Simultaneous Orthognathic and Rhinoplasty Surgery

The Problem

How to make simultaneous orthognathic and rhinoplasty surgery predictable.

The Background

Orthognathic surgery and rhinoplasty are both challenging procedures, each requires a lot of experience, skill, and knowledge such as having the clinical judgment to determine when to perform them; understanding the scope and limitations of each intervention; knowing the possible complications and how to deal with them. The two surgeries are not a good combination for the new and inexperienced surgeon, as they are two of the most complex procedures in facial surgery.

While either surgery can be performed by one surgeon (a maxillofacial surgeon trained in rhinoplasty), they can also be conducted by a multidisciplinary team that includes a maxillofacial surgeon and an otolaryngologist. If there is a team of maxillofacial and otolaryngology specialists, there must be perfect communication between the two of them, as they both must understand the range and the limits of each procedure and how one affects the development and final results of the other. For example, the surgeon must avoid cutting an excess of the septum during the orthognathic surgery (as is customary) and wait to conduct the final adjustment of the septum during the rhinoplasty. The advantages and disadvantages are presented in both scenarios.

It is important to emphasize that the success of the surgery depends directly on the skills of the surgeon or team of surgeons, as well as on the communication of the team and proper diagnosis.

The Indications

• Patients with dentofacial deformities with concomitant nasal deformities

• Patients who desire a single-stage procedure

• Patients with a compromised nasal respiratory tract (mouth breathers) who require orthognathic surgery

• Maxillary movements less than 7 mm

• One-piece Lefort surgery

The Contraindications

• Maxillary movements more than 7 mm

• Severe facial asymmetry in the axis plane where neither the nose nor the maxillaries are in the centrofacial plane

• Complex cases of orthognathic surgery

• Nasal reconstructions and/or secondary surgeries

• Insufficient experience of the surgeon, anesthesiologist, and/or team in either procedure

• Multisegmented maxillary surgery