-Step MI Mandible Constriction/Expansion” Surgical Technique
Step 1—MI Soft Tissue Approach to the Chin
Step 2—MI Access and Exposure of the Bony Chin
Step 3—Marking the Skeletal Chin Midline toward the Lower Dental Midline
Step 4—MI Chin Midline Osteotomy and Mobilization
Step 5—MI Repositioning and Rigid Fixation of the Chin/Placement of a Mandibular Transverse Expansion Device
References
8: Conditions Toward Minimally Invasive (MI) Orthognathic Surgery
Preoperative Considerations toward “MI Orthognathic Surgery”
Orthognathic Surgical Workup
3D “Virtual Surgical Planning” (3D-VSP)
Perioperative Considerations toward “MI Orthognathic Surgery”
Surgical-Anesthesiologic Team Approach
Operating Room Preparation
MI Orthognathic Instruments and Surgical Instrumentation Table Organization
Patient Preparation
Hypotensive Anesthesia and Medication
Postoperative Considerations toward “MI Orthognathic Surgery”
Patient and Wound Care
Pain, Nausea, and Vomiting Management
Dietary Support
Thermo-Therapy
Manual Lymphatic Drainage (MLD)
Patient Follow-Up
References