Chirurgie correctrice des malformations ou dysmorphies maxillomandibulaires: bases chirurgicales.

In this third article concerning maxillomandibular dysmorphia, after those dealing with preoperative reflections, the authors set out the technical principles of this corrective surgery. Before the incision, it is necessary to consider with the anesthesiologist the peculiarities of orthognathic surgery: proximity to the fields of action of each, possible difficulties of intubation, reduction of bleeding, extubation and postoperative monitoring. These imperatives also have an influence on the installation of the surgical and anesthetic teams. The authors then describe the three basic interventions that are sagittal osteotomy of the mandible, maxillary type osteotomy Fort I and genioplasty. For each of them, the authors detail step by step the typical surgical technique: preparation, approach, osteotomy, mobilization, compression and postoperative care. Regarding the sagittal osteotomy of the mandible, the focus is on the complications that can occur during and after the procedure. About the Fort I type osteotomy are detailed variants concerning the osteotomy design, the positioning of the maxillary and its impact on the facial soft tissues. If genioplasty seems simpler than the previous techniques, it poses difficulties in connection with the orientation of the osteotomy and the positioning of the symphyseal volume