Various Applications and Discussion on Debating Viewpoints of Segmental Orthognathic Surgery for Korean DFDs

Segmental osteotomy of the dental arch has been used for various purposes in orthognathic surgery. It had been developed originally from dramatic surgical change of the protruding maxillary or mandibular profile in aesthetic purpose, and now various osteotomy techniques are used not only to correct aesthetic problems but also to correct unfavorable arch coordination between upper and lower dental arch in spite of preoperative orthodontic finishing before surgery. And also it can be used to help the extraordinary limitations of the conventional orthognathic surgery in cases of unusual DFD patients.

One of the major advantages of segmental orthognathic osteotomy is time-saving improvement of the facial profile without prolonged orthodontic treatment, for example, anterior setback of the maxillary and/or mandibular protrusion by one-staged segmental osteotomy with premolar extraction. Therefore, it may preferable to the patients who suggest so they have protrusive face that want to change their profile once in a while. However it must be considered more prudentially based on not only their profile nature in DFD viewpoint but also inherent characteristics of the racial differences. Morphologic character and preferable profile of the Korean face as an Oriental are quite different from Western people, and also aesthetic demand to facial profile in DFD patients is different from them. Therefore profile change for Orientals should be considered according to their inherent racial characteristics. I will discuss debating viewpoints on true indication of anterior segmental osteotomy to improve facial profile for Koreans as an Oriental in viewpoint of DFD prediction and racial characteristics.

Another major advantage of segmental orthognathic osteotomy is overcoming of the orthodontic limitation in dental arch alignment in DFD patients. But longer operating time may be necessary and exposed more complicated situation compared to full-arch movement case in general. General characteristics of dental arch may not differ in Koreans from Western people except arch size. Therefore, various surgical indications for segmental osteotomy of dental arch for orthognathic purpose may be dependent upon the surgeon’s preference. I will present and discuss various applications of segmental osteotomy for Korean patients in my experience.

Additionally, application of segmental surgery would be useful to overcome extraordinary cases difficult to manage by conventional orthognathic surgery in severe DFD patients. We have often been faced with very unusual cases which could not be controlled by conventional orthodontic and orthognathic surgical management. I will present and discuss a few cases which used segmental osteotomy to overcome limitation of conventional orthognathic surgical modalities in unusual cases of DFD in Korea.

I hope my presentation will be helpful to understand efficient surgical modalities on various segmental orthognathic osteotomies applied to Asians for Western OMFS Surgeons.