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By Dr. Rick Bonomo

Appeared in Good News,
a publication of the Somerset Hospital, in October 1983.

SIGNIFICANT ADVANCES HAVE BEEN MADE during the last decade in the surgical treatment of facial deformities.

Virtually any deformity of the facial bones can now be corrected, according to Dr. Rick Bonomo, DMD, a Somerset Area Oral and Maxillofacial Surgeon. "Operations that were impossible ten years ago, are now being performed routinely by Oral and Maxillofacial Surgeons," he said.
Procedures have been made possible recently by accurate diagnosis of deformities -both clinically and by x-ray; modern general anesthetic techniques, innovative surgical design and the ability to deal effectively with infection. Through close cooperation between the orthodontist and surgeon, nearly ideal results can be achieved by straightening the teeth, thus allowing for accurate, predictable and stable repositioning of the jaws.
In 1954, Dr. Hugo Obwegeser developed an operation that, with modifications, has allowed for the repositioning of the small lower jaw into a more forward position. A field previously limited to surgery of the lower jaw to correct prognathism (protruding jaw), had now been opened up to unlimited possibilities.

Christy Walker, 16, of Somerset had a larger lower jaw. Recently, however, after orthodontic treatment, she was able to undergo surgery to shorten her jaw. Dr. Bonomo performed Christy's surgery at Somerset Community Hospital. Story photos show the significant difference surgery made for Christy.
Recent revolutionary advances have also been made in the surgery of the maxilla (upper jaw) making it now possible to move it in any direction necessary to correct deformities.

Prior to her surgery, Sue Ann Davis, a 13 year old Rockwood resident, attended a surgical-orthodontic treatment planning conference. At the conference, two orthodontists and four oral surgeons studied the x-rays of her facial skeleton and models of her teeth. All doctors had the opportunity to examine her and together, discuss their clinical diagnostic impressions. Sue Ann's exact diagnosis was then made and a plan of treatment developed for her. She was able to benefit from the knowledge and experience of the whole group acting together in treatment planning.
Sue Ann's diagnosis was Vertical Maxillary Excess. The upper jaw "shows" an excess gum tissue above the teeth and is unattractive when she smiles. In addition, Sue Ann was unable to close her lips together without straining while the lower position of the upper teeth pushed the lower jaw down and back to accentuate her deficient lower chin.
The plan developed for Sue Ann was to move her upper jaw up five millimeters and move her chin forward ten millimeters. Although upward movement of the maxilla allows the lower jaw to rotate upward and forward, study of the x-rays showed that to achieve a balanced profile, the additional chin operation was needed.

The surgery described was first performed on plaster models to allow the construction of a plastic splint that would fit between Sue Ann's teeth to stabilize the new position of her jaws during healing. She has continued to do well since her surgery and is considering a modeling career.
"Maxillofacial Surgery has become extremely safe and predictable in most cases," according to Dr. Bonomo.
A patient is admitted the day before surgery and virtually everything that will happen to him around the time of surgery is explained in detail so that he understands exactly what is happening at all times. Shortly after surgery, he is able to speak and ask questions although the teeth are generally wired shut. Three to four days later, he is discharged to resume a normal life style.
"Dramatic changes in appearance are often the result.", he said.

Copyright by Dr. Rick Bonomo

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