Dec 04,2017
Estimates of the number of British children and young adults receiving orthognathic surgery have varied widely over the last twenty years. Previously it was thought to be less than 1000 a year but in 1999 a survey suggested that 7% of a consultant Orthodontist’s workload was related to Orthognathic treatment. In 2009 it was estimated that 1.5 million people would warrant orthognathic treatment. I think that this change in treatment selection has been driven by the difficulty in correcting class II malocclusions by non-surgical means.
Twenty years ago most overjets treated by surgery were over 7 millimetres but currently many cases are less than 5 millimetres. This may be due to the realisation that correction by functional and dental-orthopaedic appliances is uncertain even when the overjets are small. There are few accurate figures to tell us what the current number might be and anyway the figure is distorted by the number of children who are advised to have surgery but who are too frightened to accept. These may outnumber those accepting surgery by two to one, leaving many children with disfigurement that no one can cure satisfactorily.
Information about orthognathic surgery is largely supplied by individuals who publish successful cases but of course this is always slightly unsatisfactory as one is left wondering what might have happened had another method been used. As a result there is little evidence to show if some methods get better results than others. Although modern surgery is very safe there is always the chance that things can go seriously wrong and certainly surgery should always be avoided if possible.
Most orthognathic surgery these days it a sequence of orthodontic treatment using fixed appliances and surgery, usually in that order but sometime with a second cycle of orthodontics. This can make overall treatment quite a lengthy process. Non-surgical methods such as Fixed, Functional and Herbst Appliances have been used but there is a risk of only partial improvement as a result of unattractive facial lengthening (Faure, J. 1998). Some success has been reported using Orthotropic treatment on cases previously recommended for surgery suggesting that it could be an effective alternative (see below).
Although these cases have been shown to the GDC they have said orthodontists need not “inform a patient of alternative treatments which, in the dentist’s opinion would not be appropriate”. Some readers might think that patients should be informed about all realistic alternatives especially if they can avoid invasive surgery so they are able to decide for themselves.