Orthognathic Surgery: Past, Present and Perspectives for the future (PART IIΙ)
Lazaridis Nikolaos1, Hadjiantoniou Georgios2, Lazaridis Constantinos3, Tilaveridis Ioannis4
Laboratory of Oral Maxillofacial Surgery, Aristotle University of Thessaloniki
DOI: 10.54936/haoms2627790
SUMMARY: Orthognathic surgery encompasses a broad spectrum of surgical procedures aimed at correcting dentofacial anomalies. It provides the opportunity to address jaw disharmonies and improve functions such as chewing, speech, swallowing, and breathing. Additionally, it contributes to the relief of musculofascial pain in the face, enhances the functioning of the temporomandibular joint (TMJ), and improves facial aesthetics. Today, orthognathic surgery has evolved into one of the most «influential» subspecialties within Oral and Maxillofacial Surgery. A historical journey into the development of orthognathic surgery should undoubtedly focus on the surgeons who performed, introduced, or associated their names with various orthognathic surgery procedures. Describing the development of different surgical techniques with chronological precision is not always a simple task. The majority of orthognathic surgery procedures for repositioning–i.e., repositioning the upper or lower jaw, or both simultaneously–based on the treatment plans devised by both the surgeon and orthodontist, were often conducted nearly simultaneously by surgeons from both sides of the Atlantic (USA and Europe). Through this article, we attempt to embark on a historical journey of 180 years, emphasizing chronological milestones, pioneering surgeons, and intertemporal surgical techniques that have left their mark on the evolution of orthognathic surgery. We define as past of orthognathic surgery the period from 1849, the year of Hullihen’s first surgical procedure in the USA, until 1957, when Obwegeser published his sagittal ramus split osteotomy of the mandible in Europe. The present of orthognathic surgery spans from 1957 to the present day. This period has been dominated by the remarkable presence of the “father of orthognathic surgery,” Professor Obwegeser. In parallel, especially in recent years, with the rapid advancement of technology, we have seen the emergence of significant digital techniques (e.g., CAD/CAM) that facilitate the work of surgeons. As for the future of orthognathic surgery, technology will play an even more crucial role in its evolution, developing new opportunities and possibilities in this field.
KEY WORDS: Orthognathic surgery, sagittal ramus osteotomy, bilateral osteotomy, Le Fort osteotomy, segmental osteotomies.
REFERENCES
1. Taub PJ, Patel PK, Buchman SR, Cohen MN, editors. Ferraro’s Fundamentals of Maxillofacial Surgery. New York, NY: Springer New York; 2015.
2. Naini FB. Hugo L. Obwegeser (1920-2017) - The father of modern orthognathic surgery. J Orthod [Internet]. 2017 Jan;44(4):317–9. Available from: https://pubmed.ncbi.nlm.nih. gov/29063808/
3. Turvey TA. The History of Orthognathic Surgery. In: Oral and Maxillofacial Surgery. 3rd ed. Elsevier; 2017.
4. MacIntosh RB. Le Morte d’Arthur: A Commentary on Hugo L. Obwegeser. J Oral Maxillofac Surg [Internet]. 2018 Jan 1 [cited 2025 Jan 9];76(1):6–7. Available from: https://pubmed. ncbi.nlm.nih.gov/29080405/
5. Posnick JC. Orthognathic Surgery: Principles and Practice [Internet]. Orthognathic Surgery: Principles and Practice. Elsevier Inc.; 2014 [cited 2025 Jan 9]. 1–1783 p. Available from: http://www.sciencedirect.com:5070/book/9781455726981/ orthognathic-surgery
6. White R. Evalution of sagittal split-ramusosteotomy in 17 patients. J Oral Surg. 1969;27:851–5.
7. Bell WH. Surgical correction of anterior maxillary retrusion: report of a case. J Oral Surg. 1968 Jan;26(1):57–60.
8. Kent JN, Hinds E. Management of dental facial deformities by anterior alveolar surgery. J Oral Surg. 1971 Jan;29(1):13–26.
9. Converse JM, Telsey D. The tripartite osteotomy of the midface for orbital expansion and correction of the deformity in craniostenosis. Br J Plast Surg [Internet]. 1971 [cited 2025 Jan 9];24(4):365–74. Available from: https://pubmed.ncbi.nlm.nih. gov/5115039/
10. Converse JM, Shapiro HH. Treatment of developmental malformations of the jaws. Plast Reconstr Surg (1946) [Internet]. 1952 [cited 2025 Jan 9];10(6):473–510. Available from: https://pubmed.ncbi.nlm.nih.gov/13003581/
11. Converse JM, Horowitz SL, Valauri AJ, Montandon D. The treatment of nasomaxillary hypoplasia. A new pyramidal naso-orbital mazillary osteotomy. Plast Reconstr Surg [Internet]. 1970 [cited 2025 Jan 9];45(6):527–35. Available from: https:// pubmed.ncbi.nlm.nih.gov/5444669/
12. Midtling CS, Turvey TA. Orthognathic Surgery. The History of Maxillofacial Surgery: An Evidence-Based Journey [Internet]. 2022 Jan 1 [cited 2025 Jan 9];197–239. Available from: https:// www.researchgate.net/publication/359294479_Orthognathic_Surgery
13. Fonseca RJ. Oral and Maxillofacial Surgery-Inkling Enhanced EBook: Oral and Maxillofacial Surgery-E-Book. Elsevier Health Sciences; 2017.
14. Proffit WR, Turvey TA, Phillips C. Orthognathic surgery: a hierarchy of stability. Int J Adult Orthodon Orthognath Surg. 1996;11(3):191–204.
15. Turvey TA, Proffit WP, Phillips C. Biodegradable fixation for craniomaxillofacial surgery: a 10-year experience involving 761 operations and 745 patients. Int J Oral Maxillofac Surg [Internet]. 2011 Mar [cited 2025 Jan 9];40(3):244–9. Available from: https://pubmed.ncbi.nlm.nih.gov/21185695/
16. Reichenbach E, Köle H, Brückl H. Chirurgische Kieferorthopädie. (No Title). 1965;
17. Reichenbach EH, Kole H, Schuchardt K, Brückl H. Chirurgische Kieferorthopadie. JA Barth; 1970.
18. Proffit WR, White R. Surgical-orthodontic treatment. CV Mosby, St Louis. 1991;
19. Epker BN, Wolford L. Dentofacial deformities: surgical-orthodontic correction. (No Title). 1980;
20. Turvey TA. Maxillary expansion: a surgical technique based on surgical-orthodontic treatment objectives and anatomical considerations. J Maxillofac Surg [Internet]. 1985 [cited 2025 Jan 9];13(2):51–8. Available from: https://pubmed.ncbi.nlm. nih.gov/3889206/
21. Proffit WR, White RP, Sarver DM, others. Contemporary treatment of dentofacial deformity. Vol. 283. Mosby St. Louis; 2003.
22. Proffit WR, White RP, Sarver DM, others. Contemporary treatment of dentofacial deformity. Vol. 283. Elsevier; 2003.
23. Epker BN., Stella JP., Fish LC. Dentofacial deformities : integrated orthodontic and surgical correction. 1998 [cited 2025 Jan 9]; Available from: https://books.google.com/books/about/ Dentofacial_Deformities.html?hl=el&id=8ihqAAAAMAAJ
24. EPKER NB, JP S, LC F. Integrated Orthodontic and surgical correction. Dentofacial Deformities. 1999;
25. Reyneke JP. Essentials of orthognathic surgery 2nd ed. Quintessence Publishing Co, Hanover; 2010.
26. Ghali MGZ, Srinivasan VM, Jea A, Lam S. Craniosynostosis surgery: The legacy of Paul Tessier. Neurosurg Focus [Internet]. 2014 [cited 2025 Aug 22];36(4). Available from: https:// pubmed.ncbi.nlm.nih.gov/24684329/
27. Schwenzer N, Ehrenfeld M, Bacher M, Cornelius CP, Gellrich NC, Hyckel P, et al. Mund-Kiefer-Gesichtschirurgie. MundKiefer-Gesichtschirurgie. 2011 Jun 17;
28. Eufinger H, Kübler A, Schliephake H. Oral and maxillofacial surgery: Surgical textbook and atlas. Oral and maxillofacial surgery: Surgical textbook and atlas. 2023 Jan 1;1–851.
29. Hovell JH. The surgical correction of variations in the skeletal facial pattern. In: Proc Roy Soc Med. 1956. p. 546.
30. Epker BN, Wolford LM. Middle-third facial advancement: treatment considerations in atypical cases. J Oral Surg. 1979 Jan;37(1):31–41.
31. Epker BN. Esthetic maxillofacial surgery. Lea & Febiger; 1994.
32. Turvey TA, Epker BN. Soft tissue procedures adjunctive to orthognathic surgery for improvement of facial balance. J Oral Surg. 1974 Aug;32(8):572–7.
Laboratory of Oral Maxillofacial Surgery, Aristotle University of Thessaloniki
DOI: 10.54936/haoms2627790
SUMMARY: Orthognathic surgery encompasses a broad spectrum of surgical procedures aimed at correcting dentofacial anomalies. It provides the opportunity to address jaw disharmonies and improve functions such as chewing, speech, swallowing, and breathing. Additionally, it contributes to the relief of musculofascial pain in the face, enhances the functioning of the temporomandibular joint (TMJ), and improves facial aesthetics. Today, orthognathic surgery has evolved into one of the most «influential» subspecialties within Oral and Maxillofacial Surgery. A historical journey into the development of orthognathic surgery should undoubtedly focus on the surgeons who performed, introduced, or associated their names with various orthognathic surgery procedures. Describing the development of different surgical techniques with chronological precision is not always a simple task. The majority of orthognathic surgery procedures for repositioning–i.e., repositioning the upper or lower jaw, or both simultaneously–based on the treatment plans devised by both the surgeon and orthodontist, were often conducted nearly simultaneously by surgeons from both sides of the Atlantic (USA and Europe). Through this article, we attempt to embark on a historical journey of 180 years, emphasizing chronological milestones, pioneering surgeons, and intertemporal surgical techniques that have left their mark on the evolution of orthognathic surgery. We define as past of orthognathic surgery the period from 1849, the year of Hullihen’s first surgical procedure in the USA, until 1957, when Obwegeser published his sagittal ramus split osteotomy of the mandible in Europe. The present of orthognathic surgery spans from 1957 to the present day. This period has been dominated by the remarkable presence of the “father of orthognathic surgery,” Professor Obwegeser. In parallel, especially in recent years, with the rapid advancement of technology, we have seen the emergence of significant digital techniques (e.g., CAD/CAM) that facilitate the work of surgeons. As for the future of orthognathic surgery, technology will play an even more crucial role in its evolution, developing new opportunities and possibilities in this field.
KEY WORDS: Orthognathic surgery, sagittal ramus osteotomy, bilateral osteotomy, Le Fort osteotomy, segmental osteotomies.
REFERENCES
1. Taub PJ, Patel PK, Buchman SR, Cohen MN, editors. Ferraro’s Fundamentals of Maxillofacial Surgery. New York, NY: Springer New York; 2015.
2. Naini FB. Hugo L. Obwegeser (1920-2017) - The father of modern orthognathic surgery. J Orthod [Internet]. 2017 Jan;44(4):317–9. Available from: https://pubmed.ncbi.nlm.nih. gov/29063808/
3. Turvey TA. The History of Orthognathic Surgery. In: Oral and Maxillofacial Surgery. 3rd ed. Elsevier; 2017.
4. MacIntosh RB. Le Morte d’Arthur: A Commentary on Hugo L. Obwegeser. J Oral Maxillofac Surg [Internet]. 2018 Jan 1 [cited 2025 Jan 9];76(1):6–7. Available from: https://pubmed. ncbi.nlm.nih.gov/29080405/
5. Posnick JC. Orthognathic Surgery: Principles and Practice [Internet]. Orthognathic Surgery: Principles and Practice. Elsevier Inc.; 2014 [cited 2025 Jan 9]. 1–1783 p. Available from: http://www.sciencedirect.com:5070/book/9781455726981/ orthognathic-surgery
6. White R. Evalution of sagittal split-ramusosteotomy in 17 patients. J Oral Surg. 1969;27:851–5.
7. Bell WH. Surgical correction of anterior maxillary retrusion: report of a case. J Oral Surg. 1968 Jan;26(1):57–60.
8. Kent JN, Hinds E. Management of dental facial deformities by anterior alveolar surgery. J Oral Surg. 1971 Jan;29(1):13–26.
9. Converse JM, Telsey D. The tripartite osteotomy of the midface for orbital expansion and correction of the deformity in craniostenosis. Br J Plast Surg [Internet]. 1971 [cited 2025 Jan 9];24(4):365–74. Available from: https://pubmed.ncbi.nlm.nih. gov/5115039/
10. Converse JM, Shapiro HH. Treatment of developmental malformations of the jaws. Plast Reconstr Surg (1946) [Internet]. 1952 [cited 2025 Jan 9];10(6):473–510. Available from: https://pubmed.ncbi.nlm.nih.gov/13003581/
11. Converse JM, Horowitz SL, Valauri AJ, Montandon D. The treatment of nasomaxillary hypoplasia. A new pyramidal naso-orbital mazillary osteotomy. Plast Reconstr Surg [Internet]. 1970 [cited 2025 Jan 9];45(6):527–35. Available from: https:// pubmed.ncbi.nlm.nih.gov/5444669/
12. Midtling CS, Turvey TA. Orthognathic Surgery. The History of Maxillofacial Surgery: An Evidence-Based Journey [Internet]. 2022 Jan 1 [cited 2025 Jan 9];197–239. Available from: https:// www.researchgate.net/publication/359294479_Orthognathic_Surgery
13. Fonseca RJ. Oral and Maxillofacial Surgery-Inkling Enhanced EBook: Oral and Maxillofacial Surgery-E-Book. Elsevier Health Sciences; 2017.
14. Proffit WR, Turvey TA, Phillips C. Orthognathic surgery: a hierarchy of stability. Int J Adult Orthodon Orthognath Surg. 1996;11(3):191–204.
15. Turvey TA, Proffit WP, Phillips C. Biodegradable fixation for craniomaxillofacial surgery: a 10-year experience involving 761 operations and 745 patients. Int J Oral Maxillofac Surg [Internet]. 2011 Mar [cited 2025 Jan 9];40(3):244–9. Available from: https://pubmed.ncbi.nlm.nih.gov/21185695/
16. Reichenbach E, Köle H, Brückl H. Chirurgische Kieferorthopädie. (No Title). 1965;
17. Reichenbach EH, Kole H, Schuchardt K, Brückl H. Chirurgische Kieferorthopadie. JA Barth; 1970.
18. Proffit WR, White R. Surgical-orthodontic treatment. CV Mosby, St Louis. 1991;
19. Epker BN, Wolford L. Dentofacial deformities: surgical-orthodontic correction. (No Title). 1980;
20. Turvey TA. Maxillary expansion: a surgical technique based on surgical-orthodontic treatment objectives and anatomical considerations. J Maxillofac Surg [Internet]. 1985 [cited 2025 Jan 9];13(2):51–8. Available from: https://pubmed.ncbi.nlm. nih.gov/3889206/
21. Proffit WR, White RP, Sarver DM, others. Contemporary treatment of dentofacial deformity. Vol. 283. Mosby St. Louis; 2003.
22. Proffit WR, White RP, Sarver DM, others. Contemporary treatment of dentofacial deformity. Vol. 283. Elsevier; 2003.
23. Epker BN., Stella JP., Fish LC. Dentofacial deformities : integrated orthodontic and surgical correction. 1998 [cited 2025 Jan 9]; Available from: https://books.google.com/books/about/ Dentofacial_Deformities.html?hl=el&id=8ihqAAAAMAAJ
24. EPKER NB, JP S, LC F. Integrated Orthodontic and surgical correction. Dentofacial Deformities. 1999;
25. Reyneke JP. Essentials of orthognathic surgery 2nd ed. Quintessence Publishing Co, Hanover; 2010.
26. Ghali MGZ, Srinivasan VM, Jea A, Lam S. Craniosynostosis surgery: The legacy of Paul Tessier. Neurosurg Focus [Internet]. 2014 [cited 2025 Aug 22];36(4). Available from: https:// pubmed.ncbi.nlm.nih.gov/24684329/
27. Schwenzer N, Ehrenfeld M, Bacher M, Cornelius CP, Gellrich NC, Hyckel P, et al. Mund-Kiefer-Gesichtschirurgie. MundKiefer-Gesichtschirurgie. 2011 Jun 17;
28. Eufinger H, Kübler A, Schliephake H. Oral and maxillofacial surgery: Surgical textbook and atlas. Oral and maxillofacial surgery: Surgical textbook and atlas. 2023 Jan 1;1–851.
29. Hovell JH. The surgical correction of variations in the skeletal facial pattern. In: Proc Roy Soc Med. 1956. p. 546.
30. Epker BN, Wolford LM. Middle-third facial advancement: treatment considerations in atypical cases. J Oral Surg. 1979 Jan;37(1):31–41.
31. Epker BN. Esthetic maxillofacial surgery. Lea & Febiger; 1994.
32. Turvey TA, Epker BN. Soft tissue procedures adjunctive to orthognathic surgery for improvement of facial balance. J Oral Surg. 1974 Aug;32(8):572–7.
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