Last updated date: 12-May-2023
Originally Written in English
Orthognathic surgery, also known as corrective jaw surgery or simply jaw surgery, is a surgical procedure used to correct conditions of the jaw and lower face related to structure, growth, airway issues such as sleep apnea, TMJ disorders, malocclusion problems primarily caused by skeletal disharmonies, other orthodontic dental bite problems that cannot be easily treated with dental braces, and a wide range of facial imbalances, disharmonies, asymmetries, and malproportions. Where correction can be considered to improve facial aesthetics and self-esteem.
Oral surgery and the fundamental procedures connected to the surgical removal of impacted or misplaced teeth - especially where advised by orthodontics to enhance dental treatments of malocclusion and dental crowding - are the roots of orthognathic surgery.
Correcting jaw and dental alignment with jaw surgery can result in a more balanced appearance of your lower face, enhanced tooth function, health advantages from improved sleep, breathing, eating, and swallowing, and improvement in speech problems.
What is Jaw (Orthognathic) Surgery?
Jaw surgery, also known as orthognathic surgery, is a procedure that helps correct your upper and lower jaws (mandible). If your jaws do not line up properly, it might impact your bite and make it difficult to eat and communicate.
Orthognathic ("ortho nathic") surgery is a series of procedures. It is a procedure that involves orthodontic therapy to prepare your teeth for jaw surgery, surgery, recovery, and further orthodontic treatment for up to a year after surgery. Overall, the jaw surgery procedure might take two to three years.
Benefits of Orthognathic surgery
Jaw surgery may help to:
- Improve chewing by making biting and chewing easier.
- Correct swallowing and speaking issues.
- Reduce excessive tooth wear and breakage.
- Correcting difficulties with bite fit or jaw closure, such as when the molars meet but the front teeth do not touch (open bite).
- Correct facial asymmetry (small chins, underbites, overbites, and crossbites).
- Improve your lips' capacity to fully seal comfortably.
- Relieve discomfort caused by temporomandibular joint dysfunction (TMJ) and other jaw issues.
- Repair facial damage or congenital problems.
When Orthognathic Surgery is Indicated?
Jaw bone abnormalities can be congenital (existing at birth) or developed later in life by traumas or other medical diseases that affect your jaw.
1. Congenital jaw problems:
Congenital jaw difficulties can be individual concerns, such as an overbite, or they can be associated to a larger medical illness, such as Treacher Collins syndrome. Here are a few more examples of congenital jaw issues:
- Cross bite. This occurs when some of your lower teeth protrude in front of your upper teeth.
- Bite open. When you close your mouth, several teeth do not come together, resulting in an open bite.
- Lip and palate deformity. When your face and mouth do not grow normally, you have cleft palate.
- Sequence of Pierre Robin. Children with the Pierre Robin sequence frequently have narrow lower jaws, making it difficult for newborns to chew or breathe.
2. Jaw problems caused by injuries or medical conditions:
Facial fractures The word jaw fracture can relate to either your lower jaw (mandible) or your upper jaw (maxilla). You can shatter your lower jaw if you are struck or punched by an item. You can break your upper jaw by falling, being in a car accident, or being hit:
- Cysts and tumors. To address radiation exposure, doctors may undergo jaw surgery.
- Obstructive sleep apnea (OSA). OSA occurs when your airway muscles, tonsils, tongue, or extra tissue block your airway, causing your breath to stop and start as you sleep. OSA is treated with a jaw surgery known as maxillomandibular advancement (MMA).
- Temporal mandibular joint diseases (TMJ). TMJ can be caused by an incorrect bite, which occurs when your upper and lower teeth do not line properly.
- Growth disturbances. This refers to changes in your jaw that occur when your body produces an excessive amount of growth hormone. Excess hormone causes your tissues, particularly your upper and/or lower jaw, to become abnormally large.
Before Having Orthognathic Surgery
You should understand what jaw surgery may achieve and what is entailed when you get jaw surgery. You could have a mental image of your face before and after. If you do, show it to your healthcare providers. Tell them what you hope to achieve with jaw surgery. However, everyone's jaw problems are unique. Your healthcare specialists will discuss their recommendations for resolving your unique difficulties as well as what you may expect.
One of the considerations that healthcare experts examine when prescribing jaw surgery is your personal objectives. They also assess your general health as well as the specific health risk caused by your jaw condition.
However, jaw surgery is not a one-time event. It's a long procedure that might take years to finish. Ask questions about the procedure, from pre-surgical orthodontia through recuperation to post-surgery orthodontia, as you explore jaw surgery. Understanding what jaw surgery entails can assist you in preparing for what will be a lengthy commitment.
How You Prepare?
Typically, an orthodontist will install braces on your teeth prior to surgery. Braces are normally worn for 12 to 18 months prior to surgery to level and align your teeth.
Your orthodontist and oral and maxillofacial surgeon will collaborate to create a treatment plan for you. X-rays, photographs, and models of your teeth are used to arrange your jaw surgery. To complete repair, a variation in the way teeth fit together may necessitate dental reshaping, crowning, or both.
Three-dimensional CT scanning, computer-guided treatment planning, and temporary orthodontic anchoring devices may be utilized to assist with tooth movement and shorten your time in braces. These efforts can sometimes totally remove the need for jaw surgery.
Virtual surgical planning (VSP) may be utilized to guide your surgeon throughout the process to fit and fix the jaw segment location for the best possible result.
What Happens During the Procedure?
Surgery is frequently conducted within the mouth, so no facial scars appear on the chin, jaw, or around the mouth. However, tiny incisions outside your mouth may be necessary at times.
Your surgeon makes incisions in the jawbones and slides them into place. Once your jaw has been moved, small bone plates, screws, wires, and rubber bands may be utilized to fix the bones in their new place. These screws, which are smaller than brace brackets, gradually integrate into the bone structure.
Extra bone may be added to the jaw in specific circumstances. The bone is transferred from your hip, leg, or rib and secured with plates and screws by your surgeon. In some circumstances, bone may be altered to improve fit.
Jaw surgery can be done on the upper jaw, lower jaw, chin, or any combination of these areas.
1. Upper jaw (maxillary osteotomy):
The surgeon makes incisions in the upper jaw, moves it forward, backward, up, or down as needed, and attaches it with plates and screws during upper jaw surgery.
Upper jaw surgery may be performed to correct:
- Significantly receded or protruding upper jaw.
- Cross bite.
- Too much or too little of the teeth showing.
- Open bite.
- Reduced facial growth of the middle of the face (midfacial hypoplasia).
Your surgeon will cut the bone above your teeth so that the entire top jaw, including the roof of your mouth and upper teeth, may move as a single unit. The jaw and upper teeth are advanced until they are appropriately aligned with the lower teeth. This may be planned on a computer to see whether any extra work, like as orthodontics, is required to assist correct any residual fit disparity.
Excess bone forms above the molars, causing what is typically a level, even surface to become angled. Your surgeon will shave or remove the extra bone to correct this. Plates and screws keep the bone in its new location after the jaw has been straightened.
2. Lower jaw (mandibular osteotomy):
A mandibular osteotomy can correct:
- Receding lower jaw.
- Protruding lower jaw.
When you have a mandibular osteotomy, your surgeon will:
- In either side of your lower jaw, right behind your teeth, create an incision into your gums.
- The lower jaw bone is cut, allowing the surgeon to delicately move it into a new place.
- Change the position of the lower jawbone by moving it forwards or backwards.
- Place plates or screws to secure the repositioned jawbone in place.
- Stitches are used to seal the incisions in your gums.
3. Bi-maxillary osteotomy:
Bimaxillary osteotomy is a procedure that involves both your upper and lower jaws. When a problem affects both jaws, this procedure is used.
The techniques employed for this operation include those outlined before for maxillary and mandibular osteotomies.
Because operating on both the upper and lower jaws can be difficult, your surgeon may employ 3-D modeling software to assist in the planning of the surgery.
Genioplasty is a kind of chin surgery. It can assist in the correction of a receding chin. For a receding lower jaw, it is frequently combined with a mandibular osteotomy.
During a genioplasty, your surgeon will:
- create an incision around your lower lip in your gums.
- remove a section of the chinbone, allowing them to reposition it
- Gently reposition the chinbone.
- Small plates or screws should be used to assist keep the corrected bone in its new position.
- Stitches are used to close the incision.
What Happens After Jaw Surgery?
After your operation, you may need to stay in the hospital for one to four days so that your healthcare specialists may monitor your progress. Here are some of the things you can experience while in the hospital and after your recovery:
- During surgery, your healthcare professional will implant a plastic splint in your mouth. The splint will assist you in conditioning your mouth muscles to operate with your new jaw position. Except while eating or cleaning your teeth, you must wear your splint.
- Your face will most likely be puffy. You'll sleep with your head elevated and take anti-swelling medicine.
- Your doctor will prescribe medicine to relieve pain and protect you from infection.
- Throughout the first 24 hours, you'll need to maintain ice packs on your face, 20 minutes on, 10 minutes off.
- You'll begin the liquid diet that will last many weeks.
- People may have difficulty understanding you because of the swelling and splint in your mouth. That may be aggravating. If you're truly struggling, let your doctor know. They will recommend ways for you to communicate.
- About eight months following surgery, your healthcare professional will remove the plastic splint.
- If you have braces, you will need to wear them for another six to nine months following surgery.
- You'll need to wear removable retainers after your braces are removed to keep your teeth in their new position. Your healthcare practitioner will advise you on how frequently you should wear your retainers, however most people wear them constantly for a year. Following that, you may need to wear your retainers a few nights each week.
Orthognathic Surgery Cost
You must consider the costs charged by the hospital, the doctor, the surgeon, and the anesthesia provider when determining the cost of your operation.
The approximate $20,000-$40,000 cost of corrective jaw surgery includes preliminary consultations, the surgeon's fee, the facility charge, supplies, and follow-up care. However, once again, this is an estimate for persons without health insurance.
You may need orthodontic therapy before the procedure, which will raise the cost of the procedure.
Does Health Insurance Help Cover Costs?
Corrective jaw surgery is classified as a medical procedure rather than a cosmetic one since it prevents future dental or medical issues.
Many health insurance companies fund the procedure in part. It is a good idea to contact your insurance carrier to see what is and is not covered.
Before covering one of these therapies, most insurance companies demand pre-approval.
Risks/Complications of Orthognathic Surgery
Some possible risks and complications of surgery include:
- Bleeding at the surgical site, which may necessitate a blood transfusion or readmission.
- Infection and/or wound breakdown
- Jaw joint discomfort.
- Adjacent tooth injuries might result in the loss of vitality in these teeth. In such circumstances, root canal therapy or even extractions may be necessary.
- Nerve injuries that cause partial or total numbness of the lips, chin, and tongue. Although the majority of individuals recover complete feeling within 6 months, certain instances may take up to a year. In certain circumstances, the numbness is persistent (usually partial).
- Facial nerve injury causes temporary or permanent weakening or paralysis of facial muscles.
- Recurrence (jaw reverts to the original position).
Rare complications include:
- A foreign body was discovered on the surgical site.
- Unexpected bite change following surgery.
- Poor jaw bone recovery.
- Loss of blood flow and bone vitality.
- Changes in the airway that are unexpected and cause changes in voice quality or increased snoring.
- Injuries to the orbits or base of the skull can cause double vision, excessive weeping, dry eyes, or, in extreme circumstances, blindness or stroke.
- During treatment, the components used to guide the bite (splint, wires, etc.) may get dislodged. The loose components may be swallowed or inhaled.
When to Call Healthcare Provider?
You’ll see your healthcare provider about eight weeks after surgery so they can remove your mouth splint and your stitches.
You should go to the emergency room if you:
- Are suddenly out of breath.
- Have a temperature of more than 100 degrees Fahrenheit (38.3 degrees Celsius.)
- Have pain that is worsening rather than improving?
- If your operation site is dark red or feels hot to the touch, it may be spewing a green, stinky discharge.
- Have chronic vomiting or diarrhea.
- The sutures holding your wounds together look to be separating.
- You're bleeding more than you expected.
Orthognathic surgery is jaw surgery that tries to repair upper and/or lower jaw abnormalities. It is typically used in conjunction with orthodontic therapy (braces) to repair dental and jaw irregularities.
Orthognathic surgery necessitates the collaboration of a multidisciplinary team that comprises an Orthodontist, an Oral and Maxillofacial Surgeon, and Allied Health Professionals (e.g. Dieticians, Speech Therapists).
Orthognathic surgery is required to address discrepancies in the upper and/or lower jaws. This is done to improve function (chewing/ speech/ breathing), aesthetics, and stability of your bite/ occlusion.
Common issues that can be treated with orthognathic surgery include: a flat upper jaw, excessive gum show (i.e. a gummy smile), face lengthening in general, asymmetry of the face, short lower jaw, long lower jaw, obstructive sleep apnea & trauma-related jaw malformations.
Orthognathic surgery is a significant procedure that is typically safe and is performed under general anaesthetic. The procedure usually necessitates a few days in the hospital and hospitalization leave for 4 to 6 weeks. A splint may be attached to your upper teeth after surgery to guide your bite.
For a few weeks, your teeth will be linked together to ensure your bite is stable and to rest the jaws, and you will be placed on a liquid diet. Facial swelling and restricted mouth opening are common adverse effects of surgery. These usually go away after a few weeks.