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Projecting the soft-tissue outcome of surgical and orthodontic manipulation of the maxillofacial skeleton

American Journal of Orthodontics
Publication Date
DOI: 10.1016/0002-9416(83)90113-6
  • Surgical Orthodontics
  • Maxillofacial Skeleton
  • Integumentary Changes
  • Projected Outcome
  • Treatment Planning
  • Medicine


Abstract A simple method is presented for developing one-to-one composite soft-tissue and radiographic patient images. Their use in diagnosis, treatment planning, and prediction of the outcome of surgical and orthodontic manipulations of the facial hard tissues to effect soft tissue change is discussed. Complementing cephalometric analysis and model surgery, this technique uses a 35 mm. slide, acetate tracing paper, a pencil, and a series of integumentary changes which follow rearrangements of the underlying skeleton, including the dentition, maxillae, zygomas, and nose. The pretreatment image is traced from a projected 35 mm. slide, which is sized to the cephalometric tracing to obtain a “life-sized” representation of the face. The image is then redrawn, adjusting the dysmorphic parts to the unchanged part of the face to effect balance of the profile and restore normal contours. This recreated image is used then as an objective to which the treatment planning is directed and through which it is commonly seen that the restoration of functional and esthetic balance is a mutually supportive goal. The projected image is of value to the clinician in formulating his treatment goal, but it is more valuable in the visible expression that it gives to his mental image of the ideal outcome. Moreover, it can be readily shared with the patient, who often better appreciates the changes in contours, which he sees daily, than the commonly employed profiles of cephalometric prediction, which are basically foreign to him. The technique is discussed, as are the ratios of hard-to-soft-tissue change, with case reports for demonstration.

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