Esthetic analysis of the cervicofacial region.

For many patients the primary motivating factor for orthognathic surgery is improvement of their facial appearance. In order to achieve a satisfactory esthetic result and satisfy the patients' concerns, a systematic, thorough evaluation should be performed. Because the face is a complex anatomic unit, it is best to evaluate each distinct region of the face separately, taking care to relate the various parts to the whole. During this examination it is important that the patient be in natural head position with the lips in repose and the teeth lightly touching in a centric relationship. Direct measurements from the patient are always more accurate than those obtained from photographs or radiographs. The surgeon should keep in mind that the proper relationships between the various regions of the face are more important than specific angles or numbers.

Posterior segmental osteotomy with simultaneous endosseous implant placement to facilitate fixed reconstruction.

The supra-eruption of the edentulous posterior maxilla may decrease interarch space, thus compromising the construction of an adequate fixed or removable prosthetic appliance (Henderson et al., 1985). The following case report illustrates a treatment which provides additional interarch space facilitating the restoration of the patient's dentition with a fixed prosthetic appliance. This arch space deficiency was corrected by performance of a unilateral posterior maxillary osteotomy with superior repositioning of this segment. Simultaneously, a hydroxylapatite-coated titanium endosteal dental implant was placed. Pre-operative considerations, the surgical procedure, and post-operative management of this problem are discussed.