ethnoscience

Deformations of the upper and lower jaw. Small lower jaw: etiology and treatment methods

Biting, tearing food, chewing, swallowing, breathing - all these points are closely related to the function of the jaws.

For example, with a sharply narrowed upper jaw, the nasal passages narrow and nasal breathing is impaired. This is of great importance from the point of view of providing air to the body and is especially important in childhood: if nasal breathing is impaired, encephalopathy can develop.

Patients with impaired function of biting, chopping, and chewing food often have problems with the esophagus and stomach (gastritis, etc.), since food must enter the stomach already crushed.

Bite abnormalities often lead to changes in the position of the elements of the temporomandibular joint (TMJ). Pain syndrome The pain that arises can be so pronounced that it becomes a very serious problem for a person.

But today we’ll talk about something else – the impact of malocclusion on facial features and how appearance can change as a result of orthodontic treatment.

Types of bites

Bite is the relationship of the jaws, and the jaws, in turn, determine the anatomy of the face. Various malocclusions (in the anteroposterior and vertical direction, in the right-left direction) are reflected differently on facial features. In this case, it is possible various options disproportions that are of great aesthetic importance. For example, in patients with a deep bite, the lower third of the face shortens: it appears disproportionately small and underdeveloped.

Disorders in the anterior-posterior direction:

Mesial bite: excessive protrusion of the lower jaw and lower lip relative to the upper jaw.

Distal bite: excessive protrusion of the upper jaw and upper lip, the incisors do not contact.

Rice. 1. a – mesial bite; b – distal bite

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Violations in the vertical direction:

Deep bite– excessive development of the alveolar parts of the jaws in the anterior section, in which there is too much vertical overlap of the incisors (the incisors are not visible).

Open bite characterized by the presence of a gap between the dentition when closing in the area of the frontal or lateral teeth. With an open bite, when the front teeth do not close together, there is an increase in the height of the lower third of the face, which will be greatly lengthened against the background of the overall proportions.

Rice. 2. a – deep bite; b – open bite.

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N Closing of the back teeth is a very rare situation. An open bite in the lateral region can be unilateral or bilateral. Bilateral open bite is nonsense and is extremely rare. One-sided occurs with pronounced asymmetries (Fig. 3). When the branch of the lower jaw is lengthened, its angle moves downward, pulling with it the lateral part of the body of the jaw with the lateral teeth. There is a separation of the upper and lower molars. Under the influence of gravity, the upper molars begin to move downward until they touch - the phenomenon of dento-alveolar advancement. If the advancement does not keep pace with the growth of the lower jaw or this space is occupied by the tongue, an open bite occurs in the lateral region (example Marina K.).

Rice.3. Lengthening the mandibular ramus

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

D Another situation is a sharp underdevelopment of the jaw branch on one side, in this case with opposite side teeth will sag. But this is not an independent diagnosis, but a symptom of excessive development or underdevelopment of the branch.

Violations in the right-left direction(transversal violations) are called crossbites. This is a collective concept. Crossbite can be unilateral or bilateral. When a segment of the dentition is displaced towards the cheek, a buccal bite is formed (buccalis - buccal), when displaced towards the oral cavity, an oral bite is formed (oralis - oral).

With transversal disorders, various asymmetries appear. As a rule, the chin turns out to be shifted to one side or another (Fig. 4). In this case, the closure of the lateral teeth is disrupted - one-sided chewing occurs.

Rice. 4 - cross bite

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WITH The most common situation among Caucasians is crowded teeth. This issue can be resolved by expanding the jaw, when the dentition straightens out with the movement of the lateral teeth towards the cheeks, the perimeter of the dentition increases, while the front teeth deviate forward and the plumpness of the lips increases . For some this is good, for others it is not. Too much forward bending is not physiological; it leads to non-occlusion of the front teeth and exposure of the neck of the teeth.

Lip changes as a result of orthodontic treatment

E If the teeth are very large and it is not possible to straighten the dentition by simply moving them, the method of tooth extraction is chosen. Often two teeth on each jaw are removed (usually either the fourth or fifth teeth) and then the front teeth move back. The bony support also extends backward, followed by the lips. Accordingly, the initial plumpness of the lips decreases. This solution is very important for Negroids and Mongoloids, who have an anatomical anterior inclination of teeth. Teeth go back, facial features change. The effect is comparable to protruding the chin, although no action is taken on it: due to the recessing of the lips, the chin becomes more pronounced.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Rice. 10. Clinical example. Treatment of the patient included the removal of 4 teeth. A reduction in the tension of the orbicularis oris muscle was achieved and the plumpness of the lips decreased.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

U The change in crowding does not necessarily occur with the drowning of the lips. Having aligned the front teeth, we can place micro-implants in the canine area and pull back the side teeth, and thereby achieve closure of the third and fifth teeth.

Thus, the front teeth will not change their inclination. In this case, wisdom teeth may be in demand: it often happens that they do not have enough space, but when the seventh and sixth teeth move forward, space is freed up behind them and the figure eight comes out on its own.

Relaxation of facial muscles as a result of orthodontic treatment

WITH Orthodontic treatment also helps to relax the masticatory and facial muscles that affect facial features.

Patients with bruxism have to deal with the problem of hypertonicity of the masticatory muscles. With the help of a cap, the orthodontist separates the dentition so that the muscles have the opportunity to relax.

IN Normally, the position of the lower jaw is determined by a reflex. A person has trained his muscles to maintain the lower jaw in the same position, and when he closes his mouth, he returns to this position each time with the help of muscle effort. To extinguish the reflex, you need to break the contacts of the teeth. Usually a plate with a perfectly smooth surface is made: the person closes his mouth and the lower teeth slide over the plate. Thus lower jaw loses its usual fixation and usually after 3 weeks returns to a position convenient for the TMJ. The jaw moves back, separation appears between the front teeth and the muscles relax. As a rule, after 3 weeks, patients experience pain relief.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

BMost orthodontists in our country they follow the American school, in which it is believed that “the main thing is the bone, but the meat will grow.” Therefore, when carrying out treatment, the main focus of the orthodontist’s work is on the position of bones and teeth. Having straightened the teeth and achieved normal bones, we achieve the creation of conditions for normal muscle function. In most cases this works, but not always. For example, a patient has a habit of constantly sticking his tongue between his front teeth. While the braces are in place, you can achieve the correct picture, but after they are removed, the pressure of the tongue will lead to the teeth moving apart again, and we will again get an open bite in the anterior region. The habit of biting the lower lip will also affect: the upper front teeth experience pressure from the lip from the inside, and the lower front teeth experience pressure from the outside, and there will always be a tendency for the teeth to deviate from each other and form distal occlusion. To eliminate the habit, the design of the device includes additional elements for training muscles and eliminating parafunctions.

In childhood, it is much easier to correct such things. The body grows and changes and it is usually not necessary to achieve normal bone anatomy. For the same open bite with the habit of sticking the tongue between the front teeth, a plate is made: plastic base(a plastic cover on the palate), from which metal wires descend downward, preventing the tongue from penetrating forward. After some time, the child gets used to this movement of the tongue, we achieve normalization and further development The dentofacial system will proceed correctly.

It is very bad when a child uses a pacifier for a long time. At the same time he does not train normal position language. The position of the front teeth is a balance between the position of the orbicularis oris muscle on the outside and the tongue on the inside. When using a pacifier, the child does not close his teeth and disrupts the pressure of the tongue, since the pacifier prevents the tongue from reaching the front teeth and a violation of the position of the front teeth occurs.

Standard orthodontic treatment with fixed appliances (braces) does not solve this issue. This is the main reproach to the categorical adherents of this technique. To “educate” the tongue, additional devices are used: barriers, intermaxillary traction, etc. Removable devices used in children allow you to effectively work with the muscles of the tongue.

To correct, for example, mouth breathing, the patient takes liquid into his mouth and holds it for an ever increasing duration. In such a situation, like it or not, you will start breathing through your nose.

In adults, it is much more difficult to rebuild reflexes. To do this, additional devices are used - tongue guards, cheek guards, pads, buttons, etc. Exercises are prescribed for the tongue and orbicularis oris muscle, i.e. devices and activities that force muscles to work in new ways.

It is very important not to miss the moment. If the patient is shown to the orthodontist in time, the plate will not need to be worn for years, as an adult would have to: 2-3 months are enough to teach the tongue to be in the correct position.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Children with increased facial height (skeletal open bite or long face syndrome) usually have a normal upper face and a normal maxilla 25 . This problem has been called vertical maxillary redundancy, but this is not the cause. Before adolescence Most anatomical abnormalities occur below the palatal plane, although some downward and posterior tilting of the maxilla may occur. These children usually have an open bite and almost always some overeruption. chewing teeth.

Rice. 15-26. Children with underdevelopment of the lower jaw and an increase in the height of the lower part of the face require treatment with devices that limit the extrusion of the lateral teeth. This stimulates the growth of the mandible in an anterior rather than vertical direction.

Many people experience a decrease in the height of the mandibular ramus, which causes the flatness of the mandibular plane and a large discrepancy between the anterior and posterior facial heights. The ideal treatment option for such patients is to control all subsequent vertical growth so that the mandible rotates upward and forward (Fig. 15-26). Unfortunately, vertical facial growth continues during and after puberty, meaning that even with successful growth modification during the mixed dentition period, active anchorage may be required for several years.

There are several possible approaches to correcting a “long face”. We will describe them in order of increasing efficiency.

Rice. 15-27. This figure demonstrates the excellent response to treatment with a high-traction facebow in a child with increased lower facial height. A - profile before treatment. B - profile after treatment.

Rice. 15-27 (continued). C - cephalometric comparison. Comparison of the base of the skull shows that the teeth of the upper and lower jaws do not move downwards; as a result, the lower jaw grows forward, but not downward. The lower jaw shows a forward displacement of the lower molar into the reserve space. The position of the incisors relative to the upper and lower jaws does not change.

Facebow with high traction on molars. One way to correct problems of vertical redundancy is to maintain the vertical position of the upper jaw and slow the eruption of the upper posterior teeth. This can be achieved with a high-traction facebow, worn 14 hours per day with over 12 ounces of force on each side (Figure 15-27). If the facebow has a conventional facebow on the first molars, then installation and adjustment of the facebow is performed in the same manner as these procedures described for the facebow for the correction of Class II problems 26 27 .

Rice. 15-28. A and B - to distribute the force acting upward and posteriorly on the entire upper jaw, a maxillary splint is attached to the intraoral part of the face bow. The splint better limits tooth extrusion.

Facebow with high traction on the maxillary splint. More effective way The use of extraoral traction in children with excessive vertical development is the addition of an anterior plate to the internal arch or the use of an occlusal splint (see Fig. 15-28) attached to the facebow 28 . This allows vertical force to be directed to everything upper teeth, and not just on molars. This type of appliance is especially effective in children with excessive vertical development of the entire upper jaw and protrusion of the upper incisors (i.e., in children with a “long face” and without an open bite). To ensure skeletal and dentoalveolar correction, the patient must be prepared for the fact that the treatment period can be very long.

Unfortunately, the facebow allows the teeth of the lower jaw to erupt freely, and if this occurs, then changing the direction of growth and beneficial upward and forward rotation of the lower jaw is impossible. Additionally, a facebow alone cannot correct an existing open bite.

Functional device with occlusal pads. To others alternative way is the use of a functional apparatus with occlusal pads (see Fig. 15-29). The retraction force in the functional apparatus has less effect than extraoral traction (the so-called “extraoral traction effect”).

Rice. 15-29. A and B - occlusal pads installed on this functional appliance are used to control vertical growth by limiting the eruption of all lateral teeth. The front teeth erupt freely, which helps close the vertical gap in the frontal area.

The main purpose of the device is to slow down the eruption of lateral teeth and the vertical descent of the upper jaw. This device may provide for placing the lower jaw forward, depending on the degree of underdevelopment of the lower jaw. It should be remembered that careful assessment of the sagittal skeletal relationship is necessary in the presence of vertical skeletal deviations.

Regardless of whether the mandible has been set forward into a constructive bite, if impact on molar eruption is desired, separation must be created. When the mandible is held in this position by the appliance, stretching of the soft tissues (including but not limited to muscles) is applied through a vertical intrusive force to the posterior teeth. In children with an open bite, the front teeth are allowed to erupt freely, resulting in a shorter open bite, while in less common long face problems without an open bite, all teeth are supported by occlusal veneers. Since there is no compensatory eruption of the lateral teeth, all mandibular growth must be directed anteriorly.

Rice. 15-30. This figure demonstrates a good response to treatment with a functional appliance designed to control vertical growth using occlusal pads in a child with increased lower facial height. A - profile before treatment. B - profile after treatment. C - cephalometric comparisons. Comparisons show that there was no eruption of lateral teeth and all mandibular growth was directed anteriorly. The height of the face was maintained, and the vertical gap was closed through the eruption of the front teeth. The relative position of the molars of the upper and lower jaws supporting bone was saved.

IN short time a functional apparatus of this type can carry out effective control vertical facial growth and closing the vertical gap in the frontal area (Fig. 15-30) 29.

Rice. 15-31. During treatment with fixed appliances, the eruption of the lateral teeth can be controlled using removable posterior bite blocks that separate the lateral teeth at a distance greater than the vertical resting parameters. This creates an intrusive load on the teeth at the points of contact with the blocks, caused by stretching of the soft tissues. The device is fixed in the facebow tubes using clasps.

Because of the long period of continuous vertical growth, if a functional appliance is used in the first stage of treatment, occlusal pads or other elements will be required to control vertical growth during treatment with functional appliances (Fig. 15-31) and possibly during the retention period. and teething. This is necessary because fixed appliances are not able to provide sufficient control of eruption.

Rice. 15-32. Treatment of severe underdevelopment of the lower jaw with a long face model is currently carried out using a high-traction facebow connected to a functional apparatus with occlusal pads. A and B - face before treatment. C - face bow with attachment to a functional apparatus. D and E - face after treatment.

High-traction facebow on a functional appliance with occlusal pads. Currently, the most preferred approach to growth modification for excessive vertical growth and class II relationships is the combination of a high traction facebow and a functional appliance with occlusal overlays for anterior movement of the mandible and control of tooth eruption 30 . Extraoral traction increases control of maxillary growth and ensures that force is applied to the entire maxilla rather than individually to the permanent first molars. A high-traction facebow improves functional appliance fixation (see Fig. 15-32) and directs force toward the intended center of resistance of the maxilla (see Fig. 15-21, D). The functional apparatus provides the opportunity to stimulate mandibular growth while simultaneously controlling the eruption of lateral and anterior teeth.

Rice. 15-32 (continued). F - cephalometric comparisons. Note the convexity of the face, increased height of the lower part of the face, unclosed lips, and exposure of the upper incisors before treatment begins. Comparisons demonstrate overall downward and forward growth of the mandible without increasing the angle of the mandibular plane and good control of the vertical position of the teeth.

Modifications of activators or bionators can be constructed using various elements functional apparatus for stimulating or minimizing active dental changes. When using a combination of head apparatus and activator, it is recommended to add torque springs to the activator (see Fig. 15-33) to reduce the effect of tilting of the maxillary anterior teeth. The exception among active functional appliances in this case are active elements designed to reduce dental and increase skeletal effects 31 .

Rice. 15-33. Torque springs used with a combination of head and functional appliances are designed to apply torque to the crowns of the incisors and provide corpus movement of the incisors or at least overcome some of the lingual inclination of the incisors that is common with all functional appliances.

Clinical work with the head functional apparatus is a hybrid of the techniques used for each apparatus separately, but with some interesting modifications. Firstly, the technique for taking impressions and registering the constructive bite is no different from the usual technique for a functional appliance. The facebow tubes are placed in the bite blocks in the premolar area (see Fig. 15-34). During the installation of a functional appliance, a head cap is made for the patient and a small, if not the smallest, face blower is adjusted to be inserted into the tubes. It is usually necessary to close the adjustment loops to ensure that the archwire is not installed too forward.

The combination of facebow and functional appliance is placed in the mouth and adjusted so that the resulting force passes through the intended center of resistance of the maxilla. Passive placement of the inner bow between the lips usually requires a short to medium length outer bow that curves upward. The head cap is connected to the face bow and the force is adjusted to approximately 400 g per each side. After connecting the facebow, additional adjustments to its position may be required.

Rice. 15-34. The functional appliance may have facebow tubes installed to allow additional distal and vertical force to be applied through the facebow and headcap.

As with the installation of any other devices, the patient must be able to handle this device after the first visit to the doctor. The child receives instructions on attaching the facebow, placing the facebow and functional appliance combination in the mouth, and attaching the head cap. If retraction of the anterior teeth is necessary, the adjustment of the retraction springs should be small, if the device is not equipped with clasps, otherwise the fixation of the device will be impaired.

It is usually best for the child to gradually increase the time he or she wears the functional appliance. Use of the head unit during sleep can be started immediately, and then gradually added to daytime use.

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In children, upper prognathia is 50-60% of total number all deformations of the dentofacial system.

Causes of upper prognathia (excessive development of the upper jaw)

Among endogenous etiological factors First of all, rickets and respiratory dysfunction (for example, due to hypertrophy of the palatine tonsils) should be mentioned. Among the exogenous ones are finger sucking, artificial feeding using a horn, etc.

Depending on the etiology, the structure of prognathia may be different. So, prognathia caused endogenous factors(for example, impaired nasal breathing), combined with lateral compression of the upper jaw, close arrangement of teeth in the anterior section. If it is caused by exogenous factors, then there is a significant expansion of the alveolar arch, due to which the teeth in it are located freely, even with intervals (threes), i.e., fan-shaped.

A certain role in the development of maxillary prognathism is played by the incorrect installation of permanent large molars during their eruption. When these teeth erupt, they are installed in a single-tubercle closure: the chewing tubercles of the lower large molars articulate with the same tubercles of the upper ones. Only after the chewing surfaces of the deciduous molars have been worn away and the lower jaw has been shifted medially, the upper first molar with its medial buccal cusp is installed in the intertubercular grooves of the lower ones.

If the physiological wear of the cusps of baby teeth is delayed or does not occur at all, then the first large molars remain in the position in which they erupted. This causes a delay in the development of the lower jaw, which remains in a distal position; upper prognathia develops.

Symptoms of upper prognathia (excessive development of the upper jaw)

It is necessary to distinguish between true prognathia, in which the lower jaw has a normal shape and size, and false (apparent) prognathia, caused by underdevelopment of the lower jaw. With false prognathia, the size and shape of the upper jaw do not deviate from the norm.

The main symptom of excessive development of the upper jaw is its disfiguring protrusion forward; The upper lip is in a forward position and is not able to cover the frontal part of the dentition, which is exposed along with the gum when smiling.

The lower part of the face is lengthened by increasing the distance between the base of the nasal septum and the chin. The nasolabial and mental grooves are smoothed.

The lower lip in the area of the red border is in contact with the palate or the posterior surface of the frontal upper teeth, the cutting edges of which do not contact the lower ones at all, even with increased pushing of the lower jaw forward.

The lower front teeth, with their cutting edges, rest against the mucous membrane of the palatal surface of the alveolar process or the anterior part of the hard palate, injuring it.

The upper dental arch is narrowed and extended forward; the palatine vault is high and has a Gothic shape.

Often true upper prognathia is combined with underdevelopment of the lower jaw, which aggravates the disfigurement of the face, especially its profile. The face in this case seems to be sloping downwards (“bird face”).

Treatment of upper prognathia (excessive development of the upper jaw)

Upper prognathism must be treated in childhood through the use of orthodontic appliances. If such treatment was not carried out in a timely manner or turned out to be ineffective, one has to resort to surgical methods.

U adults people with excessively pronounced prognathia, which cannot be treated with equipment, good results are obtained by removing the front teeth and resection of the alveolar process. However, despite the ease of implementation and good cosmetic results, the method cannot be called effective, since the functional power of the masticatory apparatus after such treatment is significantly reduced. Considering that resection of the alveolar process ends with the installation of a fixed bridge prosthesis, which excludes the possibility of further growth of the upper jaw, this operation acceptable only in adults.

Operation by A. Ya. Katz

In this sense, it is more gentle, since it provides for the preservation of teeth: after detachment of the mucoperiosteal flap on the lingual surface of the alveolar process within the upper 6-10 teeth, the palatal part of each interdental space is removed with a bur. The mucoperiosteal flap is placed and sutured in its original place.

Thanks to this intervention, the resistance of the alveolar ridge to the action of the sliding arch, which is installed after surgery, is weakened. The described operation is indicated when the upper teeth are fan-shaped and there are certain spaces between them. Due to these spaces, it is possible to reduce the frontal teeth back and collect them in a close row, achieving contact between the proximal surfaces of their crowns.

Symmetrical extraction of upper premolars

Symmetrical removal of the upper teeth in combination with compactosteotomy is performed in cases where the reposition of all frontal teeth cannot be achieved using the orthodontic method alone, i.e. when each of them is in contact with two adjacent teeth. In addition, it is indicated for prognathism combined with a lateral narrowing of the upper jaw or an open bite. In such cases, one (usually the first) small molar is removed from each side, and then the operation is performed as in the treatment of an open bite.

14 days after compactosteotomy, orthodontic equipment is installed to gradually move the teeth back.

Other treatments for prognathia

Osteotomy and retrotransposition of the frontal part of the upper jaw according to Yu. I. Vernadsky or by P. F. Mazanov is undertaken when it is necessary to quickly (simultaneously) eliminate prognathia, especially in cases of its combination with an open bite, as mentioned above.

The most common are congenital clefts of the jaw, which are a consequence of impaired facial formation in the early stages of embryogenesis. Isolated clefts of the alveolar ridge alone are rare. A cleft of the alveolar process of the maxilla is usually combined with a cleft of the upper lip and palate. Median cleft of the mandible and lower lip is extremely rare. Treatment of congenital clefts is surgical. Cleft palates are repaired using plastic surgery, one of the stages of which is fissurorrhaphy - suturing the edges of clefts.

Impaired development and growth of the jaws is primarily associated with damage to bone growth zones in children - trauma (including birth), inflammatory processes(osteomyelitis, arthritis, purulent otitis media), Availability deep scars in the tissues surrounding the jaws, after burns, nomas, as well as as a result of radiation damage during the period of jaw growth.

Rice. 5. Anomalies in the development of the jaws: a - excessive development of the upper jaw (prognathia); b - underdevelopment of the upper jaw (micrognathia); c - excessive development of the lower jaw (progeny); d - underdevelopment of the lower jaw (microgenia); d - uneven development of the lower jaw; e - open bite.

Underdevelopment of the lower jaw (microgenia) can be symmetrical (with uniform underdevelopment of both sides of the jaw; Fig. 5, d) and one-sided, or asymmetrical. The latter are more common. With symmetrical (bilateral) microgenia, the lower third of the face is reduced, the chin is shifted posteriorly. With unilateral microgenia, the chin is displaced from the midline of the face towards the jaw lesion, the other side looks flattened and as if sinking (Fig. 5, e). Microgenia is most often associated with previous osteomyelitis, ankylosis temporomandibular joint, trauma with damage to the growth zones of the jaw bones.

Overdevelopment the lower jaw (Fig. 5, c; macrogeny, or progeny) is characterized by a massively developed jaw with a sharply shifted forward chin. This type of jaw development anomaly is associated with heredity, as it is often observed in several generations of the same family. At the same time, the upper jaw is of normal size.

Excessive development (protrusion forward) of the frontal part of the upper jaw with a normal value of the lower jaw - prognathia (Fig. 5, a).

Underdevelopment of the upper jaw - micrognathia (opistognathia; Fig. 5, b) - is associated with growth disturbances (trauma, early surgery for cleft palate).

Open bite (Fig. 5, f) is a deformation in which, when the jaws are closed, only the molars are in contact, and a gap remains between the remaining teeth. It is observed after suffering from rickets, with improperly healed fractures of the jaws, after surgery for ankylosis of the temporomandibular joint.

Treatment of abnormalities of the jaws and dentition is mainly orthodontic (see Orthodontic methods of treatment).

Surgical treatment is carried out at the age of 15-17 years, when the formation of the facial skeleton is largely completed.

Plastic surgeries used to eliminate developmental anomalies and deformations of the jaws can be conditionally divided into two main groups: osteoplastic surgeries and contour plastic surgery. Depending on the type of developmental anomalies and deformations of the jaws, various methods of osteoplastic surgery are shown (Fig. 6). In some cases, the operation consists only of osteotomy of the body or branch of the jaw with subsequent displacement of a fragment of the jaw without the use of a free bone graft, in others - in osteotomy using a free bone graft. As a rule, along with surgery, orthodontic devices are also used to fix the jaws, as well as to correct the bite.

Contour plastic surgery is indicated for moderate degree underdevelopment of the jaws and their deformation, if there is no significant malocclusion. The operation consists of changing the external contour of the jaw and moving it correct position soft tissues. The most effective method is to place a simulated plastic implant under the periosteum.

Rice. 6. Surgical treatment of jaw deformities: a - moving back the frontal part of the upper jaw; b - osteotomy with wedge-shaped resection of the body of the lower jaw; c - osteotomy with wedge-shaped resection of the lower jaw branch; d - closed osteotomy of the lower jaw branch according to Kostechka; d - horizontal or oblique osteotomy of the lower jaw branch; e - vertical osteotomy with wedge-shaped resection of the lower jaw branch; g - osteotomy of the body of the lower jaw with bone transplantation; h - stepped osteotomy of the lower jaw branch; and implantation of plastic in the area of the receding chin.

What are the deformities and defects of the upper and lower jaw?

Depending on the structure and size of the face, the jaw can also be different sizes and shape, which is measured in individually. There may be deformation of two jaws at once or of each separately, which greatly deviate from the established size, and also stand out noticeably from other facial regions.

The next pathology of jaw deformation is underdevelopment of speech and the process of chewing food. If the jaw is too low large sizes, then it is called progeny and vice versa, an underdeveloped jaw from below is called microgeny. A jaw that is too large on top is called macrognathia, and small size carries the medical term micrognathia.

Causes of anomalies in the development and deformation of the jaws

There are many factors that cause jaws to become deformed. The fetus may begin to experience jaw deformation and underdevelopment while still in the womb. This happens due to the hereditary influence of factors on the embryo, when the parents are carriers of the infection, after severe colds or infectious diseases.

Risk areas include:

endocrine diseases;

metabolic disorders;

various infectious pathologies;

high doses of radiation;

physiological and anatomical defects in the structure and development of the female genital organs;

malposition.

In infancy, pathology in the development of the jaws in a child can begin under the influence of endogenous factors:

Infectious diseases;

Heredity;

Endocrine disorders;

Obesity.

The cause of jaw deformation can be exogenous factors:

inflammatory process in the jaw area;

radiation;

birth trauma of various types;

mechanical impact;

when a newborn sucks a pacifier, finger and sponge from below;

while sleeping, placing your fist under your cheek;

during teething, when the lower jaw extends forward;

swallowing disorders;

constant runny nose;

playing the violin in childhood.

In childhood, adolescence and adulthood, pathology in the development and deformation of the jaws can occur after severe facial trauma, improper and rough fusion of scar tissue. Just like a complication after surgical intervention regarding osteomyelitis, ankylosis. IN postoperative period Insufficient bone regeneration or, conversely, resorption and atrophy may occur. The development of dystrophy will lead to atrophy of the soft tissues and facial skeleton. It can be bilateral, limited or half. This condition is called hemiatrophy. When conditions are created that cause hypertrophy of the facial bones, the acromegalic structure of the jaws, in particular the lower one, grows. In most cases, unilateral poor development of the lower jaw is facilitated by purulent inflammation on the face or the disease osteomyelitis, which affects the temporal and lower jaw bone in patients in the first ten years of life.

Anomalies and deformations of the jaws and their pathogenesis

With the development of jaw deformation, the cause of the pathogenetic process is the suppression or limited exclusion of the territory where bone growth occurs. Also decrease bone substance and turning off the chewing function and opening the mouth. In many respects, the development of microgenia of the lower jaw plays a role in the disturbance of its growth in length, the cause of which is heredity or osteomyelitis. This defect is also facilitated by the exclusion of growth zones, in particular in the area of the head of the lower jaw. In the process of pathogenesis, deformation is caused by endocrine disorders that occur in childhood.

The pathogenesis that is associated with combined deformation of the facial bones is very closely associated with dysfunction of the synchondrosis of the bones at the base of the skull. In the process of suppression or irritation of growth zones, macro and micrognathia develops. The growth zone is located in the heads of the mandibular bones. Prognemia develops due to abnormal development tongue, which puts pressure on the jaw, as well as a decrease in the oral cavity.

What symptoms are observed with jaw anomalies and deformities?

There are several most significant symptoms that determine abnormal development and jaw deformation:

Many patients do not like the appearance of their face. Especially such claims to their appearance are noted by people in at a young age. They strive to remove the defect even with the help of surgery;
Pathology in the functioning of the teeth and jaws, which manifests itself as a violation of chewing, the ability to speak and sing clearly, to smile beautifully with the whole mouth, to play various wind instruments;
Malocclusion. This pathology makes chewing difficult. The patient is forced to quickly swallow food, chewing it poorly and not even moistening it with saliva.
Many products that have a solid structure are generally not suitable in this state on the menu;
Patients may develop depression.

When an anomaly and deformation of the jaws occurs, an instant change occurs in the entire system of teeth and jaws. They are manifested by severe caries, pathology of rapid enamel wear, incorrect position teeth, chewing disorders. Patients with pathology and deformation of the jaws are twice as likely to develop caries than patients with malocclusion. Also, with deformation of the upper jaw, carious teeth appear many times more than with pathology of the lower jaw. Inflammation and periodontal dystrophy are a common occurrence in such patients. When prognathism of the lower jaw and open bite around the teeth appear, catarrhal gingivitis develops in combination with antagonists. On x-ray it will be noticeable that the structure bone tissue uneven and has a blurred and unclear pattern, where the lower jaw is predominantly affected. With the development of deformation in the upper jaw, the formation of pockets in the gums is observed. Hypertrophic gingivitis is also characteristic, mainly in the frontal region of the teeth, which are located along the edges of the cleft and experience heavy load. The process of chewing disorders is caused by grinding and mixed types chewing food, there is insufficient electrical excitability of the dental pulp, which is in a state of underload and overload.

How to diagnose?

When making a diagnosis, it is necessary to carry out research by measuring linear and angular measurements of the entire face and its contours separately. Take photos and masks from plaster, where the face will be visible from the side and straight on. Conduct an electromyographic study, based on the results of which you can evaluate the work of the muscles that are responsible for facial expressions and the chewing process, take an x-ray of the bones of the skull and face. All these studies will help establish accurate diagnosis and pick up more effective method surgical intervention to correct abnormalities and deformations of the jaws. A pathology such as an anomaly of development and deformation of the jaws not only causes a change in the patient’s appearance, but also many complexes that are sometimes very difficult to cope with. Such people try to spend little time in in public places, they don’t have close friends, their work colleagues don’t actually communicate with them. All these complexes lead a person to depression, the consequences of which can be fatal if the patient wants to commit suicide. Therefore, it is necessary for other people to maintain understanding and ethics in relationships. Only through the joint efforts of friends, colleagues and doctors can a person be helped. Thanks to developments in modern medicine, it is possible to eliminate all defects in jaw deformation and become a beautiful and healthy patient.

Postoperative period

The postoperative period will require a lot of courage and strength from a person. This is a rather complex healing and rehabilitation process. After surgery, there may be pain and inflammation that needs to be overcome. Also, as the wounds heal, the teeth, which with this pathology are always affected by caries, should be treated. Every precaution should be taken to avoid falling and injuring yourself, which could ruin the outcome of the surgery. Usually, after surgery, patients spend a long time in a hospital setting, under the close supervision of medical personnel.

DEFECTS OF THE UPPER JAW: ETIOLOGY, CLINIC, DIAGNOSIS, ESSENCE OF METHODS OF SURGICAL TREATMENT AND INDICATIONS FOR THEM

Prognathia

With this type of deformation, excessive development of the entire upper jaw or only its anterior region occurs. As a result, the upper jaw protrudes forward in relation to the normally developed lower jaw. The anterior group of teeth on the upper jaw stands sharply forward in relation to the anterior teeth of the lower jaw. In this case, the cutting edges of the crowns of the upper teeth touch the lower lip. The upper lip is somewhat snub-nosed and shortened, the mouth slit almost always gapes, the upper teeth are not covered by the upper lip. Evidence for surgery is determined by the shape and severity of the deformity. Persistent severe maxillary deformities should be treated combined methods- surgical and orthopedic.

In certain forms of prognathia, with a sharp forward protrusion of the alveolar process and teeth of the upper jaw with a strong; leaning forward, it is recommended to remove them, hold the gum under the partial resection edges and anterior wall of the alveolar process and compensate for the defect in the dentition with a denture-like prosthesis. In severe forms of prognathia, when simple tooth extraction does not provide desired results, a compactosteotomy or decortication of the palatine plate of Lo Katzu is performed. Under infiltration anesthesia, the first premolars are removed on both sides. From the side of the hard palate, an incision is made in the mucous membrane from 41 to | _4_ teeth, 2 - 3 mm away from the necks of the teeth. The mucoperiosteal flap is peeled off, and multiple depressions are drilled on the alveolar process within the anterior part of the upper jaw with a round bur, penetrating through the entire thickness of the compact layer of bone. The mucoperiosteal flap is placed in place, secured with 2-3 sutures and pressed with a tampon soaked in iodoform and a protective plate. After 12-16 days, orthodontic treatment begins. Teeth movement is achieved within a month using the vestibular arch of Engle.

In cases of severe prognathia with a sharp protrusion of the overdeveloped upper jaw, the Field operation as modified by Semenchenko is performed. It consists of mobilizing the entire protruding area of the upper jaw and establishing it by moving it back to the anatomically correct position. Under endotracheal anesthesia or conduction and local anesthesia, the mucous membrane and periosteum are dissected in the vestibule of the oral cavity with two vertical incisions in the area 5 | 5 teeth and horizontal - along the gingival edge. The mucoperiosteal flap is peeled off from the bone and moved upward to the lower edge of the pyriform opening. In the palate, an incision of the mucous membrane and periosteum is made along the gingival margin from the lateral incisors to the first molars. Then, on both sides, the mucoperiosteal flap is peeled off from the bone to the midline and brought in the form of a tape at the level of 414 teeth, after which the 4 | 4 teeth. Using a saw or bur, a section of bone is cut out on the right and left from the lateral outer corner of the pyriform notch to the alveolar process in the area of the extracted teeth. The width of the bone cavity that is cut out is determined by the required volume of retrotransposition of the anterior part of the alveolar process. A strip of bone of the same width is cut out on the hard palate. After incising the spongy layer of the bone, the section of the upper jaw is moved back, set in an anatomically correct position and fixed with the help of dental wire splints and rubber traction. The mucoperiosteal patch is put in place and the wound is sutured with catgut.

Micrognathia

Micrognathia is underdevelopment of the upper jaw, resulting in retraction of the entire middle part of the face. When examining the pain-logo, there is a retraction of the upper lip, the lower lip overlaps the upper, and the nose protrudes forward. Among the many proposed operations, Semenchenko’s deal should be considered the most appropriate. It consists of protruding a significant part of the upper jaw forward after a horizontal osteotomy of this jaw. Under endotracheal anesthesia or bilateral conduction anesthesia A horizontal incision is made in the mucous membrane and periosteum along the transitional fold along the entire length of the alveolar process on the right and left. The second incision of the mucous membrane and periosteum is made perpendicular to the first along the frenulum of the upper lip down to a horizontal incision. Using a raspator, the mucous membrane is separated from the facial surfaces of both maxillary bones in front to the level of the infero-fossa margin of the orbit and zygomatic bone, and behind - to the pterygopalatine fossa. Then round circular saw open the bone of the upper jaw from the lower edge of the pyriform foramen horizontally backward through the zygomaticalveolar ridge under zygomatic bone to the upper edge of the maxillary hill. The same operation is carried out on the other side.

With careful movements, without much force, break off lower section the upper jaw from the pterygoid processes of the main bone. After this, the movable part of the upper jaw can easily be pushed forward and the teeth can be placed in correct bite. In this new position, the lower part of the upper jaw is securely fixed using intraoral splints and. Intermaxillary rubber traction. The mucoperiosteal shreds are placed in place. The wound of the mucous membrane is sutured with catgut sutures. The fixation period is at least 2 months. As a result of the operation, the contours of the face acquire a normal shape, the retraction in the middle part of the face and upper lip is eliminated, and the normal relationship of the teeth of the upper and lower jaws is restored.

Progenia

Progeny is an excessive enlargement of all parts of the lower jaw. Characterized by deployment of the mandibular angle and protrusion of the chin and lower teeth forward relative to the normally developed upper jaw. The bite has an inverse relationship between the front teeth.

At external inspection Noteworthy is the violation of the proportionality of the face due to the elongation of its lower third, which develops as a result of the protrusion of the massive chin and deployed angles. The lower lip stands under the upper, creating the idea of a recessed middle third of the face. Due to the increase in the actual size of the jaw body, a sagittal gap is formed - the distance from the center of the cutting edge of the upper incisor to the center of the cutting edge of the lower incisor in the horizontal direction, which can sometimes reach 15-20 mm. The alveolar arch of the lower jaw is much wider than the dental arch of the upper jaw. Functional impairments are very pronounced. Biting off food with the front teeth is difficult or impossible. The efficiency of chewing is reduced by 25-80%. The tongue in patients with progenia due to difficulty closing the lips, lack of contact between the front teeth of the upper and lower jaws is impaired (slurred and Shepelev).

Surgical treatment is indicated for occlusions formed over the age of 15 years, when there are pronounced disturbances in the act of chewing and facial distortions that cannot be corrected by orthodontic methods. The choice of surgical intervention method is determined by the degree pathological changes various departments lower jaw. Exists a large number of various methods of surgical treatment of progeny, which is carried out on the body of the jaw, in the area of the angle, branch, neck and on the temporomandibular joint.

Underdevelopment of the lower jaw on one side

With unilateral underdevelopment of the lower jaw, the child’s face appears to be reduced on one side due to the different fullness of the cheeks and the asymmetry of the contour of the lower jaw. There is an unequal opening of the mouth with a deviation of the chin in one direction or another. The bite in children is also changed. The causes of unilateral underdevelopment of the lower jaw can be either a violation of its formation in the embryonic period or damage to the lower jaw in childhood. The role of hereditary factors in the occurrence of the disease is not fully understood to date. Cosmetic degree functional failure with unilateral underdevelopment of the lower jaw directly depends on the cause of the deformity. Children suffer more severely when congenital disease- hemifacial microsomia. In this condition, there is underdevelopment of not only the bones of the facial skeleton (mandible, zygomatic and temporal bone), but also a deficiency of soft tissues of the affected half of the face, underdevelopment eyeball absence of the auricle, transverse facial cleft (Macrostomia).

Relatively light group are children whose underdevelopment of the lower jaw was a consequence of damage to the articular process of the lower jaw in early childhood. These children often have slight facial asymmetry and malocclusion caused by unilateral shortening of the lower jaw. Surgical treatment of children with unilateral underdevelopment of the lower jaw is aimed, in severe cases, at restoring the underdeveloped bone structures that form the temporomandibular joint. To do this, bone grafting is performed using one’s own bone and/or cartilage of the missing structures of the lower jaw and the articular fossa of the temporal bone. For minor deformities, the lower jaw is lengthened using distraction devices or osteotomy and the fragments of the lower jaw are moved to the anatomically correct position. At absolutely minor asymmetries, sometimes a simple relocation of the chin is enough - genioplasty. Treatment of most children with unilateral underdevelopment of the lower jaw usually does not require emergency measures; it is, as a rule, stage-by-stage and can begin at any age.

Underdevelopment of the lower jaw on both sides

Bilateral underdevelopment of the lower jaw manifests itself in the form of a reduction in the lower part of the face, chin and, as a consequence, the protrusion of the nose and upper lip. Malocclusion with this deformation is expressed in an increase in the anteroposterior distance between the upper and lower front teeth (deep bite). Sometimes, with significant underdevelopment of the chin - microgenia - the skin of the chin has a wrinkled appearance, there is no transverse fold between the chin and lower lip. The opening of the mouth with such deformation is, as a rule, not impaired.

The causes of bilateral underdevelopment of the lower jaw may be hereditary factors(Pierre-Robin syndrome, Treacher-Collins syndrome), or disorders of jaw development in the embryonic period. Development of deformation due to impact unfavorable factors It is extremely rare in early childhood. Often, hereditary underdevelopment of the lower jaw is combined with other developmental defects, such as cleft palate, oblique facial clefts, ear deformities.

The main concept of surgical treatment is symmetrical lengthening of the mandible. This result can be achieved by lengthening the jaw using distraction osteotomy devices and moving bone fragments or genioplasty (mentoplasty).

In addition to cosmetic deformation, there are significant functional problems. Inconsistency between the edges of the teeth leads to chewing problems. The displacement of the muscles of the tongues is attached to the lower jaw, leading to its retraction. In other words, there is a retraction of the tongue. This condition is considered to be the cause of the development of snoring in children, but the worst thing is that the retraction of the tongue during sleep can cause the death of a child due to breathing problems. All this determines the tactics of surgical treatment: the more obvious respiratory disorders, the sooner surgical treatment is required. If breathing problems are obvious, and the age for specific treatment is insufficient, the child is given a tracheostomy for health reasons - a special tube is installed in the trachea through which the child breathes before lengthening the lower jaw.

Underdevelopment of the upper jaw

Most common cause Underdevelopment of the upper jaw is a cleft of the upper lip and/or palate. Underdevelopment of the upper jaw can be caused by damage to the facial bones in early childhood with subsequent disruption of their growth. Severe forms underdevelopment of the lower jaw is a manifestation of rare birth defects development are combined, as a rule, with a malformation of the skull bones.

Depending on the degree of deformation, the severity of the children’s condition is determined, and, consequently, the tactics of their treatment. Thus, in case of severe syndromic craniosynostosis such as Apert, Crouzon, Pfeiffer syndromes, etc., a tracheotomy may be required during the neonatal period to prevent breathing problems. Such children usually undergo the first operations at an early age to eliminate underdevelopment of the upper jaw. In children with mild degree deformities, surgical treatment is usually postponed until the end of the growth period of the facial skeleton (15-18 years). Before surgery, orthodontic treatment is performed to correct dental imbalances. With severe underdevelopment of the upper jaw, there is a narrowing of the nasal cavity, leading to impaired nasal breathing, which may be incorrectly regarded as rhinitis, enlargement of the adenoids or tonsils. Impaired nasal breathing can cause chronic diseases ear, and eyes (conjunctivitis). A small upper jaw interferes with the development of normal speech and the act of chewing, in addition, a characteristic personality deformation occurs. All this requires careful attention to children, both from medical staff and from parents.

Lower jaw enlargement

Deformations caused by enlargement of the entire lower jaw, or half of it, are not uncommon. Bone enlargement may be combined with soft tissue hypertrophy or be isolated. In the first case, deformities are visible already at birth and, as a rule, are associated with the presence of a tumor process, such as lymphangioma or hemangioma of the cheek with growth into the lower jaw. Another cause of jaw hypertrophy can be the so-called partial gigantism, a condition in which not only the bone structures of the lower jaw increase, but also hypertrophy of other bones and soft tissues of the corresponding half of the face; lipomas are usually observed in such children. Rarely, such deformities can be bilateral.

The next reason for an increase in the size of the lower jaw is its damage by fibrous dysplasia or another tumor process. Fibrous dysplasia symmetrically affects the upper and lower jaws and is called cherubism; this condition is often regarded as hereditary disease, and it turns out for the first time at the age of 3-4 years. Bone tumors of the lower jaw most often occur between 5 and 9 years of age. More often observed benign tumors, but also malignant tumors Not unusual. During the period of mixed dentition, another type of hypertrophy of the lower jaw is observed, associated with disturbances in the zone of its growth, namely in the area of the articular head. Such children are usually treated by orthodontists for malocclusion, but the treatment does not lead to any satisfactory results and the children live with their deformity all their lives or undergo surgery in adulthood for cosmetic reasons.

It is precisely such deformations that can be mistakenly regarded as underdevelopment of the lower jaw on the side opposite to the lesion. In this case, treatment will be ineffective.

Surgical correction of deformities during mandibular enlargement has been well established. Thus, in case of tumor or dysplastic processes, operations are performed to remove tumors with plastic surgery of the lower jaw. In cases of disturbance in the growth zone with rapidly increasing deformity, the head of the affected joint is removed, followed by orthognathic correction of the jaw deformities. The situation is more complicated with partial gigantism, since it is necessary to reduce the size of not only enlarged bones, but also excision of excess soft tissue and skin, which is quite difficult to perform without further scar deformations of the soft tissues. Poorly developed treatment tactics for patients with partial gigantism are associated with extreme rarity of this disease, but at present there are still ways to solve even such a complex problem.

Usage distraction devices for the treatment of jaw deformities

The use of distraction devices for the treatment of jaw deformities is today one of the most promising directions in pediatric craniofacial surgery. This is explained simply. In order to achieve extension of the bone fragment by the required amount, there is no need to use an additional source of bone, such as a rib, skull, or pelvic bones. A distraction device fixed along the edges of the defect is capable of stretching the bone callus that forms to the required size and fixing the bone edges for the time necessary for complete ossification of the stretched callus. callus. There is a distraction device that provides education required quantity own bone, necessary to eliminate a defect or deformation of the jaw.

Currently, distraction devices are the most common for correcting mandibular deformities. Treatment with this method you can start already from the neonatal period, which is used for diseases accompanied by respiratory failure against the background of a sharp underdevelopment of the lower jaw on both sides (Pierre-Robin syndrome, Treacher Collins syndrome, etc.). More often, distraction devices begin to be used from the age of 4-5 years, when it becomes possible to use intraoral modifications to avoid the formation of scars on the skin of the cheeks. Using a distraction device involves two operations: installing and removing the device. In cases where external devices are used, their removal may not require general anesthesia, since a simple unscrewing of the fixing pins is required; 1-2 minutes is enough for this. As a rule, distraction treatment lasts at least 3 months. Thus, after a period of activation of the apparatus, during which the bone fragment lengthens, there follows a period of retention necessary for the ossification of the callus and stabilization of the result obtained. For the entire time the distraction device is worn and for some time after its removal, the child is prescribed a gentle diet that excludes the intake of solid food. After removal of the apparatus, orthodontic treatment is required, aimed at normalizing the closure of the teeth of the upper and lower jaw. Huge possibilities for treatment with distraction devices open up in children with severe underdevelopment of the upper jaw; the use of jaw distraction in this group of patients is possible starting from 1 year and allows you to very quickly cope with breathing disorders.

Osteotomy and movement of the lower jaw with its deformities

In patients aged 15-18 years, that is, after the end of the period of growth of the lower jaw, it is possible to perform a radical method of eliminating its deformations - osteotomy of the lower jaw and its surgical movement to the proper position.

Surgical treatment is carried out only after orthodontic preparation of the bite; orthodontics is also necessary after surgery. The operation is performed through intraoral incisions, so that no scars are left on the skin. Within 1 month after treatment, swelling of the soft tissues of the face persists; there may be a loss of sensitivity in the lower lip and chin area, which usually disappears on its own after a short time. In some cases, after surgery, to ensure good bone fusion, intermaxillary splinting is performed - the upper and lower jaws are fixed to each other with special devices, so that full opening of the mouth is impossible. During this period (1-1.5 months), it is possible to eat only pureed and liquid food. Often, for the best cosmetic result, an osteotomy of the upper jaw is also necessary, as well as moving the chin to the proper position - genioplasty. This is due to the fact that the growth of one jaw is closely related to the growth of the other, and when deformation of the lower jaw occurs, the upper jaw also suffers.

Osteotomy and movement of the upper jaw with its deformities

A radical solution for congenital or acquired deformation of the upper jaw is its surgical movement to the proper position. Surgical treatment is carried out only after orthodontic preparation of the bite; orthodontics is also necessary after surgery. The operation is performed through intraoral incisions, so that no scars are left on the skin. Within 1 month after treatment, swelling of the soft tissues of the face persists; there may be a disturbance in the sensitivity of the upper lip and cheeks, which usually disappears on its own after a short time. In some cases, after surgery, to ensure good bone fusion, intermaxillary splinting is performed - the upper and lower jaws are fixed to each other with special devices, so that full opening of the mouth is impossible. During this period (1-1.5 months), it is possible to eat only pureed and liquid food. Since the growth of the upper jaw continues until 15-18 years of age, radical surgery - osteotomy and jaw movement - is usually carried out no earlier than this age. Fortunately, it is now possible to perform early operations on the upper jaw using distraction devices. There is often a combined deformation of the lower jaw, which can be damaged independently or together with the upper jaw. In these cases, for the best cosmetic result, an osteotomy of the lower jaw is necessary, as well as moving the chin to the proper position - genioplasty.

Genioplasty

In some cases of underdevelopment or asymmetry of the lower jaw, it is enough to change only the contour of the chin to completely normalize the patient’s appearance. In order to change the contour of the chin, most surgeons in the world use genioplasty surgery - which consists of cutting off part of the chin of the lower jaw and moving it in the required direction to align the midline of the face. Since the growth of the lower jaw continues until 14-18 years, it is considered correct to perform genioplasty at this age. In cases of impaired social adaptation in a child due to underdevelopment of the chin, surgery can be performed at a younger age. Surgical intervention is performed through an intraoral incision, so post-operative scars are not visible. After surgery, no special diet is required, but the chin area must be protected from injury for at least 1 month to allow the displaced bone fragments to heal properly. The cosmetic result of this treatment is obvious from the first days of the postoperative period.

Surgical treatment of malocclusions

The normal position of the teeth in itself and especially their mutual arrangement in the rows of the upper and lower jaws ensures not only beautiful smile, but also harmony and proportionality of the entire personality. This is because teeth play a huge role in supporting the soft tissues of the lips and cheeks, giving them the necessary contour and volume. In most cases, incorrectly positioned teeth can be successfully moved into the desired position using special orthodontic appliances, but, unfortunately, there are a number of dental anomalies where simple orthodontic treatment is ineffective. In these cases, tooth movement is either completely impossible due to the strong difference in size between the lower and upper jaws or when obtaining a normal bite, the aesthetic proportions of the face are NOT improved, and sometimes worse. In such situations, the only acceptable method of treatment is a combination of orthodontic and surgical treatment, in which the movement of teeth is combined with the movement of individual fragments of the upper or lower jaw, ensuring harmony of the entire personality. A common dental anomaly that requires a similar approach is underdevelopment of the lower jaw and chin. In this case, moving the lower jaw fragment forward along with the chin leads to normalization of the bite and at the same time significantly improves the appearance. In some cases, orthodontic alignment of the dentition is possible, but a small chin remains; then surgical treatment can be aimed at simply moving the chin forward, which will also significantly improve the harmony of the face.

Often the cause of a violation of facial harmony is a sharp increase in the lower jaw; in this case, an operation is performed to move the lower jaw. Similar changes appearance are caused by underdevelopment of the upper jaw. This condition often accompanies cleft lip or palate. In such patients, the upper jaw is moved forward, which ensures good support upper lip and base of the nose. Some patients experience a failure of the central teeth to come together when the jaws close, a condition called an open bite. This condition is often caused by an enlarged tongue. Thus, for successful treatment of an open bite, it may be necessary not only to move the bone fragments of the jaws, but also to surgically reduce the size of the tongue, otherwise an open bite may form again. A difficult problem in orthognathic surgery is the treatment of patients with combined disorders of the size and shape of the jaws. In this case, it is necessary to simultaneously move both a fragment of the upper and a fragment of the lower jaw, sometimes supplementing the operation by moving the chin section.

The presented examples are not the only possible points of application for surgical treatment of malocclusions. Currently, with the use of distraction devices, it has become possible to provide rapid expansion of the dentition of the lower and upper jaw, which significantly facilitates and accelerates orthodontic treatment of conditions such as crowded teeth, deep bite and crossbite. In addition, it is possible to increase or decrease certain areas of the jaws and alveolar processes (the tooth-containing areas of the upper and lower jaw) in the event of traumatic amputation or bone loss as a result of tumor removal, as well as in the case of age-related atrophy associated with tooth loss. Such bone restoration is especially necessary for successful dentures, especially when using the dental implantation method.