What is Orthognathic Surgery?
Orthognathic or corrective jaw surgery is a cosmetic procedure that:
- Straightens and realigns your upper and lower jaws
- Corrects skeletal deformities and orthodontics
- Improves the appearance of your jaw and facial structure
The main purpose is to treat a severe malocclusion (misalignment between the teeth of the two dental arches).
Why consider an Orthognathic Surgery?
Orthognathic surgeries help restore misaligned jaws into place for bite reasons or aesthetic purposes. Following are some of the conditions that may indicate the need for a corrective jaw surgery:
- Birth defects
- Difficulty in chewing, swallowing or biting food
- Chronic jaw or jaw joint (Temporomandibular Joint or TMJ) pain and headache
- Involuntary mouth breathing/ Sleep Apnea (breathing problems during sleeping that includes snoring)
- Excessive teeth wear
- Inability to bring the lips together to close the mouth
- Trauma or injury to the jaw or face
- Open bite (space between the upper and lower teeth when mouth is closed)
- Protruding jaw/ Receding lower jaw and chin
- Tumor or pathology affecting the jaw
Orthognathic Surgery Types
Surgeries are performed depending on which part of your jaw requires correcting. It can be performed on your upper jaw, lower jaw or even on your chin. Listed below are a few types of surgeries that can be used for jaw correction.
Upper jaw (maxillary osteotomy): This method involves correcting a considerably receded upper jaw, a cross bite, an open bite or when you have too many or too little teeth showing. In this process, the bone above the teeth is cut to make the upper jaw and teeth move forward to place them with the lower teeth for realignment. Afterward, tiny screws and plates are inserted to retain the new position of the bone.
Lower Jaw (mandibular osteotomy): If you have a receded lower jaw, this method can be used to correct it. During this procedure, splits are created behind the molars and lengthwise down the jaw bone to slide it smoothly to its new position. Screws are later placed to hold the bone in position until healing.
Chin Surgery (genioplasty): This surgery involves correcting a severely receded jaw with a deficient chin by cutting the chin bone and placing it in the new position.
How is Orthognathic Surgery Performed?
Orthognathic procedures are performed jointly by an oral and maxillofacial surgeon (OMS) and orthodontist in an accredited hospital or a surgical center. The treatment usually takes around 18-24 months to complete. The treatment is carried out in 4 stages:
- Treatment Planning
- Pre-surgical Orthodontic Phase
- Surgical Treatment
- Post-surgical Treatment
Preparing for a jaw surgery will depend on the procedure your orthodontist and surgeon will decide upon based on your unique anatomy and needs. The initial phase of treatment will include consultation, records-taking and discussion about the treatment plan with you.
Pre-surgical Orthodontic Phase
In this phase, your orthodontist will perform a thorough check-up of your dental condition to ensure your teeth are in alignment for surgery. This phase may last anywhere between 12 and 16 months.
Here are a few things your orthodontist will do to ideally prepare you for the procedure:
- Adjust your braces and take records through photographs, X-rays and dental casts. You may be required to wear your braces for 8 to 16 months during this period.
- Check the position of your teeth and jaws.
- Inform the surgeon about the progress of your teeth.
- Give updates on when your teeth are likely to be in the right position for a surgery.
- May revise the dates of surgery, if needed.
At the end of this phase, the surgeon will modify your braces and check if the teeth are aligned so that you are ready for a surgical intervention.
Surgical Treatment: Preparations before the Surgery
- This stage involves reviewing your overall progress prior to the procedure. You will have a consultation with your oral and maxillofacial surgeon, who will finalize on the surgical plan. As with any other surgeries, your surgeon will provide specific pre-operative instructions, explain the process in detail and answer any questions that you may have. Blood tests will be conducted along with a thorough run through of your medical history to confirm you are fit for the surgery. Inform the surgeon about any past and present medical problems, allergies, operations, or medications. Also, inform about any adverse reactions to any medications you might have in the past.
Listed below are a few steps you may be asked to do before the procedure:
- Quit smoking as it slows down the post-surgery healing process.
- Avoid taking aspirin, certain anti-inflammatory drugs, and any herbal medications that can cause increased bleeding 2 weeks before the surgery.
- Allow yourself to rest and sleep well. Our bodies heal faster while we sleep and rest.
- Maintain oral hygiene as long as you can before the procedure to avoid infection.
- Wait six to twelve months after dental extractions to have surgery.
- Maintain a healthy diet as good health is critical for quick recovery
Surgical Treatment: On the day of Surgery
Orthognathic surgeries are performed in operating rooms and require you to stay in hospital for a day or two in most cases. While, some cases such as lower jaw osteotomies may be done as an outpatient procedure, surgeries like this may take anywhere from 2 to 6 hours to complete. Below are a few things you may experience during the procedure.
- General anesthesia is commonly used during the procedure, although local anesthesia or intravenous sedation may be desirable in some instances.
- The anesthesiologist will pass a breathing tube (endotracheal tube) from the nose into the trachea (wind pipe), while you are sedated.
- Your surgeon will follow the surgical plan discussed with you before surgery.
Afterward, you will be transferred to a recovery room for close monitoring. You may also be transferred to the I.C.U depending on the type of surgery. A bulky pressure dressing to reduce post-surgery swelling will be provided that will be secured around your head and the sides of your face. These will be gradually removed as your recovery progresses.
After surgery, post-surgical orthodontics will continue to achieve further alignment of your upper and lower jaws and to maintain your new jaw position. At times, extra bone can be added to your jaw if there is insufficient bone. This can be grafted from your hip, leg, or rib.
Usually, the post-surgery Orthodontic treatment is carried out for 6 to 12 months. During this phase, you may wear elastics on the braces for 3 months. Once the braces are taken off, you will wear a retainer for at least 12 months. In this time, your surgeon will ask you for a weekly visit to the clinic for a regular checkup. Radiographic assessment will also be performed in the first week and then, in the 6th week. Afterward, you will be assessed clinically and radiographically at a period of 3 months, 6 months and thereafter, yearly to ensure proper healing and stability of the surgery.
All patients experience some sort of discomfort or pain after the surgery. Usually, the recovery time and process depends on the individual as well as the procedure. Some patients may undergo a lower jaw surgery, some may have upper jaw only, while others may experience both.
While these surgeries may require a one to two day stay in the hospital, the recovery process will need you to restrict your normal activities for a short time after surgery. Here are a few instructions you may be asked to follow post your surgery.
- Avoid strenuous activities for the first couple of days, as suggested by your surgeon.
- Take your pain and antibiotic medications as instructed.
- To help minimize swelling, keep your head elevated above your heart level. Ice packs can also be applied to your face for at least 30 minutes.
- Keep your dressings around your face intact until your surgeon removes it.
- Make sure to increase fluid intake and avoid sugary liquids to prevent dehydration.
- Maintain oral hygiene by rinsing with Chlorhexidine Gluconate solution and warm salt water.
- Brush your teeth and tongue to keep the mouth clean and avoid any infection. Be careful around the incision sites to avoid bleeding.
- If you have a plastic splint wired to the upper teeth, make sure to keep that area clean as well.
- For upper jaw surgery, avoid blowing or sneezing for the first 2-3 weeks. Avoid exercising, heavy lifting or any activity that can increase your blood pressure or pulse for at least one month after the surgery. Walking and doing simple chores is highly recommended to reduce swelling and blot clots
- Avoid taking hot, prolonged showers to prevent excessive bleeding .
These are general recommendations and should be followed in consultation with your doctor, as they know your individual case best.
Side Effects and Risks
While post-surgery complications are not very frequent, such type of procedures have their share of side effects that may occur.
Normally, these effects are temporary. Following is the list of possible complications that can arise after the surgery.
- Adverse reactions to anesthesia
- Swelling and bruising
- Bleeding and infection
- Nasal congestion and throat soreness from nasal tubes used for your anesthesia.
- Nausea and vomiting
- Pain and numbness
- Difficulty in communication during the first few weeks
- Incorrect positioning of the jaw segments
- Unfavorable bone cuts/splits
- Poor blood supply to the osteotomized jaw segments
- Permanent tingling in the lips or cheek
- Jaw joint problems and damage to your teeth
- Difficulty in opening your jaw for the first 2 weeks
- Post-surgical relapse of the jaw
Are You the Right Candidate for an Orthognathic Surgery?
Before even considering a corrective jaw surgery, you need to ask yourself a few personal questions, and take into serious account if this is the right procedure for you.
- Why do you want to do it?
- Do you have a good understanding of what the surgery will accomplish?
- Are you aware of the consequences that can happen after the surgery?
- Are you ready to take the required measures before and after the surgery?
- Do you have the mental state to accept, if anything goes wrong or does not turn out as per your expectations?
- Will you be ready to have an additional procedure if the first one turns out unsatisfactory or not what you expected?
- Are you physically healthy and maintain a proper routine and diet?
The answers to these questions will help you decide whether or not, you want to undergo this procedure. You have to remember that such surgeries involve some level of risk, and you should be prepared to face them. In case, you are unsure about any of the above questions; it's best to consult your surgeon to help guide you in choosing what is best for you and your lifestyle.