One-stage correction of complex facial disproportion

Patients with facial disharmony frequently have abnormal nasal form and disordered jaw relationships. Both orthognathic surgery and rhinoplasty are required to correct such facial disproportions. During a 10-year period 100 patients with a spectrum of indications have had concomitant orthognathic and rhinoplasty surgery by a team consisting of the same plastic surgeon, oral and maxillofacial surgeon, and orthodontist. Of this group 51 patients were operated on solely for aesthetic reasons, the majority being long face syndrome. All had a rhinoplasty usually with septal surgery. Depending on the deformity, the jaw surgery varied: 5 patients had mandibular surgery only, 12 had maxillary surgery alone, and the remaining 34 patients had both mandibular and maxillary procedures. Patients were followed for between 1 and 62 months by the plastic surgeon and for at least 2 years by the orthodontist. There was no orthognathic relapse or other major complications, but 4 patients required secondary minor nasal tip surgery under local anesthesia and 2 patients had persisting unilateral inferior alveolar nerve damage. Orthognathic surgery and rhinoplasty are not routinely performed concomitantly due to the difficulty in predicting the outcome of the soft-tissue relationships and increased morbidity. In this series, a one-stage approach was used to provide facial harmony. This reduces the overall surgical and anesthetic morbidity, inconvenience, and expense, and has resulted in good cosmetic and functional results. Therefore, it is suggested that with a competent team, orthognathic surgery and rhinoplasty can be performed concomitantly with dependable results and without significant complications.