Facial Soft Tissue: The Alpha and Omega of Treatment Planning in Orthognathic Surgery

The soft tissues of the face are attached to and are draped over the underlying hard tissues. Logically, then, it may be expected that there is a mutual relationship which in the long run will determine the appearance and balance of the soft tissues. The dilemma has been that these relationships are not constant overall but appear to vary from site to site. The research on which the papers in this Journal have been based has been directed at ascertaining as accurately as possible the patterns between relative movements of the hard and soft tissues at selected sites. These data may then be applied in a prediction analysis where surgical adjustments of the hard tissues are mathematically related to the resultant re-arrangement of the associated soft tissues. This philosophy has evolved into a prediction system which relies upon a primary determination of the most favourable objectives for the soft tissue drape. Once that is known, it is practical to secondarily determine those surgical re-adjustments of the supporting bony elements which will be required to achieve the favoured soft tissue drape and appearance. The prediction system enables the Orthodontist to produce a visual treatment objective which will readily identify the treatment mechanics required, will determine whether extractions are required and will indicate the most favourable extraction plan. Critically, the prediction will determine the most advantageous pre-operative overjet (or reverse overjet), a signal factor in allowing the desired surgical jaw repositioning. The Orthodontist is truly “the custodian” of this important incisor relationship. This paper presents orthognathic surgical cases in which this prediction analysis has been applied. The records confirm the accuracy of treatment planning and demonstrate the achievement of favourable aesthetic and functional outcomes. The Orthodontist utilising the prediction process will have at hand a treatment plan which will form the basis of relevant discussions with the Maxillo-Facial surgeon partner, and together the team can plan the treatment in detail.