[Functional analysis of a surgical-prosthetic treated prognathism--10-year results (1)].
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With regard to recurrences following surgery for prognathia of the mandible, the authors draw the distinction between immediate and secondary recurrences caused by errors in surgical indication or technique. They then review late recurrences, which they classify as being alveolar, basal or by forward sliding. They then study the role played in recurrences by growth of the condyle, neuromuscular balance and the hyoid suspensor system. Finally they stress the action of the tongue and the age factor (over 17 years being, in their view, desirable).
The technique involves transposition at the site of the angle of resection via an intrabuccal approach of the horizontal ramus at its various stages. The technique is dependable and is indicated whenever correction of the malformation requires mass displacement of the dental arcade. It is preferable to sagittal split of the ascending ramus since it is more precise and less dangerous as far as the neurovascular bundle is concerned.
Cranio-facial morphogenesis and (in particular) maxillo-mandibular relations are linked with cervico-cephalic stasic. In cases of mandibular prognathia in the presence of cervical lordosis, treatment should thus take this special feature into account and seek for preference anterior maxillo-mandibular adaptation (associated when necessary with partial glossectomy), rather than the correction of skeletal abnormalities linked to a problem of position which cannot be influenced. At a time when the most highly qualified American orthodontists accept the possibility of altering basic bone features and recommend the replacement of the term orthodontics by more suitable expression dento-facial orthopaedics (10), attention must also be paid to the possibilities of true cervico-cephalic orthopaedics (in the context of general orthopaedics (17, 18, 19, 20)).
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