Simultaneous Repositioning of the Maxilla, Mandible, and Chin. Treatment Planning and Analysis of Soft Tissues

There is a clinical, biologic, and biomechanical foundation for simultaneous surgical repositioning of the maxilla, mandible, and chin in a significant proportion of adult and adolescent patients. The restoration of normal jaw function, optimal facial esthetics, and long-term stability are the sine qua non of successful orthognathic surgical procedures to simultaneously reposition the jaws. The key to the achievement of these objectives is to carefully and systematically analyze facial esthetics, establish esthetic priorities, and then coordinate and implement them through the use of cephalometric planning and occlusal studies. By meticulous and precise surgical technique, properly programmed, coordinated, and sequenced with efficient presurgical and postsurgical edgewise orthodontic therapy, and systematic postsurgical neuromuscular rehabilitation, the maxilla, mandible, and chin can be simultaneously repositioned with relatively few postoperative complications or sequelae. This article purposes to elucidate on the indications for two-jaw surgery and describe a simplified clinical-cephalometric analysis for orthognathic surgery. Representative case reports are presented and discussed to illustrate the esthetic, orthodontic, and surgical treatment objectives. The basic problems involved in diagnosis and treatment planning of patients who require two-jaw surgery are discussed as well.