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mandibular hypoplasia

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from the Chilean Ministry of Health

Functional type procedure with resultsaesthetic.

This treatment is one of the procedures   that are part of orthognathic surgery.

Basic classification of dentofacial anomalies depending on the size relationship between the maxilla and the mandible

Depending on the relationship between the maxilla and the mandible, the diagnoses of dentofacial anomalies are grouped into two types.

Skeletal Class II: Those in which the mandible is smaller than the maxilla.

Skeletal Class III: Those in which the mandible is larger than the upper jaw.

Accordingly, we will explain the treatments of both situations in detail:

Orthognathic surgery in class II patients

ortognatica clase 2
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During growth, the jaws must develop properly and together.

In general, the genetic load and the adequate function produce an advance of both jaws in a harmonious way ending the growth around 17 years with the aligned structures, with the correct dental occlusion and with the ideal functions of the stomatognathic system.

There are numerous factors that can produce a series of alterations in growth. There are genetic factors and environmental factors.

Factores que afectan el crecimiento de los maxilares

Class II

Among the environmental factors are altered functional patterns such as atypical swallowing and parafunctions such as digital sucking or prolonged use of a pacifier in childhood.

These pathological elements produce growth alterations on the one hand only in the structures of the teeth, whether in the position, inclination or bite relationship and on the other hand in the growth patterns of the complete maxillary bones.

Bad habits:

  • finger sucking

  • Use of pacifier 

  • Onychophagia (eating or biting nails)

  • biting pencils

  • Mouth breathing due to obstructions in allergic patients

  • Lingual thrust for large tongue

These factors are functional, but there is another group of pathologies that are hereditary.

Within the hereditary alterations we can find those that are simply inheritance of skeletal patterns of small jaws without becoming some kind of pathology on the part of the parents. In these cases, the parents may or may not present some type of evident alteration or simply a tendency to have a small maxilla or mandible.

These cases can manifest in children as small jaws and if we add some of the functional factors mentioned above, we may be present before an important anomaly that would require treatment by the orthodontist and the maxillofacial surgeon. 

In other cases, the parents or one of them or a blood relative manifests an obviously smaller jaw size that should also have been treated.

There is a third group of options where the size of the jaw is obviously smaller and the cause is a genetic abnormality. In these cases we associate them with syndromes, in these situations there are generally alterations in more than one structure, for example ears, eyes, skin in the area, eyebrows, even manifestations in other body systems such as the heart or hands.

In these cases with genetic alterations, the treatments must be carried out from childhood, sometimes with more than one surgery and with complementary procedures such as the use of devices designed to generate growth in the jaw. These devices are called distractors.

Many alterations associated with class II can be present. We will mention some of them in general and they will be developed in the different sections of the site as a treatment for different pathologies.

  • bruxism

  • Pathology of the temporomandibular joints

  • headaches

  • pain in the ears

  • Sensation of clogged ears

  • joint noise

  • Pain or feeling of tiredness in the chewing muscles

  • Feeling of not having rested in the morning

  • Wear on the teeth or ease of breaking the teeth

  • Snoring

  • sleep apnea

The physiognomic characteristics of class II patients are multiple but in general they tend to have a similar face and may present common signs or a combination of some.

  • smaller jaw

  • Space between upper and lower teeth

  • Wrinkled or twitching chin

  • Difficulty closing the lips

  • Absence of the mentolabial groove

  • Gummy smile, when smiling the patient shows excess gum

  • Presence of dark circles or appearance of a mouth breather

  • Presence of large tonsils

  • Presence of adenoids

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Patologías hereditarias y su influencia en el crecimiento maxilar

Las alteraciones hereditarias pueden ser simplemente herencia de patrones esqueléticos de maxilares pequeños sin llegar a ser alguna patología por parte de los padres. Estos casos pueden manifestarse en los hijos como mandíbulas pequeñas y si se suman algunos de los factores funcionales mencionados anteriormente, pueden requerir tratamiento por un ortodoncista y cirujano maxilofacial.

Síndromes y alteraciones genéticas
En algunos casos, el tamaño de la mandíbula es significativamente más pequeño debido a anomalías genéticas asociadas a síndromes. Estos pacientes generalmente presentan alteraciones en más de una estructura, como orejas, ojos, piel de la zona, cejas e incluso manifestaciones en otros sistemas del organismo como el corazón o manos.

Tratamiento quirúrgico

En casos de alteraciones genéticas, los tratamientos deben comenzar en la infancia y pueden incluir más de una cirugía y procedimientos complementarios, como el uso de aparatos diseñados para generar crecimiento en la mandíbula, denominados distractores
Alteraciones asociadas a pacientes clase II
Los pacientes clase II pueden presentar diversas alteraciones, como:

  • Bruxismo

  • Patología de las articulaciones témporo 

  • Cefaleas

  • Dolor en los oídos

  • Sensación de oídos tapados

  • Ruido en las articulaciones

  • Dolor o sensación de cansancio en los músculos masticadores

  • Sensación de no haber descansado en las mañanas

  • Desgastes en los dientes o facilidad para romper los dientes

  • Ronquidos

  • Apneas del sueño


Physionomic characteristics of class II patients

Los pacientes clase II pueden tener rasgos faciales similares y presentar signos comunes o una combinación de ellos:

  • Mandíbula más pequeña

  • Espacio entre los dientes superiores e inferiores

  • Mentón arrugado o crispado

  • Dificultad para cerrar los labios

  • Ausencia del surco mento labial

  • Sonrisa gingival, al sonreír el paciente muestra encía en exceso

  • Presencia de ojeras o aspecto de respirador bucal

  • Presencia de amígdalas grandes

  • Presencia de adenoides


Cirugía Ortognática en pacientes clase II

La cirugía ortognática es un tratamiento indicado para pacientes clase II que presentan alteraciones esqueléticas y maloclusiones que no pueden ser tratadas únicamente con ortodoncia. Este procedimiento quirúrgico tiene como objetivo corregir las deformidades de los huesos maxilares y mejorar la función masticatoria, la estética facial y la calidad de vida del paciente.

Proceso de tratamiento en pacientes clase II

El tratamiento en pacientes clase II generalmente comienza con un diagnóstico exhaustivo, que incluye análisis de radiografías, fotografías y modelos de estudio. Posteriormente, se realiza un tratamiento ortodóncico para alinear los dientes y preparar al paciente para la cirugía ortognática. Una vez que se ha logrado la alineación dental óptima, se lleva a cabo la cirugía, que puede involucrar uno o ambos maxilares, según las necesidades específicas del paciente.

Results and benefits of orthognathic surgery in class II patients

La cirugía ortognática en pacientes clase II ofrece múltiples beneficios, como:
Mejorar la función masticatoria
Corregir la maloclusión y los problemas de articulación temporomandibular
Mejorar la estética facial
Reducir los síntomas asociados a alteraciones como el bruxismo, ronquidos y apneas del sueño
Aumentar la autoestima y calidad de vida del paciente.

En conclusión, la cirugía ortognática es un tratamiento eficaz y seguro para pacientes clase II que presentan alteraciones esqueléticas y maloclusiones. Este procedimiento quirúrgico, en conjunto con un tratamiento ortodóncico previo, puede mejorar significativamente la función masticatoria, la estética facial y la calidad de vida de los pacientes afectados.


Results and benefits of orthognathic surgery in class II patients

Recovery and postoperative care
After orthognathic surgery, it is essential to follow the recommendations of the maxillofacial surgeon and the orthodontist to ensure adequate recovery and avoid complications. Some useful tips for the post-operative stage include:

  • Follow a soft or liquid diet during the first weeks, according to the surgeon's instructions

  • Maintain good oral hygiene, using rinses with antiseptic solutions and a soft toothbrush

  • Avoid intense physical activities and contact sports for the time recommended by the surgeon

  • Take prescribed medications to control pain and inflammation

  • Attend follow-up appointments with the surgeon and orthodontist to monitor the progress of the treatment and make adjustments when necessary.


Long-term expectations

Orthognathic surgery in class II patients can offer long-lasting and satisfactory results in terms of masticatory function, facial aesthetics and quality of life. However, it is essential to maintain regular follow-up with the orthodontist and maxillofacial surgeon, as well as adopt healthy oral hygiene and eating habits to guarantee the stability of the results obtained.

Orthognathic surgery is an effective and safe option to treat class II patients with skeletal alterations and malocclusions that cannot be corrected with orthodontics alone. This treatment, in conjunction with adequate orthodontic preparation and rigorous postoperative follow-up, can significantly improve the masticatory function, facial aesthetics and quality of life of affected patients. If you suspect you may be a candidate for this type of surgery, consult a specialist in orthodontics and maxillofacial surgery for a personalized evaluation and guidance.

Maxillofacial surgeons and orthodontists specialized in orthognathic surgery

It is essential to have highly trained professionals with experience in the treatment of class II patients through orthognathic surgery. Maxillofacial surgeons and orthodontists specialized in this type of intervention can offer a comprehensive and personalized approach, guaranteeing the best possible results.

When looking for a specialist, it is important to research their educational background, experience in the field, and reputation among their patients. In addition, it is advisable to attend several consultations with different professionals to obtain a second opinion and feel comfortable with the final decision.

Successful cases of orthognathic surgery in class II patients

On the Internet, it is possible to find testimonials and successful cases of class II patients who have been treated with orthognathic surgery. These stories can be a source of inspiration and confidence for those considering undergoing this type of intervention. Additionally, they can offer valuable information about things to consider when choosing a specialist and the post-operative recovery process.

Research and advances in orthognathic surgery for class II patients

Orthognathic surgery is a field in constant evolution, with new advances and techniques that seek to improve the effectiveness and safety of treatment. Research in this area allows the development of better surgical approaches, as well as new devices and technologies that facilitate the correction of skeletal deformities and malocclusions in class II patients.

Staying informed about the latest advances in orthognathic surgery is essential for professionals who are dedicated to this type of interventions, as well as for patients who want to make informed decisions about their treatment.

Emotional support for patients undergoing orthognathic surgery

Orthognathic surgery can be an emotionally challenging process for many patients, as it involves significant changes to their appearance and chewing function. It is essential to have good emotional support from friends, family and mental health professionals to help cope with the worries and fears associated with the intervention and the recovery process.

There are support groups and online communities where patients who have undergone orthognathic surgery can share their experiences and provide advice to those considering undergoing this type of treatment. These spaces can be of great help in facing the emotional and practical challenges related to orthognathic surgery.

Financing and costs of orthognathic surgery

The cost of orthognathic surgery can vary depending on various factors, such as the complexity of the case, the experience of the maxillofacial surgeon, the clinic where the intervention is performed and the geographical location. Therefore, it is crucial to do your research and compare prices before making a decision.

Some health insurances partially or totally cover the costs of orthognathic surgery, as long as it is proven that the treatment is necessary from a functional point of view and not just aesthetic. It is important to review your health insurance coverage and contact your provider for detailed information about the conditions and amounts covered.

Additionally, there are financing options and payment plans available at some clinics, which can facilitate access to orthognathic surgery for patients with different financial capabilities.

Orthognathic surgery and self-esteem

The correction of skeletal deformities and malocclusions in class II patients through orthognathic surgery can have a positive impact on self-esteem and perception of body image. Many patients report greater satisfaction with their appearance and an improvement in their quality of life after undergoing this type of treatment.

It is important to keep in mind that orthognathic surgery not only seeks to improve facial aesthetics, but also correct functional problems, such as chewing and breathing. Therefore, the increase in self-esteem in patients treated with orthognathic surgery may be related to both aesthetic changes and improvements in masticatory and respiratory function.

Prevention of class II problems

Although some class II cases have a genetic origin and cannot be completely prevented, there are measures that can help reduce the risk of developing malocclusions and skeletal problems in children and adolescents:

  • Promote breastfeeding, as it promotes the proper development of the jaws and the position of the teeth

  • Correct harmful habits, such as thumb sucking and prolonged pacifier use, which can alter jaw growth and the position of teeth

  • Promote correct oral hygiene from childhood to prevent dental problems that may affect the occlusion and growth of the jaws.

  • Go to regular check-ups with the pediatric dentist and orthodontist to detect and treat possible anomalies in time.

In summary, orthognathic surgery is an effective and safe treatment for class II patients with malocclusions and skeletal deformities that cannot be resolved with orthodontics alone. Collaboration between maxillofacial surgeons and specialized orthodontists is essential to guarantee a comprehensive and personalized approach, as well as to achieve the best possible results. Patients who undergo orthognathic surgery can experience an improvement in their self-esteem and quality of life, both due to aesthetic changes and the correction of functional problems.

Treatment in patients with classes III or prognathisms

Prognathism is a facial condition in which the lower jaw is positioned prominently forward in relation to the upper jaw. This malformation can have various clinical characteristics that are important to understand. Below, we will explore some of these features based on the results of the search carried out.

Importantly, the search results did not provide specific information on the clinical characteristics of prognathism. However, we can mention some general considerations:

  1. Jaw projection: The most obvious feature of prognathism is excessive forward projection of the jaw, resulting in a disproportionate facial appearance.

  2. Dental malocclusion: Prognathism can cause dental malocclusion, which means that the upper and lower teeth do not fit together correctly. This can result in bite problems and chewing difficulties.

  3. Facial alterations: In addition to jaw projection, prognathism may be associated with other changes in facial appearance. These may include a prominent chin and a smile that shows more of the bottom teeth than the top.

  4. Breathing problems: In some cases, prognathism can cause upper airway obstruction, which can make breathing difficult and lead to breathing problems during sleep, such as sleep apnea.

It is important to keep in mind that clinical characteristics may vary depending on the severity of prognathism and the individual characteristics of each patient. The appropriate diagnosis and treatment must be carried out by health professionals, such as orthodontists and maxillofacial surgeons, who will evaluate each case in a personalized manner.

The treatment of prognathism is basically the same as that of classes II, planning is carried out in conjunction with the orthodontist. The orthodontic specialist, after a study, decides how to align the teeth so that the surgeon at the time of surgery can match both dental arches in a class I. This orthodontic preparation can last between 1 and 3 years. depending on the age of the patient, characteristics of their bones and degree of dental crowding.

Once the orthodontic preparation process is completed, the orthognathic surgery preparation stage begins. At which time your surgeon will align your jaws, definitively correcting your profile from an aesthetic and bite point of view.

Class III generally have respiratory problems associated with mouth breathing, difficulty breathing through their nostrils. During surgery, the area is cleared to improve ventilation and your jaws are accommodated, fixing them with miniplates. and titanium screws. 

Recovery and postoperative care in orthognathic surgery


Recovery after orthognathic surgery may vary depending on the complexity of the case and the surgical technique used. However, there are some general tips that can help patients navigate the recovery process more comfortably and safely:

  1. Follow the instructions of the maxillofacial surgeon and orthodontist regarding medication, wound care, and physical activity restrictions.

  2. Maintain a liquid or soft diet during the first weeks after surgery, according to the specialist's recommendations.

  3. Avoid tobacco and alcohol consumption, as they can interfere with healing and increase the risk of complications.

  4. Perform gentle mobility and mouth opening exercises, always under the supervision of the specialist, to facilitate the recovery of chewing function and prevent stiffness in the temporomandibular joints.

  5. Attend follow-up consultations with the maxillofacial surgeon and orthodontist to evaluate the evolution of the case and adjust the treatment if necessary.

Risks and complications of orthognathic surgery


Although orthognathic surgery is a safe procedure with high success rates, like any surgical intervention, it carries certain risks and complications that must be taken into account. Some of the most common complications include:

  • Hemorrhages

  • Infections

  • Problems with tissue and bone healing

  • Damage to the facial nerves, which may cause temporary numbness or weakness in the affected area

  • Bone resorption or instability in osteotomy areas

  • Relaxation or displacement of the plates and screws used to fix bones

It is essential that patients are well informed about the risks and complications associated with orthognathic surgery and discuss their concerns with the maxillofacial surgeon and orthodontist before making a treatment decision. In addition, following postoperative instructions and care is essential to minimize risks and guarantee a successful recovery.

Orthognathic surgery and quality of life

Orthognathic surgery not only improves the physical appearance and self-esteem of class II patients, but can also have a significant impact on overall quality of life. By correcting functional problems such as chewing and breathing, patients may experience a reduction in the occurrence of symptoms and complications associated with malocclusion and skeletal deformities.

Some of the benefits that orthognathic surgery can offer in terms of quality of life include:

  • Improved ability to chew and enjoy different foods

  • Reduced tension and pain in the temporomandibular joints and facial muscles

  • Decreased snoring and sleep apnea, which can improve the quality of your night's rest

  • Improvement in nasal breathing and reduction of obstruction in patients with mouth breathing

  • Preventing long-term dental problems such as tooth wear and fracture

  • Improved communication and social interaction, due to increased confidence in appearance and the ability to speak and chew correctly

Orthognathic surgery is an effective and long-lasting treatment for class II patients with malocclusions and skeletal deformities. Most patients experience satisfactory long-term results and stability in the correction of their dental and skeletal problems.

However, it is important to remember that orthognathic surgery is only one part of the comprehensive treatment for these patients. Collaboration with an experienced orthodontist is essential to ensure an adequate approach and stability of results over time. Patients should continue with regular visits to the orthodontist and follow maintenance and care instructions to avoid the appearance of new problems or the recurrence of malocclusions.

In conclusion, orthognathic surgery is an effective and safe treatment option for class II patients who present malocclusions and skeletal deformities that cannot be resolved with orthodontics alone. By addressing both the aesthetic and functional aspects of dental and skeletal problems, patients can experience significant improvement in their self-esteem and quality of life. A multidisciplinary team of maxillofacial surgeons and orthodontists is essential to ensure a comprehensive and personalized approach and achieve successful, long-lasting results.

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