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.
Orthognathic Surgery 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.
