Cooperation between Maxillofacial Plastic Surgeon and Orthodontist

The importance of cooperation between surgeon and orthodontist can be literally revealed. Orthognathic surgery only represents half the work as the complete phrase should be surgical-orthodontic treatment. Therefore, the communication and common consensus between maxillofacial plastic surgeon and orthodontist are extremely important!

Without a good orthodontist, your dental occlusion will not be perfect no matter how pretty your surgeon assisted you in creating your new facial appearance. Similarly, without a maxillofacial plastic surgeon with aesthetic sense, your appearance will not be enhanced even if your orthodontist and surgeon help to perfect your dental occlusion. Due to the inseparable relationship, an issue has always existed for surgical-orthodontist treatment. Who should be leader? Who is the captain of the ship?

Dr. Hsieh and his team have believed in a philosophy. Issues related to the beauty of facial contour is the full responsibility of maxillofacial plastic surgeon but the responsibility of issues with dental occlusion is equally divided between surgeon and orthodontist. Good orthognathic surgeons should have high sensitivity to “beauty” and “personality”. Besides knowing the influence to facial changes by movement of facial bone, the orthognathic surgeons should also clearly understand if the changes will fit in with the patients’ natural facial features and personality. In addition, the moved jawbone should help to optimize the dental occlusion and minimize the orthodontic treatment duration after the surgery. Good orthodontists should not waste time on adjusting issues which can be easily adjusted by the surgeon in the surgery (for instance, dental midline deviation and inclination of occlusal plane). There is a half-jokingly statement – “Ten-minute work for the surgeon in the OR means ten-month work for the orthodontist”. The dental distance which can be pulled by the orthognathic surgeon in 10 minutes is equal to 10 months (or longer) orthodontist’s work. Furthermore, orthognathic surgeon’s present is required in most cases to correct slanted mouth corner from skeletal and muscular issue because these issues cannot be changed by orthodontists. Therefore, there is no need for the orthodontist to spend time on these fruitless efforts. Sometimes, some orthodontists may “meddlesome-ly” try to adjust the inclination of occlusal plane (to reduce the work burden of orthognathic surgeon). As a result, the orthognathic surgeon may be unable to completely correct the deviation of jawbone, nose and muscle attached to mouth corner and zygoma because of the occlusal limitation.

In a good surgical-orthodontic team, it would be best for the surgeon and orthodontist to meet patient at the same time and communicate face-to-face. With good consideration and communication on every details (including pre-surgery orthodontics (if necessary) before surgical-orthodontic treatment), the most complete and comprehensive treatment plan can be established.

Most of the details with treatment plan are established by orthodontists. In most cases, even the surgical plan is completely drafted by the orthodontists. However, the pre-assumption is that, the orthodontist has the ability to bear the full responsibility of appearance and function. Occasionally, Dr. Hsieh will encounter some patients who have undergone surgery from other clinics. As the surgical results are not satisfying, they returned to the surgeons but the surgeons would claim that the orthodontists are the ones who drafted the treatment plan, hence, the patients should return to the orthodontists. However, the patients would be confused, as if they should seek repeat surgery from their orthodontists?

Consequently, an orthognathic surgeon should has a double background in dentistry and maxillofacial plastic surgery because surgeon like Dr. Hsieh has to bear the dual responsibility of patients’ aesthetics and normal occlusion. Moreover, Dr. Hsieh prefers to be the one who establishes the overall surgical treatment plan, but not the “consignment medical approach” which the surgeon has to follow the instruction of orthodontist in performing the surgery. (Dr. Hsieh is not interested in who is the captain of the ship because the primary governing principles are the attractive appearance and occlusal function of patients.)

Without entrusting another person, Dr. Hsieh does every procedures by himself including visual treatment objective (VTO), surgery design and model surgery. Therefore, the meticulous treatment plan established by Dr. Hsieh can be completely followed on the day of surgery, in order to successfully achieve both the goals in attractive appearance and occlusal function!