The techniques of skeletal surgery of the midface were originally developed to treat problems related to congenital and posttraumatic deformities affecting the occlusion. Occlusion – the way the upper and lower teeth come together – is determined by the position of the tooth bearing arches of the upper and lower jaws relative to each other. The possible variations are alignment, upper jaw too far protruding or lower jaw too far protruding.
It soon became apparent that correction of the deformity by establishing a good relationship of the dental arches also dramatically improved the appearance underlining the importance of the skeleton in determining facial beauty.
Today aesthetic surgery of the facial skeleton of the midface is employed to alter such diverse entities as excessive or diminished cheekbone projection, flatness, a small or retrusive chin, long face and gummy smile, “masculinize” or “femininize” facial characteristics, change some ethnically determined features and so forth.
The following presentation given originally as a grand rounds lecture details some of the possibilities of aesthetic surgery of the facial skeleton in the midface and also illustrates the change of reasoning in this area over the years – the external appearance desired determines the treatment plan as we today know how to set the occlusion almost arbitrarily in space.
Function follows form. Structure is beauty.
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