Orthognathic surgery

The face is probably one of the most important parts of the body. Not only is it the prime focus of the appearance but it is also responsible for several daily functions important for good health. Eating, breathing, smell, taste and speech are some of these functions.

Among the bones of the face are the upper (maxilla) and lower (mandible) jaws. They contain the teeth and enable proper chewing, swallowing and speech. Along with other facial bones, they give the bony support to the soft tissues of the face that allow for individual contours. Function and appearance are so closely related in this area that it is often difficult to separate the two. If a person has a deficiency or excess in the jaws, it may cause chewing, breathing or esthetic problems. These problems can be corrected by repositioning the misaligned structures. This type of surgery is called orthognathic surgery (orthos = straight; gnathos = jaw).

Orthognathic (jaw) surgery is needed when the jaws and teeth don’t meet or align correctly. Teeth are straightened with braces (orthodontics) and corrective jaw surgery repositions the misaligned jaws. This is done primarily to ensure that the teeth meet correctly and function properly, but it may also enhance facial appearance.

Who needs orthognathic surgery?

People who can benefit from orthognathic surgery include those with an improper bite or people whose jaws are positioned incorrectly. In most cases, the upper and lower jaws have grown at different rates, and are not properly aligned. Sometimes jaw fractures or birth defects can affect jaw alignment.

People needing orthognathic surgery often have one or more of the following problems:

  • difficulty in chewing, biting or swallowing;
  • speech problems;
  • chronic jaw or temporomandibular joint (TMJ) pain;
  • open bite (front incisors don’t overlap);
  • protruding or receding jaw;
  • breathing problems such as sleep apnea.

PRIOR TO SURGERY

Most patients are referred to our practice by their orthodontist when they believe the results of treatment will be superior if braces are offered in conjunction with orthognathic surgery to correct occlusion or jaw alignment problems. However, we often see patients who present without having consulted with an orthodontist. If orthognathic surgery is considered, then these patients are referred to an orthodontist in their area. Orthognathic surgery is now rarely done without braces.

At your initial consultation, we will summarize the goals of surgery, the recommended procedure(s), the potential risks, benefits and alternatives to orthognathic surgery. Your surgeon will send a summary of his evaluation and treatment recommendations to your referring orthodontist.

During this process, feel free to ask any questions that you have regarding the treatment. It is with a thorough understanding of this process that you will maximize its benefits.

SEQUENCE OF TREATMENT

Although every patient’s situation is different, the typical treatment sequence will involve three stages:

  1. Pre-surgical orthodontics: the orthodontist will straighten the teeth, often without regard to how the upper and lower teeth fit together. Wisdom teeth often need to be removed at that time. Braces are usually worn for 12 to 24 months. The orthodontist will then inform you and the surgeon that you are ready to proceed with surgery. You will meet with your surgeon again to review the procedure. The surgical planning is usually done one to two weeks prior to surgery. X-rays, pictures, impressions and measurements are obtained which will help the surgeon plan your surgery in detail.
  2. Orthognathic surgery: the maxilla and/or mandible will be surgically re-aligned. This is done in a hospital setting and may require a hospital stay of one or two nights followed by a recovery period at home of two to four weeks.
  3. Post-surgical orthodontics: this will usually start four to six weeks after surgery. The orthodontist will adjust your teeth for six to twelve months to optimize the occlusion (bite).

As you can see, the time commitment for the treatment is significant, and can range between one to three years or even more, depending upon the complexity of the problem. Braces are kept on the teeth throughout the entire treatment and it is important to keep up on good oral hygiene both at home and through frequent professional cleanings.

SURGERY

Your orthognathic surgery will be performed in a hospital. An anesthesiologist will put you to sleep and the surgeon will perform the surgery. He will be assisted by another oral and maxillofacial surgeon or an assistant.

When you awake, you will have elastics (rubber bands) between your upper and lower braces, assisting with keeping your jaws together in their new position. You won’t be able to open your mouth much for the first few days, so a liquid diet is recommended during this initial period. You will be able to speak and breathe fine, but it will feel awkward at first. Post-operative pain is typically well controlled with either liquid pain medication taken orally or intravenous medications.

You will go home with liquid pain medication, liquid antibiotics, and sometimes a decongestant. Your elastics will hold your jaws together for two weeks, and then your surgeon will remove them. At this point, you will be able to start chewing soft foods which can be easily squished between the prongs of a fork. It takes six to eight weeks for the jaw bones to heal enough to withstand normal chewing, so it is important to refrain from eating normal foods for at least six weeks.