ORTHOGNATHIC (JAW) SURGERY
Orthognathic surgery involves the surgical repositioning of the upper and/or lower jaw. Orthognathic surgery may be necessary if the there is functional problews with the teeth or appearance deformity and when the orthodontic treatment (clip therapy) by itself cannot correct the problem.
Treatment can be one or two-stages, the teeth will be straightened with orthodontics (braces) by your orthodontist before and after surgery in traditional plans, then corrective jaw surgery will be performed to reposition the misaligned jaws. In few cases, orthodontic treatment is done after the surgery. Not only will this ensure that the teeth meet correctly and function properly, it also may lead to dramatic cosmetic results.
Who Needs Orthognathic Surgery?
In most cases, the orthodontist will be the first point of contact to suggest that surgery may be beneficial. They may recommend a consultation with oral & maxillofacial surgeons.
Any of the following problems can exist at birth or can be acquired after birth, whether from facial trauma or hereditary or environmental influences.
- Incorrectly positioned Jaws
- Difficulty in chewing, biting, or swallowing
- Speech problems
- Breathing problems
- Chronic jaw or TMJ (Joint) pain
- Open bite, underbite, overbite or crossbite(Misaligned teeth)
- Sleep apnea(Arrest of breath while sleeping)
- Facial asymmetry
Benefits of jaw surgery may include:
- Improved bite alignment
- More efficient, safer and more comfortable chewing function
- Improved speech and swallow
- Improved breathing and sleep
- Improved smile
- Improved facial appearance
- Improved self-esteem
Why do we have misaligned jaws?
The upper and lower jaws develop at different rates as the growth of the jaw is a gradual process. This can result in a complexity of problems that affect speech, chewing function, oral health, and facial appearance.
Jaw alignment are also affected due to Birth defects and injury. Orthodontic treatment alone may correct bite problems but orthognathic surgery may be necessary if the jaws also need to be repositioned.
Pre-requisites for Surgery ?
A complete treatment plan with its expected outcome and results will be explained to the patient. A complete clinical and radiological examination is done. A specialised x-ray that includes OPG and 3D CT is advised. Feel free to ask our doctors or surgeons any questions that you may have regarding your specific treatment
Technology we implement for Orthognathic Surgery
We use 2-dimensional and 3-dimensional facial photographs, digital impressions of the teeth and a 3- dimensional facial x-ray (CBCT) to show you exactly how your jaw surgery will be approached and completed.
This technology can help both the surgeon and patient understand the surgical process and treatment plan. It can also be used to help you comprehend and see the benefits of orthognathic surgery.
With these, we develop Plastic Splints that helps us guide and provide precision during jaw movements and fixation in surgery.
3D Skull imagining
Upper jaw (maxillary) surgery:
The most common operation to correct an upper jaw alignment problem is a Le Fort I osteotomy. This procedure is done entirely from within the mouth. A precise bone saw is used to separate the upper jaw from the surrounding structures. The upper jaw is mobilized, repositioned, and held in the new position with small bone plates and screws. The wounds are then closed with stitches.
In patients with very narrow upper jaws and/or large open bites, the upper jaw may need to be widened or separated into multiple pieces to achieve ideal alignment. This is sometimes done at the time of the Le Fort I osteotomy, but often requires a separate procedure called Surgically Assisted Rapid Palatal Expansion (SARPE) that occurs at the start of orthodontic treatment. When segmentation is done during a Le Fort I osteotomy, a small plastic splint, similar to an orthodontic retainer, is usually applied to the upper teeth with wires during the operation and is left in place for 6 weeks after surgery to improve stability.
Lower jaw (Mandibular) surgery
The most common operation for the lower jaw is called bilateral sagittal split osteotomies (BSSO).This procedure is done almost entirely from inside the mouth. The lower jaw is accessed by incisions behind the molar teeth on each side. A precise bone saw is used to separate the front portion of the jaw from the parts that contain the jaw joints. The lower jaw is then repositioned and held in the improved position with bone plates and/or screws. The wounds are closed with dissolving stitches in the back of the mouth on each side.
Chin surgery (Genioplasty)
A genioplasty is used to improve the position of the chin. This is often done to make a small chin look more prominent or to correct a chin asymmetry.
A genioplasty can be done without another operation but is most commonly combined with upper and/or lower jaw surgery. This procedure is done entirely from inside the mouth. The chin is accessed through an incision behind the lower lip and a precise cutting bone saw is used to separate the bottom portion of the chin from the rest of the lower jaw. The chin is moved to an improved position and held in place with small bone plates and screws.
Depending on the desired correction, the chin can be brought forward, backward, rotated, shortened, lengthened or contoured during this procedure.
What to expect after surgery
- Jaw surgery is performed in an operating room under general anesthesia. Most patients stay in the hospital for 1-2 nights after surgery though same day surgery may be an option. During the hospitalization our team of specialized nurses and physician assistants will teach you how care for yourself at home.
- After jaw surgery, the face is typically swollen for several weeks. The swelling peaks at 72 hours and then slowly improves. The worst swelling is seen in the first 2 weeks after the operation, but some swelling can remain for up to 6 months or more. There may be some bruising of the skin of the cheeks, neck or around the eyes.
- Most patients will experience numbness of the lips, cheeks, chin and/or teeth after jaw surgery. This improves over the first few months, though can be prolonged or even permanent in rare cases.
- Sinus congestion is common after upper jaw surgery. This typically lasts for 7-14 days. You may be prescribed nasal sprays and decongestants to improve this congestion shortly after the operation.
- Ear congestion/popping may also occur for the first few weeks after upper jaw surgery, and typically resolves over the first 7-14 days.
- Bleeding may occur in the areas of the incisions for the first several days after surgery. This will arrest on its own. After upper jaw surgery, it is common for some dried scab-like blood to come out of the nose 1-2 weeks after the procedure as the blood that collects in the sinus cavities from the operation is naturally removed by the body.
- There is typically some pain after surgery. Most patients do not find jaw surgery to be a particularly painful procedure but need for some pain medication for the first week is common. Your surgeon and specialized nurses will help determine the best pain medication for you to go home with during your time in the hospital.
- You may have elastic bands on your braces after surgery that limits mouth opening. Because of these bands and normal postoperative pain and swelling, it may be uncomfortable to open your mouth widely in the first week. Our team will help you learn to drink fluids using a syringe and other helpful techniques during this period of limited mouth movement.
Our specialized nurses and physician assistants will help explain the postoperative care you will need at home during your hospitalization. Some highlights include:
- Hygiene: It will be very important to keep your mouth clean before and after your operation to reduce the risk for infection. This will include tooth brushing and mouth rinsing, which will begin on the first day after the operation.
- Diet: Although the hardware holding your jaws in place can withstand normal mouth opening and speaking, they are not strong enough to sustain forces of chewing before some bone healing has occurred. Therefore, you will be on a non-chewing diet for 6 weeks. For the first 2 weeks, you will mostly have liquids only. You can then move up to milk shake-consistency foods and anything that can be blenderized. After 6 weeks, your surgeon will tell you when it is safe to return to a normal diet
- Physical activity: Sports and heavy physical activity after surgery may increase your swelling and pain and my risk causing breakage of the hardware. We will ask you to avoid the kind of physical activities that jars the face (i.e. running), those that have a risk for falls and facial trauma (i.e. biking, basketball), and those that raise the blood pressure significantly (i.e. weight lifting) for 8 weeks after surgery.
- Time out of school/work/activities: Most patients will need 2-3 weeks to rest and recover at home before they are ready to return to school, work and other activities. Some patients, especially if concerned about being seen by friends and colleagues while swollen, will need longer.
- Postoperative braces: There will be a period of continued orthodontic treatment after jaw surgery. The amount of time in braces is different for every patient and should be discussed with your orthodontist. You will typically return to your orthodontist to restart braces adjustments 4-6 weeks after jaw surgery.
Frequently asked questions
Yes, you will be able to speak immediately after the operation. Your speech may be less clear in the first week after surgery due to lip swelling and soreness associated with mouth movement, but this will resolve quickly, and speech will ultimately be normal.
No. The hardware used for jaw surgery is made from titanium, a non-ferrous metal, which has a long track record of successful use in many surgical applications. This type of metal will not trigger metal detectors and it will be safe for you to have magnetic resonance images (MRI), if ever necessary, after jaw surgery.
Your jaws are typically NOT wired together at the end of the operation, though this is sometimes necessary in unusually complicated cases. Stretchy elastic bands are usually applied in 2 places on the braces to guide your jaw comfortably in to your new bite. These elastics do not limit mouth opening significantly -you will be able to open your mouth and speak immediately after the operation.
The conditions treated by jaw surgery are typically not life threatening, so you can decide if jaw surgery is right for you. Your surgeon, orthodontist and dentist will help you understand the benefits of surgery and the long-term risks of avoiding surgery
Your diet will be limited to foods that can be safely swallowed without chewing for 6 weeks after jaw surgery. You will receive additional instruction about this diet during your time in the hospital.
The bone plates and screws used during jaw surgery are extremely small and are designed to become integrated in the bone over time. You will not be able to see or feel them, and they are typically not removed.
Initially after the operation, the jaws are weakened and cannot safely withstand the forces of chewing. Strength is regained quickly, however, and you will have no restrictions in chewing or activity after the first few months. Jaw strength will be nearly normal by around 1 year after the operation.