The retrognathic mandible--surgical correction.

The preceding case reports demonstrate the excellent results available to the patient with a retrognathic mandible. Etiology, adverse effects, and the modalities used in evaluation of the underdeveloped mandible have been discussed. The age at which surgical intervention is undertaken needs additional input by clinicians. Several surgical procedures have been and are employed to advance the mandible. The C osteotomy is recommended since the final result has been excellent and consistent. The surgeon has constant surgical control and vision. The advanced portion of the mandible can be firmly held by intraosseous wires. There is minimak disturbance of muscle position and the inferior alveolar nerve. We have not encountered unusual loss of blood, immediate postoperative problems with the airway, infection, or unfavorable relapse. A postoperative regimen that has been found rewarding is discussed. We have come to the conclusion that most patients can tolerate lengthy surgical procedures with few adverse side effects. Our colleagues in anesthesia and nursing provide superb operative and postoperative care. When the preoperative work-up indicates that more than one procedure is indicated, we recommend that the total surgical treatment plan be carried through at one operation, although occasionally this approach may be contraindicated. We should strive for perfection and can fall short of this goal when a patient will not return for additional surgical procedures which could have been accomplished during the first operation. Although good results have been experienced with both the C osteotomy and the sagittal split osteotomy, we believe that the C osteotomy is a superior procedure. However, this does not imply that the sagittal split osteotomy should not be a part of the armamentarium of the oral surgeon. In conclusion, the C osteotomy, the sagittal split osteotomy, genioplasty, and additional procedures--such as a mandibular alveolar osteotomy to intrude supraerupted teeth--when indicated, can provide very favorable results in cases of retrognathia or micrognathia of the mandible.