CHAPTER 19

Principal Standard Operation Techniques and Instruments

The treatment of facial skeletal deformities due to man­dibular growth anomalies cannot be limited to mandib­ular procedures only. The treatment plan and its execu­tion must include all additional parts of the facial skele­ton which are either directly malformed by the mandib­ular anomaly or which may exist independently of it but will have to be corrected simultaneously. Naturally, the mandibular sagittal splitting procedure, the Le Fort I­type mobilization, the chin and masseter hypertrophy corrections and tongue reduction techniques will be dealt with in more detail than the anomalies of the upper half of the facial skeleton. The possibilities for correcting the latter we owe solely to the ingenious in­ventions of P. Tessier (1967, 1968); P. Tessier et al. (1967). I want to include these possibilities using a very few cas­es only.

Frequently I have been asked about the historical background of the procedures which I had developed and which nowadays are used as standard procedures all over the world and how I conceived the ideas to pro­duce them. It gives me much pleasure to recount what I remember about this. It has given me also deep satisfac­tion to research the literature in great detail since I had now, after my retirement, time enough to do so.

Ideas for new procedures do not fall from the clouds like raindrops. They are always the result of intellectual effort to find a solution to an existing problem. "It is not difficult to find a solution to a problem, it is only difficult to identify the problem" (Principle No. 36). New good ideas are the consequence of being repeatedly confront­ed with the same problem. And they are born on the ba­sis of experience and knowledge. Once one has recog­nized a certain problem and believes a solution to that problem has been found, it does not mean at all that that solution is the ultimate answer to that problem. That so­lution may be the basis for further improvement and an even better answer.

In surgical techniques the ultimate best procedure may finally be produced by someone else who has real­ized that an additional improvement is needed and pos­sible. Or it is the originator himself who has improved his own techniques, maybe through new and better in­strumentation, through observed complications with the original procedure or through recognition of addi­tional needs in a variety of cases. Once a procedure has

become a standard operation technique, the possibility of additional variations or alterations is not excluded. But it will still always remain the originator's primary idea and basic procedure.

It is almost unbelievable how often colleagues pub­lish such procedures as if they were themselves the orig­inators. I also do not understand why, so often in publi­cations, the drawings of an original technique of the au­thor are reproduced as if this were his present day meth­od, although he has improved his technique and pub­lished it many times. This indicates reprehensible ineffi­ciency in searching the current literature. A typical sample is the sagittal splitting procedure on the ascend­ing rami. It is often reproduced in publications (the drawings taken mostly from my papers and articles published in 1955 and 1957) as if this was my present­day technique. However, my current methods for the ra­mi sagittal splitting procedure are not one but several variations depending on the requirements of the case. I have published these variations many times, including the reasons for using them.

A second reason besides the historical background, why I want to mention these procedures is that rather often through questions of colleagues, I gather that they are having occasional problems with the standard oper­ation techniques for the correction of maxillo-mandib­ular disharmonies. Frequently, questions arise about the incidence of damage to the mandibular canal contents and other problems with the sagittal splitting proce­dure. There is again and again the question of how to mobilize the maxilla properly and to avoid relapse after advancing it, particularly in cleft cases. Some colleagues seem to have problems with the transoral chin correc­tion and even several very experienced surgeons have asked me, not too long ago, about which techniques I use for the correction of masseter hypertrophy and tongue reduction. For this reason, I will discuss these procedures and how I did these standard operations us­ing my latest methods. I will also discuss the main pos­sible complications during and after surgery, how to deal with them and how to avoid them.

When I developed these procedures, I had to use or­dinary surgical instruments. When certain surgical problems arose repeatedly I had special instruments de­veloped in order to overcome these difficulties, in par-

H. L. Obwegeser, Mandibular Growth Anomalies© Springer-Verlag Berlin Heidelberg 2001

358 CHAPTER 19 Principal Standard Operation Techniques and Instruments

ticular to avoid complications during and after surgery. These instruments have come on the market under my name. It grieves me what poor quality instruments are often sold as "Obwegeser Instruments". Some of them are very poor copies of my"Original Obwegeser" instru­ments. Others are just old patterns of my original in­struments. With instruments it is the same as with sur­gical techniques: through experience, one constantly improves both the operation techniques as well as the instruments.

For that reason I will show how the more important newer ones are applied in each specific operation tech­nique. I will also give information on which companies are producing my instruments and permit me to check them for correct design and quality and therefore have the right to call my instruments "Original Obwegeser" and put my name on them.