# Current Trends in Orthognathic Surgery in Poland--A Retrospective Analysis of 124 Cases
## 1 Introduction
### Historical Development of Orthognathic Surgery  
There are not too many reports on the treatment of skeletal deformities in the 19 th century. The first operation on a deformed mandible is attributed to [PERSON], who, in 1848, moved back a segment of the alveolar part of the mandible.  
The first correction of the ramus of the mandible was reported by [PERSON] of Lyon in 1897. The author reported on the treatment of mandibular prognathism through osteotomies of the condyle [5].  
The first half of the twentieth century marked the development and work on horizontal osteotomies of the ramus of the mandible in two major centres in the world--Europe and the USA. Complications of the method, such as recurrence of the deformity, pseudointhrombs, irreversible damage to a branch of the fifth cranial nerve and the seventh cranial nerve, as well as salivary fistulae and unsightly skin scars, among other things, prompted a search for new solutions [5; 7; 10].  
Bearing in mind the difficulties and complications, it was necessary to find a method that would ensure that bone fragments contacted over a larger region compared to horizontal ramus mandibular osteotomy.  
In 1955, [PERSON] [5; 7] proposed the method of intraoral sagittal split ramus mandibular osteotomy (Figure 1), which opened a new chapter in corrective surgery of the mandible--mainly as a result of a significantly smaller number of complications.  
An important modification of [PERSON]'s osteotomy was made in 1958 by [PERSON]--a surgeon from Italy--by extending the sagittal cleft towards the body of the mandible, which significantly increased the adhesion surface for osteotomy fragments (Figure 2). An interesting fact is that [PERSON] never used his method in clinical work after  
Figure 1: Schematic view of sagittal mandibular osteotomy modo [PERSON].  
he had returned from his internship in Zurich [10]. To date the [PERSON] modification has been used successfully by numerous surgical centres in the world.  
The scope of mandibular osteotomy with regard to the lingual side was also subject to modification. [PERSON] and [PERSON] saw no need to extend it towards the posterior edge of the mandibular ramus (Figure 3), but to end osteotomy internally, right behind the mandibular foramen, and their concept also finds its supporters today [11; 12].  
At the same time, observations and modifications regarding the possibility of maxillary osteotomy were carried out [5; 7]. The first maxillary osteotomy--a means to access the nasopharyngeal tumour--was performed by [PERSON] in 1859. In the 1920s, [PERSON] practised osteotomies on the anterior segment of the maxilla and made attempts to perform osteotomy with regard to the entire maxilla along the Le Fort I fracture line.  
Figure 3: Schematic view of oblique mandibular osteotomy modo Obwegeser–[PERSON] (Hunsuck).  
Figure 2: Schematic view of sagittal mandibular osteotomy modo Obwegeser–Dal-Pont.  
[PERSON], on the other hand, preferred segmental osteectomies within the maxilla, which, however, failed to become established in orthognathic surgery (5,7).  
However, it was only in the 1950s when significant progress in this regard was made, and thanks to [PERSON], [PERSON] and [PERSON], Le Fort I maxillary osteotomies became permanently established in clinical practice (Figure 4).  
Almost 15 years after starting the treatment of mandibular deformities, [PERSON] (9) presented the use of Le Fort I maxillary corrective osteectomies, as well as the combination of maxillary and mandibular osteotomies during one surgery, which marks the beginning of the bimaxillary era (10).  
However, [PERSON]--who, in 1936, proposed the correction of the mandibular body accessed extraorally--is considered to be the originator of genioplasty (7). Today, after modifications, this surgery has become a permanent part of the canon of orthognathic surgery (Figure 5).  
Figure 4: Schematic view of Le Fort I osteotomy.  
Figure 5: Schematic view of genioplasty.