What is Orthognathic Surgery?
Orthognathic surgery is sometimes called "Surgical Orthodontics" because, just as an orthodontist repositions teeth, an oral and maxillofacial surgeon uses orthognathic surgery to reposition one or both jaws. Just as "orthodontics" means "straight teeth", "orthognathic" means "straight jaws". In fact, because moving the jaws also moves the teeth, orthognathic surgery is usually performed in conjunction with orthodontics so that the teeth are in proper position after surgery. The objective of orthognathic surgery is the correction of a wide range of minor and major facial and jaw irregularities, and benefits include an improved ability to chew, speak and breathe. In many cases an enhanced appearance can also result.
Who needs orthognathic surgery?
Who needs orthognathic surgery?
People who can potentially benefit from orthognathic surgery include those with an improper bite and those with jaws that are positioned incorrectly. Jaw growth is a slow and gradual process, and in some instances, the upper and lower jaws may grow at different rates. The result can be a host of problem that can affect chewing function, speech, long-term oral health, and appearance. Injury to the jaw and birth defects can also affect jaw alignment. While orthodontics alone can correct many "bite" problems if only the teeth are involved, orthognathic surgery may be required if the jaws also need repositioning.
The following are some of the conditions that may indicate a need for orthognathic surgery:
The following are some of the conditions that may indicate a need for orthognathic surgery:
difficulty chewing or biting into food
difficulty swallowing
speech problems
chronic jaw pain
excessive wearing of teeth
open bite (space between upper and lower front or back teeth when mouth is closed)
unbalanced facial appearance
facial injury or birth defects
receding chin
protruding jaw
inability to make lips meet without effort
chronic mouth breathing with dry mouth
sleep apnea (breathing problems when sleeping such as snoring)
Unequal growth of the jaws, injury or birth defects can produce problems and symptoms that require treatment by a team that usually includes an oral and maxillofacial surgeon, and orthodontist, and sometimes your dentist. In order to determine if you are a candidate for orthognathic surgery, and evaluation of your condition by this team in necessary.
Phases of Orthognathic Surgery
Pre-Surgical OrthodonticsIn many cases pre-surgical orthodontic is necessary to move your teeth into a new position prior to your surgery. During you surgery, adjustments will be made to your jaw to reposition them so that they fit together properly. Because your teeth are moved into a position that will be correct after surgery, you may think that your bite is getting worse rather than better during this phase of treatment. If you still have your wisdom teeth or other crowding, it may be necessary to remove certain teeth prior to beginning orthodontic treatment in order to make space for proper tooth movement.
Pre-Surgical Records
As your pre-surgical orthodontic treatment nears completion, an appointment with your doctor will be necessary to make final preparations for the surgical procedure. Additional records will be taken. Your dentist will look at your models and the most recent x-rays of your teeth and jaws to "simulate" surgery in order to finalize the surgical movements of your jaws. In other words, he will be doing a several mock surgeries on paper as well as models to insure that his predictions will give you the optimum final results.
Preparing For Surgery
You will be seen one more time in his office prior to your surgery. At this appointment he will do a history and physical as is required by the hospital before admission. The doctor will review your most recent health information and collect basic data about your current physical health. Orders for any tests that may be necessary prior to surgery are written up and a surgical consent form is signed. You will receive a packet of information that you will take with you to the hospital upon admission. In most cases, you will check into the hospital on the day of your surgery. Your anesthesiologist will discuss the general anesthetic procedure to be used. In addition to the general anesthesia that is given to "put you to sleep" you will be receiving intravenous fluids and medication to prevent dehydration and infection, and to minimize pain and swelling. It is very important that you adhere to any medication schedule or diet prescribed by your surgeon.
The Surgical Procedure
The orthognathic surgery itself will several hours depending on the amount and type of surgery needed. Certain movement may require the jaws to be separated into several parts, with bone added or removed to achieve the proper alignment and stability. Other facial bones that contribute to the imbalance may also be repositions, augmented, or reduced in size. For the majority of orthognathic cases, incisions are made inside the mouth and there will be no visible external scars. If there is a need to make any external incisions, care is taken to conceal the incisions in the natural skin creases.
The most common types of procedures used are:
The most common types of procedures used are:
Mandibular Osteotomy -(Also called a Mandibular Split) -
Allows for moving the lower jaw back or forwards to create a more stable bite and improve esthetics. This procedure can also be used to rotate the jaw if necessary.
Maxillary Le Fort Osteotomy -
Maxillary Le Fort Osteotomy -
Allows for repositioning of the upper jaw (maxilla). The jaw can be cut into pieces, if necessary, to reposition bony segments in their most ideal positions.
Another frequent procedure is a Genioplasty. A genioplasty can be used for repositioning the chin for a better esthetic result. It can be performed as a separate procedure, or can be performed at the time of your orthognathic surgery
Another frequent procedure is a Genioplasty. A genioplasty can be used for repositioning the chin for a better esthetic result. It can be performed as a separate procedure, or can be performed at the time of your orthognathic surgery
Immediately Following Surgery
Immediately after surgery you will be moved to the recovery room until the general anesthesia has worn off. Your family may not be allowed in the recovery room, but they should be able to visit you shortly thereafter. An IV will be attached to your arm to provide required medications and nutrients until you are able to take sufficient liquids by mouth. Medications may be administered to control post-surgical discomfort.
The length of stay in the hospital can be one or more days. You can expect temporary swelling, especially of the lips and cheeks. Bruising may also result. These conditions are a part of your bodies normal healing response and should disappear during your initial recovery time.
To aid in healing, your jaws may need to be prevented from moving. This is done with the use of fixation appliances. In many cases the jaw sections are held together during the healing period by small screws placed by your doctor. In other cases wires are used to hold the bones together and keep the jaws from moving.
While your jaws are in fixation and healing, you will need to consume a liquid diet. Some weight loss may occur during this time but can be regained after the fixation period is over. During the first week after surgery your diet is extremely important. If necessary, you may need to supplement your diet with liquid vitamins or diet supplement drinks (example would be Ensure). A blender can be used to liquefy almost any food to provide a balanced diet.
Smoking is highly discouraged post-operatively for any surgical procedure, but especially following orthognathic surgery. Smoking can unnecessarily inhibit the healing process. Strenuous activities should be avoided during the first few post operative weeks.
The length of stay in the hospital can be one or more days. You can expect temporary swelling, especially of the lips and cheeks. Bruising may also result. These conditions are a part of your bodies normal healing response and should disappear during your initial recovery time.
To aid in healing, your jaws may need to be prevented from moving. This is done with the use of fixation appliances. In many cases the jaw sections are held together during the healing period by small screws placed by your doctor. In other cases wires are used to hold the bones together and keep the jaws from moving.
While your jaws are in fixation and healing, you will need to consume a liquid diet. Some weight loss may occur during this time but can be regained after the fixation period is over. During the first week after surgery your diet is extremely important. If necessary, you may need to supplement your diet with liquid vitamins or diet supplement drinks (example would be Ensure). A blender can be used to liquefy almost any food to provide a balanced diet.
Smoking is highly discouraged post-operatively for any surgical procedure, but especially following orthognathic surgery. Smoking can unnecessarily inhibit the healing process. Strenuous activities should be avoided during the first few post operative weeks.
During Healing
When you leave the hospital you should be able to return to work or school as soon as you feel like it. Most patients are back to their normal routine within 2 weeks. Your appearance may have changed somewhat due to the repositioning of your jaws and associated swelling. Friends and family may show signs of surprise, but it won't take long for them to adjust to the new you.
You will see your oral surgeon and your Orthodontist for regular evaluation visits. It is extremely important that these appointments are made in a timely manner and kept. The doctor will monitor your healing which will allow him to determine the appropriate time to remove any fixation devices that may have been used.
The initial healing process will take approximately 6 weeks. The compete healing process may take anywhere from 9 to 12 months. It is important to maintain a high level of oral hygiene during the entire healing process.
The Orthodontist will usually begin the post-surgical phase of orthodontic treatment 4 to 8 weeks after surgery to make any minor adjustments to your bite that may be necessary. IN most cases braces are removed within 6 to 12 months following surgery.
You will see your oral surgeon and your Orthodontist for regular evaluation visits. It is extremely important that these appointments are made in a timely manner and kept. The doctor will monitor your healing which will allow him to determine the appropriate time to remove any fixation devices that may have been used.
The initial healing process will take approximately 6 weeks. The compete healing process may take anywhere from 9 to 12 months. It is important to maintain a high level of oral hygiene during the entire healing process.
The Orthodontist will usually begin the post-surgical phase of orthodontic treatment 4 to 8 weeks after surgery to make any minor adjustments to your bite that may be necessary. IN most cases braces are removed within 6 to 12 months following surgery.
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