One-stage correction of complex facial disproportion

Patients with facial disharmony frequently have abnormal nasal form and dis ordered jaw relationships. Both orthognathic surgery and rhinoplasty are re quired to correct such facial disproportions. During a 10-year period 100 p atients with a spectrum of indications have had concomitant orthognathic an d rhinoplasty surgery by a team consisting of the same plastic surgeon, ora l and maxillofacial surgeon, and orthodontist. Of this group 51 patients we re operated on solely for aesthetic reasons, the majority being long face s yndrome, All had a rhinoplasty usually with septal surgery. Depending on th e deformity, the jaw surgery varied: 5 patients had mandibular surgery only , 12 had maxillary surgery alone, and the remaining 34 patients had both ma ndibular and maxillary procedures. Patients were followed for between 1 and 62 months by the plastic surgeon and for at least 2 years by the orthodont ist. 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. Or thognathic surgery and rhinoplasty are not routinely performed concomitantl y due to the difficulty in predicting the outcome of the soft-tissue relati onships and increased morbidity. In this series, a one-stage approach was u sed to provide facial harmony, This reduces the overall surgical and anesth etic morbidity, inconvenience, and expense, and has resulted in good cosmet ic 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.