Page 5 - Surgery-First Approach in Orthognathic Surgery
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Chapter 1 The Development of
Surgery-First Approach for

Orthognathic Surgery

History of the development of orthognathic surgery

In 1849, Hullihen first reported the orthognathic correction of mandibular elongation. (Poulton &
Ware, 1959)
Since then, numerous surgical techniques have been used for the dissection of the
mandibular body or ascending ramus to correct mandibular prognathism. During the World War II,
surgeons in Europe gained more experience in treating facial trauma and learned how to put the
jaw and dental occlusion back to the original position. During the postwar period, surgical
techniques and concepts were refined by many European surgeons (e.g., Heinrich Kole, M.
Wassmund, Richard Trauner, Hugo Obwegeser) In 1957, Trauner and Obwegeser (Trauner & Obwegeser,
introduced sagittal splitting ramus osteotomy, which marked the beginning of the modern era
of orthognathic surgery. This intraoral approach could move the mandible in three dimensions
according to a designated surgical plan, keeping the condyle in the glenoid fossa, and, most
importantly, maintaining sufficient bone contact area to allow primary bone healing after
orthognathic surgery. After introducing osteotomy in the mandible, Obwegeser was also the first
to develop LeFort I osteotomy to move the maxilla in all three dimensions, reporting a large series
of maxillary osteotomy cases in 1969 (Obwegeser, 1969) . Since then, numerous surgical techniques have
been developed for the dissection of the maxillomandibular region to correct oral-facial

Figure 1-1 Diagram showing Obwegesser's

original sagittal split ramal osteotomy. (Obwegeser,

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