Double Jaw Surgery

Many daily functions, such as breathing, eating, swallowing, and speaking, are influenced by your facial shape and jaw position. Your teeth and chin will be properly aligned, allowing them to work in harmony with your facial muscles and jaw joints. Orthognathic surgery, often known as jaw surgery, can help cure a variety of facial and dental malformations, as well as visually improve the shape and dimensions of your face.

In Asia, where beauty standards favor a soft, delicate facial shape over an angular and pronounced jawline, facial bone contouring procedures are routinely performed. Double jaw surgery, also known as two-jaw surgery or bimaxillary osteotomy, is a successful technique for patients seeking functional and/or aesthetic improvements to both their upper and lower jaws.

What is Double Jaw Surgery?

Double jaw surgery, also known as maxillomandibular surgery, is a type of Orthognathic surgery that corrects both upper and lower jaw skeletal defects. Although orthognathic jaw surgery can adjust all or part of the upper jaw or lower jaw, many patients require double jaw surgery, which involves both the upper and lower jaws as well as the chin.

Double jaw surgery enhances a patient's ability to chew, talk, and breathe as well as their smile and looks. Face pain, headache, snoring, and obstructive sleep problems, such as sleep apnea, may all be treated with double jaw surgery. Although orthognathic surgery can substantially improve a patient's appearance, double jaw surgery is generally used to treat functional issues.

Why is it Called Double Jaw Surgery?

One jaw is usually treated at a time during orthognathic surgery. Maxillary osteotomy is a separate treatment that works on the upper jaw or maxilla. The lower jaw, or mandible, is the subject of the mandibular osteotomy. Bimaxillary osteotomy, often known as double jaw surgery, corrects both jaws at the same time.

When both jaws are operated on at the same time, the surgeon has the greatest flexibility in adjusting the jaw bones and reshaping the face, providing the patient with the best possible chance for a realistic, cosmetically acceptable result. The surgeon uses a holistic approach to solve all functional and aesthetic issues by reshaping, resizing, or repositioning the upper and lower jaws into more ideal positions.

5 Signs That You Need Jaw Surgery

Oral surgeons undertake orthognathic surgery, also referred to as jaw surgery, to repair misaligned jaws. Realigning the jaws has helped to breathe, speak, and chew in many patients. Do you think you could require jaw surgery? Here are five possibilities:

You frequently suffer from jaw discomfort or headache. Temporomandibular Joint Disorder can cause frequent headaches and migraines, as well as jaw pain (TMJ). TMJ causes pain and stiffness in the jaw joint and surrounding muscles, as well as headaches, but TMJ can be treated with corrective jaw surgery.
You find it difficult to bite, chew, or swallow. When the upper and lower jaws grow at different rates, it might result in misaligned jaws that make eating difficult. You may need orthognathic surgery if you have difficulty biting, eating, or swallowing.
You experience snoring, sleeping, or breathing difficulties. Another sign of misaligned jaws is sleep apnea. Sleep apnea can be caused by misaligned jaws obstructing breathing pathways. Through jaw surgery, an oral surgeon can eliminate the effects of sleep apnea.
Your mouth is open. When your mouth is closed, is there a gap between your top and bottom teeth? If this is the case, you have an open bite, which can impact your speech. If your open bite is significant, double jaw surgery may be required to close it.
You've had a facial injury or your jawline appears to be uneven. Jaw fractures and aesthetic abnormalities in the jawline can be treated by orthognathic surgery. If you have significant damage to your face or jaw, surgery may be beneficial.

Double Jaw Surgery Indications

People who benefit from Double Jaw Surgery have mismatched teeth and jaws, resulting in an incorrect bite that cannot be corrected with a single jaw procedure. Jaw growth is a slow process, and the upper and lower jaws may grow at different speeds at times. This can lead to functional issues such as chewing, talking, breathing, sleeping, and general oral health. A significant misalignment can have an impact on a person's look as well as psychological and emotional troubles.

Jaw alignment can also be affected by a jaw or head injury, as well as congenital abnormalities.

Conditions that may need double jaw surgery:

Obstructive sleep apnea
Difficulty chewing or biting food
Difficulty swallowing
Chronic jaw or temporomandibular joint pain and headache
Excessive wear on the teeth
Underbite
Overbite
Open bite (a gap between the upper and lower teeth when the mouth is closed)
Unbalanced facial look from the anterior or side
Facial injury or birth defects
Receding chin
Protruding jaw
Inability to make person’s lips meet without straining
Breathing Problems. Chronic mouth breathing and dry mouth
Snoring
Sleep apnea (respiratory problems with sleeping, including snoring)
Speech Problems

Double Jaw Surgery may Involve:

Upper Jaw (Maxilla)
Lower Jaw (Mandible)
Cheekbones
Nasal Bones
Other Facial Bones

Double Jaw Surgery Evaluation

The doctor consults with your dentist and orthodontist to evaluate whether single or double jaw orthognathic surgery is necessary, as well as which procedures are suitable. Your medical history is checked, and a full examination is performed, which includes facial measurements, pictures, X-rays, bite recordings, and teeth impressions.

Double Jaw Surgery Benefits

Double jaw surgery has similar advantages to single jaw surgery. Orthognathic double jaw surgery realigns your teeth and jaws into more balanced, functional, and healthy postures. Although orthognathic surgery is intended to improve your bite and function, many patients report improvements in their appearance, breathing, and speaking as well. Orthognathic surgery can have a major and positive impact on many parts of your life, including your self-esteem and confidence.

Bite correction and improved chewing. Jaw surgery typically results in a dramatic transformation, allowing many people to chew food more normally and eat foods they previously couldn't.
Reduction in jaw discomfort. While many patients experience lessening jaw pain or jaw muscle pain, there is no guarantee that correcting jaw position will completely eliminate or lessen pain.
Improved facial look. Jaw surgery can improve facial appearance by restoring facial balance and harmony while addressing overbites, underbites, crossbites, and open bites.
Improved breathing. Orthognathic surgery on the jaws is conducted for facial symmetry and commonly improves breathing. Sleep apnea, which can induce or be connected with other major medical conditions, is often improved with corrective jaw surgery.
Improved speech. Correct jaw alignment can help with the development of a proper speaking style. To treat some speech disorders, jaw surgery may be paired with speech therapy.
Reduction in treatment time. Because relocation of the jawbone to a better natural position may reduce the amount of orthodontic treatment required, a coupled orthodontic and surgical approach can be accomplished in less time.

Double Jaw Surgery Preparation

Consultation

The doctor and his colleagues will go over your medical history during your appointment. We'll go over your functional and aesthetic concerns with you. Your head and face will be examined and measurements will be taken. They will go over the surgical possibilities with you and let you know about other treatment options. Before and after images of people with similar diagnoses will be displayed.

Surgical Workup and Treatment Planning

Panorex and cephalometric X-rays, facial and dental pictures, and dental models are all included in your records. The doctor will also undertake a computer-aided cephalometric analysis to create a design for your surgical and orthodontic procedures. In the office, the doctor will also perform a CBCT CAT Scan. This enables him to simulate and plan an orthognathic surgical procedure simulation tailored to each patient using patient-specific information. Before the procedure, you will be able to see a simulation of double jaw surgery.

This information will be taken immediately into the operating room by the doctor and used to improve efficiency and accuracy.

Presurgical Orthodontics

Your orthodontist aligns your teeth with braces before surgery, which normally last 6 to 12 months and require monthly orthodontist visits. Because braces reposition your teeth into a position where they will fit together after surgery, your bite may appear to be worse during this time. Your teeth should align together correctly once your jaws are repositioned after surgery.

Wisdom teeth. During this stage of treatment, one or more teeth, including your third molars (wisdom teeth), may need to be extracted.

Presurgical Records

The doctor makes final surgical preparations after the initial orthodontic alignment. New records, such as X-rays, photographs of your face, and dental models, are updated and used as a guide for your procedure.

Orthognathic Surgery Preparation

Most orthognathic surgeries are done in a hospital or ambulatory surgery center under general anesthesia. A physical exam and a review of your medical history are performed prior to surgery. In addition, special dietary guidelines and prescriptions are given, as well as laboratory tests. An anesthesiologist consultation is sometimes required prior to surgery.

Double Jaw Surgery Procedure

Orthognathic surgery takes a different amount of time depending on the type of surgery and the degree of the defect. Your doctor will provide you with an estimate of how long the procedure will take.

Upper Jaw Surgery

The jaw is split from its base in the upper jaw and then adjusted up, down, forward, or backward. The surgeon will then adjust your facial bones to meet your personal needs. Bone is occasionally added, removed, or altered. To keep your jaws in their new positions, small surgical plates and screws are inserted.

Lower Jaw Surgery

The back (joint part) of the jaw is frequently separated from the front piece that supports your teeth during lower jaw surgery. They can now move your lower jaw forward or backward using this technique. Small surgical plates and screws are used to realign the bony segments. In severe cases, the jaws may need 5-7 weeks of dental wiring.

Distraction Osteogenesis and SARPE

The slow stretching of the bone is known as distraction osteogenesis. Because of the slow displacement or stretching of surgically induced bony fractures, more bone and soft tissue are formed. Soft tissue such as skin, mucosa, muscle, neuron, and blood vessels are also generated using distraction tactics. In these circumstances, bone grafting is not required.

Transverse discrepancy or a narrow upper jaw are treated with surgical assisted rapid palatal (maxillary) expansion (SARPE or SARME). The tooth part of the upper jaw is removed from its root and then widened using an expander appliance inserted by your orthodontist a few days before the surgery. The doctor will advise you on how to use the expander appliance on a daily basis after the procedure. Your upper jaw will be wider within a few days, and the bones will heal in their new expanded position. The anterior teeth will be moved to close the gap, while the back teeth and upper jaw will be left open. This outpatient technique is done prior to orthodontic treatment and several months before double jaw surgery.

Sliding Genioplasty

To complement the appearance, we frequently adjust the chin region of the lower jaw forward, backward, upward, or downward. This may also aid with lip closure and muscular tone. Sliding genioplasty is the name of the procedure. An incision is created below the lower lip inside the mouth. After that, the bony chin part of the jaw is excised and advanced or repositioned. A small bone screw or wire is then used to fix this portion. By repositioning the lower jaw, the Sliding genioplasty pushes the patient's true chin.

Double Jaw Surgery Recovery

Following surgery, patients are usually transported to a recovery area until the anesthetic wears off. (In the recovery area, family members are not admitted.) Patients may go home the same day of surgery or may need to stay in the hospital overnight, depending on their specific needs. In either situation, you must drink enough water to stay hydrated and eat properly before returning home. Patients are given food advice as well as a timeline for progressing to a regular diet. Tobacco, alcohol, and vigorous physical activity should all be avoided. Following all instructions to the fullest is essential for proper healing.

Following orthognathic surgery, discomfort is usually moderate and readily managed with over-the-counter medications. Antibiotics, pain relievers, and ice packs are all provided as part of the healing process.

Swelling is to be expected, peaking between 48 and 72 hours before gradually subsiding. The majority of the swelling goes away in 7 to 10 days, although some swelling can last for months. Bruising, nasal congestion, and a sore throat are all possible side effects of surgery that will gradually fade. The doctor works with your orthodontist to fine-tune your bite after surgery. After your braces are withdrawn, you may need to wear a retainer to keep your bite in line. It may take 1-2 years to complete your care, which includes orthodontics before and after orthognathic surgery.

Follow-up Care

The doctor and your orthodontist will decide when and how often you require bite re-evaluations after your orthognathic surgery and orthodontics are finished. Regular dental examinations with your general dentist are also necessary for optimal dental health.

Double Jaw Surgery Complications

Every procedure, including double jaw surgery, has risks. This comprises:

Double jaw surgery carries the same hazards as single jaw surgery.
During jaw surgery, blood loss is usually minor, and bleeding that necessitates a transfusion is quite rare. Minimal bleeding from the nose may occur shortly after surgery, particularly on the upper jaw. Although significant or protracted bleeding after surgery is rare, if it occurs, your surgeon may need to provide further care.
During orthognathic surgery, the nerves that supply sensation to the jaws are uncovered, and while some temporary tingling sensation is common after surgery, it usually fades as healing progresses. The changed sensation may be lifelong in some cases.
The position of the jaws and bite is established when the patient is lying down during surgery. Under general anesthesia, the jaw muscles are entirely relaxed at this point. When the patient is awake and upright, the patient's jaw muscular tone returns and the bite changes somewhat. Following surgery, the doctor monitors each patient's progress to ensure that the new bite is in line with the original plan. During this stage, orthodontic rubber bands are frequently used to guide the growth of the bite. If the bite is not exactly as expected, subsequent surgery may be required in rare cases.
While infections are a possibility after any surgical treatment, they are extremely infrequent and are routinely treated with medication.
During any surgical treatment in the mouth, inadvertent injury to teeth, roots, fillings, bridgework, or adjacent tissues can occur.

Conclusion

Orthognathic surgery requires close coordination between the surgeon and the orthodontist throughout the treatment process, from preoperative planning through occlusion completion. Virtual computer planning allows for more precise dentofacial deformity evaluations and preoperative planning. It's also a great tool for giving thorough patient education.