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3.1 Non Surgical Treatment

3.1.1 Maxillary Anterior Protrusion
Nursing english 2
By Ilham

Chapter 1

Activator is an acrylic plate made in the maxilla and mandible which is

combined into one. This tool continues the functional strength that comes from the
muscles around the oral cavity. The impulses of these muscles through activators
are forwarded to the teeth, the supporting tissues of the teeth and the jaw, causing
the desired changes. The workings of this tool are to expand the maxilla where
widening occurs to get space for the maxillary anterior teeth so that they can be
moved to the palatal and also move the mandible to the work bite position, so that
overjet and overbite are corrected.4
Oral screen is a functional tool that does not have an active element to
produce pressure on the teeth but has the effect of directing the pressure of the
muscles and soft tissues of the cheeks and lips. The usefulness of this tool is to
improve the arrangement of teeth and occlusal relationships, and to practice the
function of the labial muscles to improve posture and function and prevent mouth
breathing. This tool is used on the lip region and the dental labial segment of the
tooth to get good treatment results. This is where the effect of using an oral screen
looks right and objective. The mechanism of action of this tool is that if the incisors
are proclinated and hollow, there is an overjet oral screen made in such a way that it
only touches the incisors that procline and do not come into contact with the teeth in
the buccal segment.13

A fixed tool can also correct the anterior maxillary protrusion where the fixed
device is constantly in the oral cavity so that the results are
faster than removable devices, it's just that control of fixed tools must be more
frequent and thorough so that all deviations from the operation of the tool can be
avoided.

3.1.2 Open Bite Anterior

Equipment used to correct anterior open bite is usually used in conjunction
with habit breaking equipment to stop or prevent habits that are a contributing factor.
Anterior open bite tends to heal if the etiologic factor is stopped. It can only be a
problem if the treatment of etiological factors is delayed or the patient is a teenager
or an adult. In cases where bone components are still blocked or correction results
do not appear spontaneously, fixed appliances are used with removable or fixed
habit breaking appliances. The Chin cup mounted on the head with a vertical pull
head cap can be used for the purpose of correcting the anterior open bite in patients
who are still in the pre-adolescent age.7,11,14

3.2 Surgical Treatment

The treatment of orthodontic malocclusion does not always stand alone but
can coordinate with surgical treatment. This situation occurs when
orthodontic treatment fails or the severity of an anomalous dentofacial relationship.
Orthognathic surgery is an action to correct skeletal anomalies or malformations of
the maxilla and or mandible. Orthognathic surgery is also called orthodontic surgery
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because orthodontic repositioning teeth and oral surgeons use orthognathic surgery
to reposition all or part of one or both jaws. This is because by moving the jaw, there
is also tooth movement. Orthognathic surgery is performed in conjunction with
orthodontic treatment so that the teeth will be in the right and stable position after
surgery
Malformation of the jaw can occur at birth or the possibility of being manifest
when the patient grows. This can cause difficulty chewing, abnormal speech
patterns, early tooth loss and damage and dysfunction of the temporomandibular
joint. The aim of orthognathic surgery is to correct various small and large facial and
jaw irregularities, and the benefits include increasing the ability to chew, speak and
breathe. In most cases this surgical treatment results in a perfect harmony of the
face

3.2.1 Indications
Indications for orthognathic surgery include severe class II or III skeletal
discrepancies, deep bites in non-growing patients, severe anterior open bites, severe
dentoalveolar problems (too severe for
corrected by orthodontic correction), very weak or disturbed periodontal situations
and skeletal asymmetry.15,16
Ricketts (1982), proposes 4 specific conditions that are indicative of surgical
action, namely if: 1) the expected improvement of dental position is difficult to
achieve with only orthodontic treatment, because malposition is very severe; 2) poor
skeletal patterns for the possibility of good orthodontic correction; 3) only with
orthodontic treatment can not be obtained compatible facial aesthetics; and 4) only
with orthodontic treatment or other restorations that functional occlusion cannot be
achieved. Whereas Alexander (1986) stated that orthognathic surgery can be
performed if orthodontic treatment cannot be obtained by dentoalveolar balance and
facial soft tissue profile.15

3.2.2 Contraindications
All general health conditions, namely all surgical interventions, are
contraindicated. 15
When the balance of indirect gains and losses leads to the decision to treat
the patient with orthodontic surgery, one can decide to delay treatment.17
If the complaint is mild, or when the patient has not seen the need for
treatment, a plaster model can be taken, allowing the evaluation of changes later.17
In young patients, it is recommended to allow complete growth before surgical
intervention. The exception to this is the treatment of mandibular deficiency with the
inclined, low mandibular (convergent morphology), which can be treated with split
sagittal osteotomy or distracted osteogenesis before growth is complete. 17
Financial reasons can also be a decision not to do orthodontic surgery at that
time.17

3.2.3 Maxillary Anterior Protrusion

Maxillary surgery, which is anterior segmental osteotomy, is recommended in
cases of anterior maxillary protrusion because the indications are vertical maxillary
abnormalities, vertical maxillary deficiency, and maxillary AP deficiency (maxillary
hypoplasia).
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3.2.4 Open Bite Anterior

Anterior subapical mandibular osteotomy where this indication of surgery is to
advance or reverse the anterior segment of the lower jaw and to close the anterior
open bite. 15

Chapter 4 SURGERY TECHNIQUES

4.1. Prabedah
4.1.1 Prabedah Evaluation
Preoperative diagnosis is very important for the success of orthognathic
surgery. Diagnosis aims to determine the nature, severity and etiology of possible
dentofacial deformities
General medical evaluation is the patient's general medical history must be
recorded to prevent medical errors from occurring. Patient's dental health must be
evaluated. Pulpo-periodontal problems must be corrected before surgical
intervention.
The socio-psychological evaluation of the patient is assessed to determine
whether he is aware of the dentofacial abnormalities experienced and what he
expects from surgical therapy. This is very helpful in determining and motivating
patients. The patient's social status must also be evaluated.
Cephalometric evaluation is an important evaluation in determining the
nature and severity of cases. Commonly used are cephalometric Burstone analysis
and quadrilateral analysis. Analysis of frontal cephalometry helps in determining the
asymmetrical face

Figure 5 (A) Skeletal maxillary cephalometry protrusion. (Anonymous. A method of

cephalometry evaluation. Http: // www.cleber. Com.br/macnamar.html. June 5, 2012)
Figure 6 (B) Cephalometric anterior open bite. (Kim S, Park Y and Chung K. Severe
anterior open bite malocclusion with multiple odontomas treated by Lingual retractor
and horseshoe mechanics. Angle orthodontist, vol 73 (2), 2003: 206-212)
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Some radographic examinations performed before surgical intervention are:

1. Intra-oral periapical radiographs: These radiographs help in determining the
condition of the teeth and alveolar bone. Pathological conditions around the teeth
can also be determined using radiography
2. Panoramic: Panaromic radiographs offer a broad view of all dentofacial parts
including the temporomandibular joint. This radiograph is useful in evaluating bone
pathology, temporomandibular joints and maxillary sinuses.
3. Angle of point view submento: This radiography is routinely used, it is to determine
the bucofacial thickness.
Study models are also very helpful in evaluating occlusion from all directions. It
is used to assess differences between the arch and intra-arch.
Temporomandibular joints are evaluated by inspection, palpation of ausculation,
and by radiographic examination to evaluate movement and pathology.4
4.1.2 Orthodontic Preparation
The aim of pre-surgical orthodontics is to prepare patients for orthognathic
surgery and not make the occlusal relationship as ideal as possible. The following
procedure is carried out in accordance with the pre-orthodontic surgery
1. Teeth in the arch of the jaw: Diastema and rotation are treated during pre-surgical
orthodontic treatment. Simple corrections can be achieved with a loose orthodontic
appliance. However fixed appliances are preferred because they offer better control
and are possible for aligning multiple teeth. The space needed for gear movement
can be obtained by extraction. Extraction during pre-surgical orthodontics is
generally carried out to reduce moderate and severe cases of congestion in the
dental arch and to facilitate the procedure of cutting segmental bones. 18
2. Incisor inclination: the upper incisors that protrude in Class II, division I, may need
to be pulled back to the axial incisors more to normal inclination. When class II
division 2 occurs retrognatically and must be repaired into protrusion
3. Decompansation: Very often skeletal jaw severity is compensated by changes in
axial tilt in the anterior teeth. For example, retrognatics
the mandible is associated with anterior lower protrusion to partially offset the
difference in skeleton. Class III with a mandibular protrusion usually shows a lower
inclination of the incisors to compensate for skeletal relationships. The orthodontic
procedure must correct this position to position the correct tooth above the
supporting bone. This procedure is called decompensation
4. Stability of archwire: patients approaching the end of orthodontic preparation for
surgery, it is helpful to take x-ray photos and examine the model for occlusal
compatibility. Small disorders can significantly inhibit surgical movements. When
these final orthodontic adjustments have been made, archwires must be placed at
least 4 weeks before surgery, so that they are passive when doing x-ray photos for
surgical instructions (usually 1 to 2 weeks before surgery). This is to ensure that
there will be no tooth movement that will become an obstacle and damage the
surgical results.17

4..2 Surgical Procedure

4.2.1 Surgery for Anterior Segmental Osteotomy
This procedure is performed under general anesthesia with nasal intubation,
which is local infiltration with 2% lignocaine HCl with 1: 80000 adrenaline as is done
in the anterior maxillary region. The mucoperiosteal vertical incision is made in the
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bilateral bicuspid area, where previous extractions have been carried out (premolar 1
over bilaterally withdrawn both) .19
The incision pierces the subperiosteal, dissecting forward to the piriform edge about
5mm above the peak level of the canine teeth. The buccal cortex of the bone is cut
with an oscillating saw or fissure bur, first vertically and distal to the canine teeth and
then horizontally to the piriform edge above the tooth apex. Osteotomy
bilateral completion. 19.20

Gambar 7. Insisi vertikal ditempatkan pada area kaninus, flep tercermin dan
potongan tulang terbuat dari daerah premolar pertama untuk batas lateral bukaan
pyriform, jauh di atas apeks akar dari kaninus. (Mani V. Surgical correction of facial
deformities.Mosby: Jaypee medical,2010: 112-4)

An incision made crossing the palatal and posterior palatal tissue will be seen to
allow the surgeon to complete the palatal osteotomy
transversely. 19.20

Gambar 8. Midline sagital insisi dibuat untuk mengakses palatum untuk osteotomi.
(Mani V. Surgical correction of facial deformities.Mosby: Jaypee medical,2010: 112-
4)

A short vertical incision is made directly above the anterior nasal bone. Minimal
dissection of soft tissue is done to allow placement of an osteotomy to separate the
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premaxila from the nasal septum. The premaxillary segment can now be rotated in a
superior direction to the soft tissue, allowing the surgeon to directly access the
osteotomy site for cutting. 19.20
When a segment can be placed in a planned position, this condition is
stabilized by orthodontic wire, intermaxillary fixation and orthodontic protection. Then
suturing the mucosal and submucosal tissue is done to seal the opening of the
surgery with
absorbable synthesis suture. 19.20

Gambar 9. Anterior rahang atas osteotomi sehubungan dengan Le Fort I osteotomi

(A)diagram (B) foto. (Mani V. Surgical correction of facial deformities.Mosby:Jaypee
medical,2010: 112-4)

There is a modification of the segmental anterior maxillary surgery technique that is

surgery subapical anterior maxillary segmental osteotomy.22
The initial procedure is the same as segmental anterior maxilla and then is
followed by a vertical incision that thickens the alveolar socket of the premolar tooth
extracted on both sides. In order for the root tip of the tooth that is close to the wall of
the anterior maxillary sinus and the inferior piriform aperture not to be disturbed
during the incision, a horizontal osteotomy is performed, the point is marked with a
3mm interval above the root end area using a fissure bur. Based on these points, a
horizontal osteotomy is performed in the form of a bull horn between the apex of the
anterior tooth and the pyrid aperture. This osteotomy will be continued with a vertical
osteotomy made between the two sides. After mobilizing, the anterior dentoalveolar
bone beam was smoothed using a volcanic bur and then positioned it in the
prefabricated occlusal splint. After strong fixation with miniplates, surgical wound
closure is carried out with absorbent material. This osteotomy was modified so as
not to affect the width of the alar base, the spine of the anterior nose and nasal
septum because of the preservation of the inferior edge of the piriform aperture.22
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Gambar 10. Skematik SAMSO menampilkan garis bergelombang osteotomi

horisontal 3-mm di atas kaninus dan apeks gigi. Diseksi subperiosteal dan
osteotomy horisontal dilakukan lebih rendah daripada tulang belakang hidung dan
aperture Piriform. ( Wu et al. Subapical anterior maxillary segmental steotomy: A
modified surgical approach to treat maxillary protrusion. The journal of craniofacial
surgery. vol 21(1),Januari 2010:97-100)

4.2.2 Surgery for Anterior Subapical Mandibular Osteotomy

After administration of local anesthesia, scalpel No. 15 was used to make an incision
on the lower lip of about 15 mm from the vestibule. The expansion of the incision is
carried out from the first premolar to the first premolar on the opposite side and the
anterior part of the mandible towards the inferior edge. The dissection process is
carried out posteriorly along the inferior edge until the mental neurovascular bundle
can be seen
Osteotomy can be done with a rotary instrument or with a mini microsaw. After
making a vertical cut, a horizontal cut is made connecting the vertical pieces with a
size of 5 mm at the bottom of the apical anterior teeth. Osteotomy must be done with
a small osteotomy or chisel spatula. Segment pieces can be mobilized with light
pressure on the osteotomy side to the desired position.15
The wound closure is carried out with layers per layer. Resorbable chromic suture
measuring 4-0 is placed on the submucosa, followed by a vertical mattress suturing
technique to cover the mucous layer. Then external pressure is given 5 to 7 days to
avoid edema or hematoma.15
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Gambar 11. Lower subapical anterior osteotomy (A) diagram (B) foto (C) Lower
subapical anterior osteotomy dapat dikombinasikan dengan genioplasty. (Mani V.
Surgical correction offacial deformities.Mosby:Jaypee medical,2010: 112-4)

4.3 Post-Surgical Care

After surgery, the patient is taken to the postanesthesia care unit, that is, the
recovery room for the right period, usually until alert, oriented, comfortable and
showing stable vital signs, the patient is returned to the hospital room. Trained and
experienced nurse staff are placed in postoperative care of surgical patients to
continue to monitor postoperative progress. Patients are discharged when feeling
comfortable, urinating without assistance, taking food and fluids orally without
difficulty and ambulating too. Postoperative hospitals stay usually from 1 to 4 days.
Patients generally require only mild to moderate pain medication so far and often do
not need analgesics after being justified in returning home. Once the patient is cured,
postoperative radiographs are obtained to ensure that bone changes are targeted
and that the stabilization device is in the right position. The importance of
postoperative nutrition, should be discussed with patients and their families before
entering the hospital for surgery.14
In the past, one of the main concerns in the immediate postoperative period
was the difficulty of the IMF's intermaxial fixation. When the upper and lower jaws
are fixed together, the patient feels difficulty in getting adequate nutrition, doing oral
hygiene, and communicating. The IMF period ranges from 6 to 8 weeks. Over the
past few years, several systems using small bone screws and bone plates have
been developed to provide direct bone stabilization in the osteotomy area. The latest
development in rigid internal fixation is the use of screws and plates made of
absorbent material. This material is able to maintain sufficient strength to stabilize
the bone during the healing period and then reabsorbed by hydrolysis. The use of
this fixation system allows for early release or total elimination of the IMF, which
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results in improved patient comfort, comfortable speaking and oral hygiene and
better postoperative jaw stability and function.14
During surgery, a small occlusal acrylic wafer is used to help reposition and stabilize
occlusion. When the IMF is released (usually in the operating room), the splint is
attached to the maxilla or lower jaw. The light elastic rubber is then placed on the
splint and the combination of the splint and elastic rubber serves to help the jaw into
the new occlusion after postoperation. After an adequate period of time, an occlusal
splint will be removed and the patient referred for orthodontic treatment.14
If the desired jaw movement and stability in the osteotomy area have been reached,
orthodontic treatment can be stopped. The procedure for composing and
repositioning teeth has been achieved when each remaining extraction room is
closed. Vertical elastic rubber is left in the osteotomy area to cause proprioceptive
impulses from the teeth, where if not done the action will cause the patient to look for
a new position of maximum intercuspal. The adaptation process takes place quickly
and rarely takes longer than 6 to 10 months. Retention after orthodontic surgery
makes no difference to adult patients and definitive periodontal and prosthetic
treatment can begin as soon as this final occlusal relationship has been reached.
Patients should be recommended for tooth and periodontal control for about 10 to 14
weeks postoperatively. After the orthodontic appliance is removed, thorough oral
hygiene is recommended with prophylactic techniques
4.4 Complications
4.4.1 Injury nerves
Nerve injury in orthognathic surgery can be caused by indirect trauma, such
as compression by surgical edema, or direct trauma, such as compression, tearing
or cutting with a surgical or stretching instrument
during segmental osteotomy manipulation. Seddon (1943) classified neurosensory
and motor deficits into three categories to describe the morphophysiology of
mechanical nerve injuries, namely neuropraxia, axonotmesis and neurotmesis.21
Neuropraxia is the mildest form of injury and is described as damage to the
myelin sheath locally without continuity defects. The majority of inferior alveolar
nerve (IAN) injuries after split sagittal bilateral osteotomy in the mandible (BSSO) are
neuropraxias and may be caused by nerve manipulation, traction or compression.
Normal sensation or function usually resolves within two months.21
Axonotmesis is characterized by disruption and damage to axons and myelin
sheaths without interference with perineurium or epineurium. This is due to greater
or longer damage, and neurosensory deficits longer and more profound than those in
neuropraxia. 21
Neurotmesis is a severe disorder of the nerve stem, which can cause deep
and possibly permanent neurosensory deficits.
Facial nerve injuries in orthognathic surgery are rare, but the consequences
of these injuries can be detrimental to the patient. Damage to the marginal branch of
the mandibular nerve is a complication of the extraoral approach to the mandibular
ramus or angles, but this approach in orthognathic surgery is rare. Facial nerve has
been reported to have been damaged in vertical intraoral subcondylar osteotomy
and in BSSO regression procedures with an incidence of less than 1%. The
mechanism of trauma is thought to have caused compression
by a retractor behind a fracture, the posterior ramus from the styloid process and
direct pressure as a result of the decline of the distal segment. 21
Disorders of the palatine and infraorbital neurosensory nerves are most likely
to occur after maxillary osteotomy. The incidence of prolonged sensitivity to
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disorders has been reported to be lower than 4%, and they do not seem to bother
patients.21

4.4.2. Complications in TMJ.

Fibrous TMJ ankylosis or hypomobility after orthognathic surgery has been
proposed, caused by several factors, namely: immobilization of the jaw joint with
fixation intermaxillary (IMF), iatrogenic displacement in the posterior condyle and
intra-articular hematoma or excessive tissue extraction from the periosteum and
muscle attachment to the ramus , resulting in contraction and formation of
myofibrotic scar tissue. Fibrillation and erosion of the condylar cartilage are a
consequence of these factors resulting in hypomobility or condylar resorption.
Progressive idiopathic condylar resorption is a condition that is thought to be caused
by factors that reduce functionally normal remodeling capacity (age, systemic
disease, hormones) or increase biomechanical stress in the jaw joint (occlusal
therapy, internal disorders, parafunctional, makrotrauma, unstable occlusion). As a
consequence, condylar declines, ramus height, growth rate (juvenile), progressive
mandibular retrusion or apertognathia and limited mandibular movements. Condylar
resorption can be associated with orthognathic surgery. Several risk factors have
been proposed, namely morphological factors or
functional preoperatively which includes radiological signs of osteoarthrosis, TMJ
dysfunction, high mandibular angle and ratio of posterior and anterior facial height.

4.4.3 Vascular Complications

Uncontrolled bleeding in the jaw can result from mechanical vascular disorders
or congenital or acquired coagulation. A common cause of bleeding in orthognathic
surgery is an imbalance of hemostasis during surgery. The anatomy of bone or blood
vessels or the handling of inadvertant tissue with normal anatomy, hypotensive
anesthesia or infection is the cause of immediate or secondary bleeding. If large
bleeding can be avoided, recovery will be faster.
Upper jaw osteotomy, especially Le Fort I and II osteotomy, has high potential
for severe bleeding in orthognathic surgery. This complication can appear as direct
intraoperative bleeding or as postoperative swelling or epistaxis. The most common
source of bleeding is the terminal branch of the internal maxillary artery, especially
the artery of the palatine or sphenopalatine.
Bleeding most associated with the mandibular osteotomy tends to be
intraoperative and rare compared to the maxillary osteotomy. If the soft tissue is
properly withdrawn it allows surgery to be carried out entirely in a periosteal
envelope and the risk for significant bleeding is very small.
Long-term severity and disruption in the blood circulation can cause avascular
tissue necrosis, which can cause tooth devitalization, abnormalities
periodontal or even loss of large bone segments. Because the anastomosis tissue is
dense on the face, this is a rare occurrence, but in fact it may be in both the maxilla
and deep mandible, especially in relation to segmental osteotomy. The anterior
maxilla is a special risk zone. 21

4.4.4. Relapse
Relapse is an unexpected risk of orthognathic surgery. Relapse may occur on
dental or skeletal or both.
In general, advancing the mandible will be stable, if internal fixation is stiff
and anterior facial height is maintained. Several factors that can affect recurrence in
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the process of advancing the mandible are: surgeon's skills, control of the proximal
segment, including the condylar position and prevention of proximal segment
rotation; prevention of opposite rotation of the distal segment in cases with a high
mandibular angle; the degree of progress of the mandible, and stretching of the
perimandibular tissue, including the skin, connective tissue, muscles and
periosteum.
Mandibular deterioration is not always stable and the inclination of ramus
during surgery seems to have an important influence on stability.21

4.4.5 Infection
Infection after orthognathic surgery can be acute or chronic, local or general.
Most postoperative infections are caused by endogenous bacteria
most likely by aerobic bacteria, streptococci. Infection occurs when the balance
between the host defense system and the virulence of the bacteria is lost. Factors
contributing to orthognathic surgery include steroid use, duration of surgery, patient
age, impaired blood supply to bone segments, dehydration from injuries, presence of
foreign bodies, hospitalization in large wards, nutrition, hematoma and smoking. The
experience of the surgeon, good aseptic techniques and good handling of tissues
are also relevant factors.21

4.4.6 Other Complications

Fractures of the osteotomy segment in BSSO, ie poor splits, have been reported
to occur in 3% - 23% of cases. Medical complications are a rare sequel to maxillary
osteotomy namely decreased visual acuity, ocular muscle dysfunction,
neuroparalytic keratitis and nasolacrimal problems. This injury appears to be caused
by direct trauma to the neurovascular structure during pterigo-maxillary dysjunction
or fractures extending to the skull base. Periodontal problems and tooth decay may
be found, especially in segmental osteotomy. This problem may be caused by errors
in surgical techniques. The design of soft tissue incisions is very important: vertical
incisions in the osteotomy are thought to cause periodontal problems. Trauma in the
palatal mucoperiosteum is a risk. Excessive heat from an oscillating or rotating
instrument, injury to soft tissue or removal of excessive interdental bone can result in
a large supply of blood vessels as well as repositioning the segment. Poor oral
hygiene also has a role in periodontal problems. Many
surgical problems can be minimized if the interdental space is made before surgery
or preoperated with an orthodontic device. 18
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CHAPTER 5
CONCLUSION

Dentofacial skeletal abnormalities and abnormal facial profiles (prognati / retrognati

mandible) that affect facial aesthetics are often encountered by dentists. In the
condition that it is estimated that the use of orthodontic devices has limitations in
correcting the abnormality, the choice that can be made is to treat orthodontic jaw
surgery or orthognathic surgery.
Anterior maxillary protrusion wherein protrusion occurs anteriorly but does not
involve the posterior teeth and is in class I Angle. Anterior open bite is also a
condition where there is a gap or room or there is no contact between the upper
teeth and the lower teeth in the anterior region when the jaw is in a centric
relationship. The etiology of these two malocclusions is the same, namely the growth
factor of the jaw and bad habits.
Management of orthognathic surgery in oromaxillofacial skeletal abnormalities
includes preoperative assessment, surgical management, surgical techniques
(maxillary / mandible), and post-surgical treatment phases.
The type of orthognathic surgery that is suitable for anterior maxillary
protrusion is a segmental anterior osteotomy but has been modified namely
subapical anterior maxillary segmental osteotomy and for the case of an anterior
open bite is the anterior subapical mandibular osteotomy. Orthognathic surgery is
increasingly developing along with technological advancements. In the past, surgical
techniques that were often performed were totally in the maxilla or mandible, but in
the present time it has been simplified where osteotomy is only done segmentally.
After surgery, the use of fixation material in the mandible or maxilla is done to
stabilize the results of the surgery so that it can help the healing process. Patients
are given education in terms of food preservation, good oral hygiene and periodic
control to achieve good results.
Surgical complications that can occur in maxillary surgery generally include bleeding,
failure to reposition segments, loss of segment blood supply, nerve complications,
microorganism infection and airway complications.

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