Home | Procedures | Orthognathic Surgery
By Dr C. Sharath Babu
Prosthodontist and Implantologist
By Medicover Hospitals / 13 July 2022

Article Context

  1. Overview
  2. Procedure
  3. Recovery after surgery
  4. Care at Medicover
  5. Frequently Asked Questions

Overview

Orthognathic surgery is also called jaw surgery that helps align your upper and lower jaws. If your jaws are not properly aligned, it can affect your bite and make it difficult for you to eat and speak.

Orthognathic surgery is not a single event. It is a process that involves teeth preparation for your surgery, the jaw surgery itself, recovery and remaining orthodontic treatment for upto a year.

It can also make a person's smile and facial profile look better.Orthognathic surgery aims to fix the functional issues caused by jaw problems.

When is orthognathic surgery or jaw surgery recommended?

Orthognathic surgery is recommended for treating the following problems :

  • Facial asymmetry: Corrects facial imbalance such as small chins, underbites, overbites and cross bites
  • Lip incompetency: Improves th eability of the lips to fully close comfortably
  • Facial trauma: Repairs facial injuries caused by accidents such as facial fractures, cysts or tumours
  • Jaw Problems: In patients who have spent years in orthodontic treatment in an attempt to correct a jaw problem
  • Obstructive sleep apnea(OSA): This condition occurs when the airways muscles, tonsils, tongue or excess tissue block the airway causing sleep disturbances and snoring
  • Temporomandibular joint disorders: This may be caused by improper bite, leading to jaw pain
  • Congenital jaw problems
  • To correct problems with swallowing and speech
  • Bruxism: To minimise excessive wear and breakdown of teeth To correct bite fit or jaw closure issues. For instance, when the molars touch but the front teeth don't touch (open bite)
  • Growth disturbances: This refers to changes in your jaw that occur when the body produces excess amounts of growth hormone (more than necessary). This unwanted hormone causes tissues to grow abnormally large, including the upper and lower jaw
  • Procedure

    Before the Procedure

    • Dentists will take a thorough medical history, including your family history, general health status, previous operations, and any medications you may be taking
    • They will examine your facial features, and take photographs for medical record
    • The photographs are needed to be documented to analyse postoperative outcomes
    • Records (or models) of your teeth are taken
    • Radiographs such as x rays, orthopantomogram, lateral cephalogram are taken to analyse your facial skeleton (skeletal analysis)
    • Treatment plan, benefits and potential risks will be discussed with you
    • Prior to surgery, several blood tests may be required to assess your liver and kidney function. This will aid in determining if you have an infection, blood disorder, or anaemia.
    • Virtual surgical planning: It is critical to plan your corrective jaw surgery. A cone beam CT scan (CBCT) is used to plan your surgery virtually. This also allows your surgeon to review the three-dimensional plan and predict outcomes with you in the clinic prior to surgery.
    • Pre-orthodontic treatment: Prior to initiating orthodontic treatment, your teeth may need to be restored and filled. Extractions are also commonly used to address crowding problems and to remove impacted teeth that would interfere with either orthodontics or jaw surgery.
    • Pre-surgical orthodontics: Straightening and aligning your teeth is required so that the jaw can be precisely positioned during surgery. This normally takes 6-18 months. When the orthodontist determines you are ready for surgery, you will be referred back to the surgeon to finalise the surgical plan.

    During the Procedure

    • Your jaw surgery will require hospitalisation for the operation under general anaesthesia.
    • Oral and maxillofacial surgeons make an incision in the soft tissue and cut the bone and move the jaw as required. For instance, a small jaw may be lengthened, or a large jaw may be reduced in size. To avoid scarring on the face, incisions are usually made inside the mouth.
    • If the surgeon needs to make an external incision, care is taken to make it in natural skin creases.
    • Once the jaws are in the desired position, they are permanently fixed in place with small bone plates and screws.
    • Depending upon the complexity of the surgery, this procedure may take from one hour (for a single jaw) to four hours or even more time (in some cases) for combined upper and lower jaw surgery.

    What are the most common orthognathic procedures performed?

    Most common jaw surgeries are:

    Le Fort I

    This is a surgical operation of the upper jaw. In this procedure, the surgeon makes an incision above the teeth in the upper jaw bone. Following which, the upper jaw and teeth will then be moved forward and rotated to align properly with the lower teeth.

    Bilateral Sagittal Split Osteotomy (BSSO)

    This is a surgical operation of the lower jaw. During this process, the surgeon makes incisions behind the lower molars in the lower jaw. The lower jaw can then be advanced and rotated to align with the upper jaw properly.

    Genioplasty

    This is a surgical operation of the chin bone. This is frequently performed in conjunction with one of the preceding procedures to promote midline chin position and improved facial aesthetics.

    Distraction osteogenesis

    • When the upper or lower jaw is underdeveloped, it cannot be safely advanced in a single surgery. A surgical technique known as distraction osteogenesis is used in these cases to gradually lengthen the bone. This is especially helpful in young children whose lower jaw is so small that it interferes with their ability to breathe and eat safely.
    • Distraction osteogenesis involves a cut in the lower jaw bone (mandible) or upper jaw bone (maxilla) and inserting an expansion device known as a distractor.
    • Screws are used to secure the distractor to either side of the bone cut. On the outside of the body, a small portion of the distractor is noticeable.
    • For two to three weeks, the device is turned daily, gradually increasing the gap between the bones to promote new bone growth.
    • Distraction is complete when the appropriate length is reached. After about 12 weeks, the distractor devices are surgically removed to allow the bone to heal.

    After the Procedure

    • Your visit to hospital will usually vary from one to three days depending upon the procedure and your rate of recovery.
    • You will be administered intravenous fluids and medications to prevent dehydration and infection and to minimise pain and swelling. After surgery, the intravenous line and drip will stay attached to your arm until you are able to take adequate fluids and oral medications.
    • The sooner you commence eating, drinking and moving about normally, the quicker you will be discharged from hospital.
    • Immediately after surgery, you will experience mild facial swelling and your jaws will feel stiff. There is usually minimal pain and you may start having a liquid diet.
    • You may have facial numbness which resolves gradually. After the surgery, it is necessary to attend regular appointments with the surgeon to monitor healing and jaw position. At this points, your doctor would begin with your orthodontic treatment.
    • Post surgical orthodontics- Following the surgery, it is typical to continue orthodontic treatment for several months to achieve the final accurate teeth and jaw alignment.

    Recovery after surgery

    • Stitches: In most situations, dissolving stitches are employed. They disintegrate progressively over three to four weeks. As long as there is no continuous bleeding, you should not be concerned if they fall out earlier.
    • Jaw support: In some patients, the jaws may be held together with elastic bands during the healing phase.
    • Oral hygiene and brushing: Oral hygiene is critical for rapid healing and prevention of infection. Brushing can prove difficult during the first week of the surgery. You must try to use a soft brush and stay on teeth and avoid the surrounding gums and incision sites. At least four times daily you will be required to rinse your mouth with warm salt water and chlorhexidine (antiseptic) mouth wash, particularly after meal times.
    • Diet: You should consume a soft diet generally for four to six weeks until swelling and discomfort diminishes. Adequate nutrition is essential for healing. In the early days following surgery, eating small portions, five to six times a day is recommended due to discomfort. Your surgeon will advise dietary requirements. In the latter stages of healing, you may gradually return to your normal eating habits. It is important however, to rinse your mouth immediately following each meal.
    • Work: It is generally advisable to take at least two weeks off work following your surgery. Your surgeon can issue a medical certificate to cover you for this period of absence.
    • Appearance: Your appearance may have changed, so you should be prepared for the possibility of surprise from your family and friends. It will not take long for you or them to adjust.
    • Orthodontist: You surgeon will keep you informed on when it is time to return to your orthodontist for band adjustment. The braces will remain on your teeth for another six to twelve months so that the orthodontist can adjust your bite for the best possible results.
    • Follow up care: Following your orthognathic surgery, you may require another six to twelve months of orthodontic treatment to help finesse the position of your teeth and bite. Your surgeon and orthodontist will want to see you periodically to be certain that your teeth and jaws remain properly aligned.

    Care at Medicover

    Medicover is at the helm of dental care as it offers the best dental treatment in general, cosmetic, implant dentistry, orthodontics and complex jaw surgeries. A comprehensive range of dental treatment is offered by a team of expert dentists. Our committed team of specialists ensure superior results with precision. The dental department is equipped with sophisticated equipment that boasts state of the art technology. Functioning as a collaborative team, our dentists and other departments work together to give you a healthy and happy dental experience.

    Frequently Asked Questions:

    The procedure is considered safe for suitable candidates. But it’s important to keep in mind that it is a serious surgical procedure, which can involve a 3-4 day hospital stay.

    You will be completely pain-free during the procedure because you will be under general anaesthesia. Some patients report mild discomfort following surgery, for which you will be given painkillers in recovery process.

    Initial jaw healing typically takes about six weeks after surgery, but complete healing can take up to 12 weeks. After initial jaw healing at about six weeks, your orthodontist finishes aligning your teeth with braces.

    When carried out by a skilled maxillofacial surgeon, these procedures are generally very safe to carry out. Few risks associated with surgery are blood loss, infection, nerve injury, and relapse of the jaw movement.

    It could take 10-14 days after surgery. Try opening and closing your mouth in front of a mirror. You should be able to fit at least one finger between your teeth after ten days. This should progress to three fingers between your teeth.

    You may begin brushing your teeth the day after your surgery. Initially, simply use a soft toothbrush and warm water. Brush after each meal and stay on the teeth and surrounding gums and avoid the incision sites.

    The mandible is the moving jaw and therefore discomfort is precipitated with increasing movement, such as chewing, yawning, and talking. Reduction of these activities for the first few weeks following surgery alleviates the discomfort.

    Most patients do not need to be wired or rubber banded closed for more than 2-3 weeks, and in many cases, even lesser time is required. It is difficult to eat, speak, or brush your teeth during this time. You must adjust to a liquid or pureed diet. During this period, some weight loss is normal.

    The length of your orthognathic surgery is approximately two to three hours.

    In order to undergo surgery, you must be at such an age that your jaws have stopped growing to achieve results which are not altered by bone growth. For girls, this usually means being 16 or older and for boys aged 18 and above. Orthognathic surgery can be performed on more mature adults as well, provided you are in good health and you are willing to commit to orthodontic treatment prior to surgery.

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