Orthognatic Surgery - Corrective Jaw Surgery
What is orthognathic surgery?
Orthognathic surgery means jaw alignment. Orthognathic surgery, or corrective jaw surgery, improves the appearance and function of a patient's jaw by moving one or both jaws. When the jaws move, the teeth also move. That's why the orthodontist and maxillofacial surgeon work closely together in preparation for orthognathic surgery. The orthodontist prepares the patient before and after the procedure so that the patient's teeth and bite are in the correct relationship after surgery and so that the patient's chewing function is normal. In addition to the appearance and chewing function, orthognathic surgery can also improve the patient's speech and breathing.
What causes a jaw discrepancy?
A discrepancy often develops without a specific cause although there may be a family history. Occasionally jaw discrepancies arise as a result of a growth disturbance, for example: following a jaw fracture in childhood or repair of a cleft lip or palate. It can be associated with a syndrome, such as hemifacial microsomia.
A jaw discrepancy may be detected in early childhood, but usually becomes more marked during puberty. The unusual jaw growth usually ceases in late adolescence and treatment is directed towards correction of the deformity once growth is complete.
Is corrective jaw surgery for you?
Corrective jaw surgery is needed when the upper and lower jaws are not in good relationship or the teeth in the upper and lower jaws do not fit together.
Jaw growth is gradual and in some cases the upper and lower jaws can grow at different rates. The difference in the development of the upper and lower jaws can be present from birth, but it can also develop as a result of heredity or childhood trauma.
If you have any of these symptoms, you may be a candidate for jaw surgery:
- a protruding jaw or a disproportionate facial appearance
- difficulty biting and chewing food
- difficulty swallowing
- persistent pain in the temporomandibular joint
- gum showing when speaking or smiling
- an open bite (there is a space between the upper and lower teeth when the mouth is closed)
- an underbite (the teeth and upper and lower jaws overlap too much)
- congenital or acquired facial asymmetry
- chronic mouth breathing
- severe snoring and sleep apnea
What are the benefits of the treatment of jaw discrepancies and facial deformity?
- Improvement in oral function (ability to bite and chew)
- Improvement in facial and dental appearance
- Long-term improvement in health-related quality of life, oral health-related quality of life and psychological function
How to decide on surgery?
If you think that corrective jaw surgery can help you, look for a maxillofacial surgeon or orthodontist who specializes in preparing and performing these procedures. In a conversation with the doctor, you will find out if you can benefit from this type of surgery. The decision whether you are a candidate for orthodontic or surgical treatment can only be made after the complete examination, which consists of photographs, X-rays and taking plaster models of the upper and lower jaws. Only after analyzing the photographs, cephalometric analysis (measurements of the angles and planes of the face) and analysis of the jaw model can the treatment plan that best suits you be made. In St. Catherine, we use a computer to analyze photographs and X-rays. It is possible to simulate treatment on a computer, but the simulation is never identical to the actual result. If your bite requires only tooth movement, treatment will require only orthodontic surgery. In the event that there is a discrepancy in the growth of the jaw, treatment will require combined orthodontic and surgical treatment.
If you decide to have surgery, your doctor will outline a treatment plan for you. Depending on the deformity, treatment will require orthodontic therapy before surgery, and very often after surgery. Before any treatment, it is necessary to repair all teeth, so the family dentist should also be involved. If tooth extraction is necessary for orthodontic or surgical needs, an oral surgeon is also involved in the treatment. Active treatment is usually not started before the age of sixteen or seventeen.
What else you need to know about surgery?
Orthodontic preparation for surgery can take between 6 months and 3 years. Once the preparation is complete, admission to the hospital is scheduled. Before admission, you need to undergo preoperative preparation for general anesthesia (you will receive the types of tests you need to do from the ward nurse). You will be admitted to the hospital the day before or on the day of surgery.
What types of jaw surgery are possible?
Depending on the deformity, the surgery can be on the lower and/or upper jaw and chin.
Bimaxillary osteotomy or double-jaw surgery
When surgery is performed on both the upper and lower jaws at the same time, it is called bimaxillary osteotomy.
Upper jaw
The most common type is the LeFort osteotomy. The surgical incision is made in the mouth and there are no external scars. The lower segment is separated from the remaining part of the upper jaw by cutting the bone 3-4 mm above the tips of the roots of the upper teeth. The freed upper jaw is pulled (forward, backward, down or up) according to the plan obtained on the models with the help of an intermaxillary guide plate. Fixation of the upper jaw in the new position is achieved with so-called miniplates and screws.
Lower jaw
There are different surgical techniques. The lower jaw is accessed through an incision in the mucosa.
After the jaw is brought into the correct position, the parts are secured with screws. The only external scar from this operation is a puncture wound in the area of the lower edge of the jaw, which is used to insert the screws. This is closed with a single suture that is removed on the fifth postoperative day. At the end of the operation, so-called drainage tubes are usually placed on both sides to drain blood and secretions from the wound. They are removed on the second day after the operation. After the operation, we generally do not connect the upper and lower teeth with rubber bands.
The plates and screws that are placed during the operation are made of titanium and are not rejected by the tissue. They do not need to be removed later. They are only removed if the patient wishes or if they cause difficulties.
Horizontal Chin Osteotomy
Horizontal chin osteotomy is a surgical procedure used to correct the position of the lower jaw. The surgery is usually performed under general anesthesia and involves cutting the lower jaw at two points and moving the front of the jaw forward or backward to achieve the desired position.
Before surgery, the patient will undergo a thorough examination and evaluation to determine if they are a good candidate for the procedure. During the surgery, the surgeon will make an incision in the mouth to allow access to the lower jaw. He will then make two horizontal incisions in the jaw bone and then move the front of the jaw forward or backward to achieve the desired position.
Once the desired position is achieved, the surgeon will fix the bone with special plates and screws to ensure a stable position of the jaw. The patient will wake up with a thick compress in the mouth that is kept in place for several hours to reduce swelling.
After surgery, the patient should expect swelling, bruising, pain, and discomfort. It is important to follow your surgeon's instructions on how to properly care for your mouth during the postoperative period to prevent infection and ensure a speedy recovery.
Mandibular Sagittal Split Osteotomy
Mandibular sagittal split osteotomy is a surgery performed on the lower jaw to correct its position in relation to the upper jaw. This surgery is used to treat conditions such as recession of the lower jaw, overexposure of the upper teeth, malocclusion, and other conditions that affect chewing function and facial aesthetics.
This surgery can be performed under general anesthesia or local anesthesia, depending on the patient's needs and preferences.
In a mandibular sagittal split osteotomy, the surgeon usually accesses the lower jaw through the patient's mouth. He then makes an incision in the lower jaw bone and moves the front of the bone forward or backward, depending on the patient's needs, then repositions the bone and secures it with metal plates and screws.
After surgery, the patient will need to stay in the hospital for several days to ensure proper recovery. During this time, the patient will need to follow a special diet and follow wound care instructions to ensure successful bone healing. Physical activity and a normal diet are gradually reintroduced over a period of several weeks to several months after surgery, depending on the patient's recovery.
Mandibular sagittal split osteotomy is a complex surgical procedure that requires an experienced and trained surgeon. It is important to discuss all the possible risks and benefits of this procedure with your dentist or oral surgeon before deciding to have it.
Recovery after jaw surgery
On the first day after surgery, the patient receives intravenous pain medication, and on the second day, he takes pills. Painkillers are usually not needed when he goes home. Regardless of the type of procedure, the duration of hospital treatment is from 3 to 7 days.
What should you pay special attention to?
In some cases, additional antibiotic protection is required. Swelling of the cheeks and lips is expected after the procedure. The swelling subsides 7 to 14 days after surgery. In the first few days, there may be a trickle of bleeding from the wound area, which partially drains through the nose. When the bleeding stops, the drainage tubes are removed. The wounds are sutured with material that the body breaks down on its own, so the stitches do not need to be removed.
Jaw surgery outcome
The chances of success are very good. Additional jaw and orthodontic treatment is required to precisely adjust the optimal jaw relationship. Moving the upper and lower jaws will change your appearance to a greater or lesser extent. The surgery usually achieves a harmonious relationship between the jaw and the profile. However, regular check-ups are necessary to monitor the effectiveness of the treatment.
