Corrective Jaw Surgery

Orthognathic Surgery (Corrective Jaw Surgery)

Corrective jaw surgery, also known as "orthognathic" surgery, is performed to correct various facial skeletal and/or dental irregularities. The word "orthognathic" is derived from two Greek words; "ortho" refers to straight, and "gnathic" refers to jaws. Orthognathic surgery, performed by oral and maxillofacial surgeons, not only improves a patient's smile and appearance, but it also improves their ability to chew, speak and breathe. Other benefits may include the relief of facial pain, headaches, snoring and obstructive sleep disorders. While a patient's appearance may be dramatically enhanced as a result of surgery, corrective jaw surgery is performed primarily to rectify functional problems.

Orthognathic surgery may reposition all or part of the upper jaw, lower jaw and chin. In some cases, facial cosmetic surgery may be done simultaneously with orthognathic surgery, and patients are encouraged to inquire about possible options that are available, and discuss them with Dr. Joseph

Surgery may involve:

• Upper Jaw (maxilla)
• Lower Jaw (mandible)
• Cheekbones
• Nasal Bones
• Other facial bones.
  
  

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Who Needs Corrective Jaw Surgery?

People who benefit from orthognathic surgery are those whose misaligned teeth and jaws create in an improper bite. Jaw growth is a gradual process, and the upper and lower jaws may occasionally grow at different rates. This can cause functional problems including difficulty with chewing, speaking, breathing, sleeping and overall oral health. A severe misalignment may affect a person’s appearance and produce psychological or emotional problems.

Jaw or head injuries and birth defects may also affect jaw alignment. Orthodontic braces usually correct bite problems caused by tooth misalignment, and orthognathic surgery corrects jaw misalignment.

Conditions that may indicate the need for orthognathic surgery:

• difficulty chewing or biting food
• difficulty swallowing
• chronic jaw or jaw joint (TMJ) pain and headache
• excessive wear on the teeth
• open bite (space between the upper and lower teeth when the mouth is closed)
• unbalanced facial appearance from the front or side
• facial injury or birth defects
• receding chin
• protruding jaw
• inability to make one’s lips meet without straining
• chronic mouth breathing and dry mouth
• sleep apnea (breathing problems when sleeping, including snoring)

Evaluating Your Need for Orthognathic Surgery

Dr. Joseph works closely with your dentist and orthodontist to determine whether orthognathic surgery is recommended, and which procedure is deemed appropriate.

Prior to surgery, your medical health history is reviewed, and a thorough examination – including facial measurements, photographs, X-rays, bite recordings and dental impressions – is completed.

What is involved in Orthognathic Surgery?

Pre-Surgical Orthodontics

Before surgery, your orthodontist aligns your teeth using braces. This phase of treatment usually lasts from 6 to 12 months and requires regular orthodontist appointments for adjustments. Because your teeth are being moved into a position that will fit together after surgery, your bite may seem worse during this period. However, when your jaws are repositioned during surgery, your teeth should fit together properly. It may be necessary to have one or more teeth, including your third molars (wisdom teeth) removed during this early phase of treatment.

Pre-Surgical Records

After the initial orthodontic alignment, Dr. Joseph makes final surgical preparations. Records, X-rays, pictures and models of your teeth are updated and function as a guide for your surgery.

Preparing for Orthognathic Surgery

Most orthognathic procedures are typically performed under general anesthesia in a hospital or an ambulatory surgical center. Prior to surgery, your medical history is reviewed, and a physical examination is completed. Also, special dietary instructions and prescriptions are provided, and lab tests are performed. Occasionally a pre-surgical consultation with an anesthesiologist is required.

The Surgical Procedure

The duration of orthognathic surgery varies. Procedures involving the lower jaw usually require the separation of the rear portion of the jaw from the front portion that supports your teeth. This allows Dr. Joseph to reposition the tooth-bearing part of your lower jaw forward or backward. In the upper jaw, the tooth-bearing portion of the jaw is separated from its base and then repositioned up, down, forward or backward.

During surgery, Dr. Joseph moves your jawbones according to your specific needs. Occasionally, bone is added, taken away or reshaped. Tiny surgical plates and screws are used to hold your jaws in their new positions.

Also, wires or rubber-bands may fasten your jaws together temporarily depending on the circumstances. Dr. Joseph may also place a plastic bite splint or guide to help maintain a proper bite. Although incisions are usually made inside the mouth, it is sometimes necessary to make small incisions outside the mouth. Care is always taken to minimize scarring.

Immediately Following Surgery

After surgery, patients are typically taken to a recovery room until the effects of the anesthesia have subsided. (Family members and loved ones are not permitted in the recovery room.) Whether patients return home the day of surgery, or are required to stay overnight in the hospital, depends on each patient’s specific needs. In either case, it is important to drink adequate fluids to maintain proper nutrition before you return home. Patients are supplied with instructions for a modified diet, as well as a schedule for advancing to a normal diet. Tobacco products and strenuous physical activities must be avoided. Proper healing depends on strictly following all instructions.

Discomfort following orthognathic surgery is easily controlled. Prescriptions for pain medication, and ice packs that aid in the healing process are supplied.

Post-surgical swelling is expected. It typically peaks between 48 and 72 hours and then gradually subsides. Most swelling dissipates between 7 and 10 days, but slight residual swelling may be visible for several months. Bruising, nasal congestion and a sore throat may also occur after surgery and will steadily improve.

After surgery, Dr. Joseph works in conjunction with your orthodontist to “fine-tune” your bite. Once your braces are removed, it may be necessary to wear a retainer to help maintain your bite. Your treatment, including orthodontics before and after orthognathic surgery, may take 1-2 years to complete.

Follow-Up Care

After your orthognathic surgery and orthodontic treatment are completed, Dr. Joseph and your orthodontist will determine when and how often re-evaluations of your bite are needed. Also, regular check-ups with your general dentist are critical to maintain optimum dental health.

Enjoy the Benefits

Orthognathic surgery moves your teeth and jaws into positions that are more balanced, functional and healthy. Although the goal of orthognathic surgery is to improve your bite and function, many patients also experience enhancements to their appearance, breathing and speech. The results of orthognathic surgery can have a dramatic and positive effect on many aspects of your life, and it’s likely that your self-esteem and confidence will be significantly boosted.

During Healing

Orthognathic surgery is a major operation, and it’s important that you are informed of some risks.

• Blood loss during jaw surgery is typically modest, and bleeding that requires a transfusion is extremely rare. Immediately following surgery, particularly of the upper jaw, minor bleeding from the nose may occur. Although excessive or prolonged bleeding after surgery is uncommon, if it occurs it may prompt further care by your surgeon.
• The nerves that supply sensation or feeling to the jaws are exposed during orthognathic surgery, and even though some temporary numbness or tingling following surgery is typical, it diminishes as healing progresses. In very rare cases, the alteration of sensation may be permanent.
• During surgery, the position of the jaws and the bite are set when the patient is lying down. At this time the jaw muscles are completely relaxed under general anesthesia. When the patient is awake and upright, jaw muscle tone is regained and the bite is subtly different. After surgery, Dr. Joseph carefully follows each patient’s progress to ensure the new bite is identical to the original plan. Orthodontic rubber bands are often used during this time to guide the development of the bite. In rare cases, if the bite is not exactly as projected, additional surgery may be necessary.
• Infection, while a potential risk following any surgical procedure, is very rare and is usually treated with antibiotics.
• Inadvertent injuries to teeth, roots, fillings, bridgework or surrounding tissues may occur during any surgical procedure in the mouth. If they occur, they may require appropriate correction.
• Healing from surgery and adjusting to the new position of your jaws may result in some temporary limited jaw movement and/or chewing or speaking difficulty. These symptoms will improve as healing progresses. In some instances, special jaw exercises are prescribed to help you become adjusted to your new jaw position and bite.
• Any procedures, such as dental treatment, orthognathic surgery or orthodontics, that change the position of the teeth may aggravate or result in TMJ (Jaw Joint) problems. While orthognathic surgery is frequently performed to improve TMJ functions and symptoms, in rare cases, it may exacerbate a pre-existing condition.

Patients are able to return to work or school one to three weeks after surgery. Although the initial phase of healing is about 6 weeks, complete healing of the jaws takes nine to 12 months. After surgery, Dr. Joseph decides when your orthodontist may begin "fine-tuning" your bite, which usually takes about six months. Your orthodontist determines when your treatment is complete.