Jaw Surgery (Orthognathic Surgery)

Orthognathic surgery, commonly known as jaw surgery, is a specialized procedure to correct various jaw and facial structure irregularities. This procedure addresses functional issues such as difficulties with chewing, speaking, and breathing and aesthetic concerns related to facial balance and symmetry. Orthognathic surgery is a collaborative effort between oral and maxillofacial surgeons, orthodontists, and other medical professionals to achieve optimal functional and aesthetic outcomes for individuals with jaw abnormalities.

Understanding Orthognathic Surgery

Orthognathic surgery is performed to correct misalignments of the upper and lower jaws and other facial skeletal discrepancies that impact appearance and function. These irregularities can result from developmental issues, genetics, trauma, or conditions like temporomandibular joint (TMJ) disorders.

Steps involved in Orthognathic Surgery?

Orthognathic Surgery Procedure

Orthognathic surgery, commonly called jaw surgery, is a complex procedure to correct various abnormalities in the jaw and facial structures. The surgical process involves carefully planned upper and lower jaw movements to achieve optimal alignment and balance. Here's an overview of what happens during orthognathic surgery:

  • Comprehensive Evaluation: The process begins with thoroughly assessing the patient's condition. This includes detailed X-rays, scans, photographs, and dental impressions. These images help create a precise three-dimensional model of the patient's facial and jaw structures.
  • Collaborative Treatment Planning: Oral and maxillofacial surgeons collaborate closely with orthodontists to develop a comprehensive treatment plan. The plan outlines the movements and adjustments required for the upper and lower jaws to achieve proper alignment.
  • Orthodontic Preparation: Before the surgical phase, patients often undergo orthodontic treatment to align their teeth properly. Braces are used to position the teeth to complement the anticipated surgical changes.
  • Surgical Procedure: On the day of surgery, the patient is placed under general anaesthesia. The oral and maxillofacial surgeon makes incisions inside the mouth, usually along the gum line, to access the jaw bones. Depending on the patient's specific needs, the surgeon may need to reposition the upper jaw, lower jaw, or both.
  • Upper Jaw Surgery (Maxillary Osteotomy):
    • The upper jaw is carefully separated from the skull, allowing the surgeon to reposition it based on the treatment plan. The jaw is secured in its new position using specialized surgical plates, screws, or wires that promote stability and healing.
    • Lower Jaw Surgery (Mandibular Osteotomy): Like upper jaw surgery, the lower jaw is cut and repositioned as needed. Surgical hardware is used to fix the jaw in its new alignment.
  • Closure and Healing: After the repositioning, the incisions are closed using dissolvable sutures. The surgical wounds are covered with gauze to aid in healing.

Indications of Orthognathic Surgery

Orthognathic surgery, or jaw surgery, is recommended for individuals with significant jaw and facial irregularities that affect both function and aesthetics. These irregularities can result from developmental issues, genetics, trauma, or conditions like temporomandibular joint (TMJ) disorders. Indications for orthognathic surgery include:

  • Malocclusions: Malocclusions are bite problems involving improper upper and lower teeth alignment. These include overbites (overjet), underbites (underjet), crossbites, and open bites.
  • Facial Asymmetry: Individuals with noticeable facial asymmetry due to jaw discrepancies may benefit from orthognathic surgery to improve facial balance and harmony.
  • Difficulty Chewing and Speaking: Jaw misalignments can lead to difficulty chewing, biting, and speaking. Orthognathic surgery can correct these functional issues, improving overall oral function.
  • Breathing Difficulties: Severe jaw misalignments can contribute to obstructive sleep apnea or breathing difficulties. Orthognathic surgery can help open the airway and alleviate breathing problems.
  • TMJ Disorders: Temporomandibular joint disorders, characterized by pain, discomfort, and limited jaw movement, can sometimes be improved through orthognathic surgery.
  • Open Bite or Deep Bite: An open bite occurs when the upper and lower front teeth don't touch, while a deep taste involves excessive overlap of the upper front teeth over the lower ones.
  • Overjet or Underjet: Overjet refers to the upper front teeth protruding excessively, while underjet involves the lower teeth positioned farther forward than the upper teeth.
  • Inability to Fully Close the Lips: Jaw misalignments can result in an inability to fully close the lips without straining.
  • Jaw Pain and Discomfort: Chronic jaw pain, discomfort, or headaches linked to jaw misalignments might indicate orthognathic surgery.
  • Aesthetic Concerns: Individuals with significant aesthetic concerns due to jaw irregularities might choose orthognathic surgery to enhance facial appearance and self-esteem.
  • Impaired Oral Hygiene: Severe malocclusions can make it challenging to maintain proper oral hygiene, increasing the risk of dental problems. Surgery can improve access to effective oral care.
  • Social and Psychological Impact: Jaw irregularities can negatively impact self-confidence and overall quality of life. Orthognathic surgery can help individuals regain self-esteem and social well-being.
  • Recovery and Healing: Following the surgery, patients are monitored as they wake up from anaesthesia. They may experience swelling, discomfort, and minor bruising. Pain management medications are prescribed to alleviate any postoperative pain.
  • Orthodontic Finishing: After the surgical healing, orthodontic treatment continues fine-tuning the bite and ensuring the teeth fit together correctly.
  • Follow-Up Care: Regular follow-up appointments are scheduled to monitor healing, evaluate progress, and make any necessary adjustments to the orthodontic treatment.

Who will treat for Orthognathic Surgery?

Orthognathic surgery, a specialized and comprehensive procedure, involves a multidisciplinary approach that requires the expertise of various healthcare professionals. Here are the critical specialists who are interested in treating orthognathic surgery:

  • Oral and Maxillofacial Surgeon: Oral and maxillofacial surgeons are the primary healthcare professionals who perform orthognathic surgery. They have specialized training in both dentistry and surgery, making them uniquely qualified to address jaw and facial skeletal issues.
  • Orthodontist: Orthodontists play a critical role in the treatment process. They specialize in diagnosing and treating malocclusions and dental alignment issues. Orthodontists work closely with oral surgeons to prepare the patient's teeth for the surgical phase and ensure proper alignment after surgery.
  • Dentist: Dentists are involved in the overall oral health management of the patient. They may be consulted for dental examinations, cleanings, and necessary dental treatments before or after surgery.
  • Prosthodontist: Prosthodontists specialize in dental restorations, including crowns, bridges, and dentures. They may be consulted if restorative dental work is required as part of the treatment plan.
  • Medical Anesthesiologist: An anesthesiologist is responsible for administering anaesthesia to ensure the patient's comfort and safety during surgery. They monitor the patient's vital signs throughout the procedure.
  • Radiologist: Radiologists analyze imaging studies such as X-rays, CT scans, and MRIs to assist in the diagnosis and treatment planning process.
  • Speech Therapist: In cases where orthognathic surgery affects speech patterns or function, a speech therapist may be consulted to help the patient regain proper speech patterns and articulation.
  • Nutritionist/Dietitian: Nutritionists or dietitians can guide dietary adjustments and proper nutrition during recovery to support healing.
  • Psychologist/Counselor: Addressing the psychological impact of jaw irregularities and the surgical process is essential. Psychologists or counsellors can provide support to help patients cope with stress and anxiety.
  • Otolaryngologist (ENT Specialist): In cases where orthognathic surgery is related to airway or breathing issues, an ear, nose, and throat specialist may be consulted to assess and address those concerns.

Preparing for Orthognathic Surgery

Preparing for orthognathic surgery involves several essential steps to ensure a smooth and successful surgical experience and recovery. Here's a guide to help you prepare:

  • Consultation with Oral Surgeon: Consult an oral and maxillofacial surgeon specializing in orthognathic surgery. During this consultation, your surgeon will evaluate your condition, discuss treatment options, and answer any questions you have.
  • Orthodontic Assessment: If you haven't already, consult with an orthodontist. They will assess your dental alignment and work on pre-surgical orthodontic treatment to prepare your teeth for surgery.
  • Medical Evaluation: Your oral surgeon will likely require a complete medical evaluation. Inform them about your medical history, current medications, allergies, and any existing medical conditions.
  • Imaging Studies: You'll undergo various imaging studies, such as X-rays, CT scans, and 3D scans. These help create detailed images of your facial and jaw structures, aiding in treatment planning.
  • Treatment Plan Discussion: Your oral surgeon and orthodontist will collaborate on a comprehensive treatment plan outlining the surgical movements needed for optimal results.
  • Pre-Surgery Orthodontics: Depending on your case, you may need to wear braces or other orthodontic appliances to align your teeth properly before surgery.
  • Nutritional Assessment: Maintain a balanced and nutritious diet to support your body's healing process. If needed, consult with a nutritionist for guidance.
  • Dental Hygiene: Maintain excellent dental hygiene to reduce the risk of infections. Your surgeon might recommend using an antibacterial mouthwash.

Recovery after Orthognathic Surgery

The recovery period after orthognathic surgery is a crucial phase that requires patience, careful adherence to postoperative instructions, and support from your healthcare team and loved ones. Here's what you can expect during the recovery process:

  • Hospital Stay: Depending on the complexity of the surgery, you might need to stay overnight in the hospital or surgical centre for observation and initial recovery.
  • Swelling and Discomfort: Swelling and discomfort are joint after orthognathic surgery. Cold compresses and prescribed pain medications can help manage these symptoms.
  • Diet: Initially, your diet will be limited to soft foods or liquids. As healing progresses, you'll gradually transition to a regular diet.
  • Oral Care: Maintaining good oral hygiene is essential. Follow your surgeon's instructions for rinsing and cleaning your mouth to prevent infections.
  • Medications: Take prescribed medications as your surgeon directs, including pain relievers and antibiotics.
  • Rest and Recovery: Rest is essential for healing. Avoid strenuous activities and follow your surgeon's recommendations for returning to normal daily activities.
  • Follow-Up Appointments: Attend all scheduled follow-up appointments with your oral surgeon and orthodontist to monitor healing and progress.
  • Swelling Reduction Techniques: Elevate your head while sleeping and avoid activities that can increase swelling, such as bending over or vigorous physical exercise.
  • Gradual Resumption of Activities: As you heal, gradually reintroduce light activities and exercise, as your healthcare team advises.
  • Speech and Swallowing: Speech and swallowing may be affected temporarily due to the changes in your jaw position. Speech therapy might be recommended to help you adjust.

Lifestyle Changes after Orthognathic Surgery

After undergoing orthognathic surgery, specific lifestyle changes can help facilitate a smoother recovery process and optimize the procedure results. These temporary adjustments support your healing, comfort, and overall well-being. Here are some lifestyle changes to consider:

  • Diet Modification: Start with a soft or liquid diet, as your healthcare team recommends.Gradually introduce solid foods as your healing progresses and you receive approval from your surgeon.
  • Oral Hygiene:Maintain excellent oral hygiene to prevent infections and promote healing.Follow your surgeon's instructions for cleaning your mouth and teeth and caring for the surgical sites.
  • Medication Management: Take prescribed medications as directed by your healthcare provider. Manage pain, swelling, and discomfort with the prescribed pain relievers and cold compresses.
  • Follow-Up Appointments: Attend all scheduled follow-up appointments with your oral surgeon and orthodontist. These appointments are essential for monitoring your progress and making any necessary adjustments.
  • Physical Activity: During the initial recovery period, limit strenuous physical activities. Gradually reintroduce light exercises and activities as advised by your healthcare team.
  • Sleeping position: Sleep with your head elevated for the first few weeks to help reduce swelling.
  • Speech and Communication: Speech and articulation may be affected temporarily. Be patient and consider speech therapy is recommended.
  • Stress Management: Manage stress and emotions to support your overall well-being during the recovery phase.
  • Sun Protection: If your incisions are healing and you spend time outdoors, protect surgical areas from direct sunlight to prevent pigmentation changes.
  • Hydration and Nutrition: Maintain proper hydration and ensure you receive adequate nutrients for healing. - Consult with a nutritionist if needed to plan a balanced diet.
  • Avoid Smoking and Alcohol: Avoid smoking during the healing phase, as it can hinder proper healing. - Limit or avoid alcohol consumption, as it can impact healing and interact with medications.
  • Regular Follow-Up with Orthodontist: Continue orthodontic treatment as your orthodontist recommends to ensure optimal bite alignment.

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Frequently Asked Questions

1. What is orthognathic surgery?

Orthognathic surgery, or jaw surgery, is a procedure that corrects irregularities in the jaw and facial structures to improve function, aesthetics, and overall quality of life.

2. Who is a candidate for orthognathic surgery?

Individuals with significant jaw misalignments, malocclusions, facial asymmetry, or functional issues related to the jaws may be candidates for orthognathic surgery.

3. How is orthognathic surgery performed?

Orthognathic surgery involves carefully planned surgical movements of the upper and lower jaws. Incisions are typically made inside the mouth to reposition the jaws, followed by using plates, screws, or wires for stabilization.

4. Is orthognathic surgery painful?

Pain and discomfort are expected after surgery. However, pain can be managed with prescribed medications and usually subsides as healing progresses.

5. How long does the recovery take after orthognathic surgery?

Initial recovery takes several weeks, with complete bone healing and adjustment of the bite taking several months to a year.

6. Will I have visible scars after orthognathic surgery?

Incisions are usually made inside the mouth, minimizing visible scarring. Any imperfections are typically hidden within the mouth.

7. Will I need braces before and after surgery?

Yes, pre-surgery orthodontic treatment aligns your teeth for surgery, and post-surgery orthodontics fine-tunes your bite and alignment.

8. What type of anaesthesia is used for orthognathic surgery?

Orthognathic surgery is typically performed under general anaesthesia to ensure your comfort and safety during the procedure.

9. Can orthognathic surgery improve my breathing and speech?

Yes, orthognathic surgery can improve airway patency and resolve specific speech issues caused by jaw misalignments.

10. How long will I be in the hospital after orthognathic surgery?

Hospital stays vary based on the complexity of the surgery but typically range from one day to a few days.

11. Will my appearance change after orthognathic surgery?

Yes, orthognathic surgery can enhance facial aesthetics, correct asymmetry, and improve overall facial balance.

12. Are there risks associated with orthognathic surgery?

Like any surgery, there are risks, including infection, bleeding, nerve damage, and changes in sensation. Your surgeon will discuss these risks during your consultation.

13. Can I resume normal activities after orthognathic surgery?

You'll need to limit strenuous activities initially and gradually continue them as your healing progresses and under your healthcare team's guidance.

14. Will I need to wear braces for a long time?

The duration of braces treatment varies but typically spans from several months before surgery to several months afterwards.

15. Will I need speech therapy after orthognathic surgery?

Some patients may require speech therapy to adjust to any changes in speech caused by the surgery. Your healthcare team will guide you.

16. Can orthognathic surgery correct temporomandibular joint (TMJ) disorders?

In some cases, orthognathic surgery can help improve TMJ disorders by addressing jaw misalignments contributing to the condition.

17. Will I have to follow a special diet after orthognathic surgery?

Yes, you'll start with a soft or liquid diet and gradually transition to a regular diet as your healing progresses.

18. Can I smoke after orthognathic surgery?

Smoking can hinder proper healing. It's advisable to avoid smoking during your recovery period.

19. Will my insurance cover orthognathic surgery?

Coverage varies by insurance plans and is often determined by medical necessity. Consult your insurance provider for details.

20. How can I find a qualified oral surgeon for orthognathic surgery?

Seek referrals from your orthodontist or general dentist. Ensure the surgeon is board-certified and has experience with orthognathic procedures.

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