Orthognathic surgery refers to the surgical correction needed to fix substantial abnormalities of the maxilla (upper jaw), the mandible (lower jaw), or both. The abnormality may be a birth defect, a growth defect, or the result of traumatic injuries to the jaw area. Orthognathic surgery involves a wide variety of surgical procedures performed to place the teeth, jaw bones, and other associated hard and soft tissue structures into their best anatomical positions.
Correction of these abnormalities generally results in improvement in function such as chewing, speaking and breathing and often enhances facial esthetics.
Orthognathic surgery is generally performed by an Oral and Maxillofacial Surgeon to correct malocclusion (bad bite) in cases where routine orthodontic treatment has not or will not be effective. Orthognathic surgeries include the reconstruction of the mandible or maxilla, mandibular ramus, maxilla osteotomy, and mandibular osteotomy.
There are several classifications of malocclusion (the improper coming together of teeth) which may require orthognathic surgery:
This malocclusion means that the lower anterior incisors sit directly behind the upper anterior incisors when the patient bites down. This is considered less destructive than Class II and Class III malocclusions.
This is identified when the lower anterior incisors lie significantly behind the upper anterior incisors during the biting process; in some cases hitting the soft tissue behind the upper incisors. This is commonly referred to as an overbite and can cause discomfort, bone damage, excessive wear of the upper front teeth, and tooth loss.
This is commonly known as an underbite and occurs when the lower anterior incisors and lower jaw are positioned beyond the upper teeth, making the lower jaw much more prominent than the upper jaw.
The malocclusion of the teeth can create greatly destructive forces among the five powerful muscles that control the closing and opening of the jaw. These muscles generate a tremendous force when clenching, grinding or chewing. Misalignment can seriously damage the function and aesthetic appearance of the teeth in many ways if left untreated, such as:
Tooth Wear – In the case of an overbite, the pressure and wear on the teeth is not spread evenly. This can also lead to TMJ, migraine headaches, and tooth loss.
Improvement in jaw pain - Patients who have jaw joint pain or pain in their jaw muscles may experience some improvement after correction of jaw position. While this pain reduction occurs for many patients, there is no absolute guarantee that correction of jaw positioning will be able to totally eliminate or reduce pain.
Loose Teeth – When uneven pressure is continually exerted in unintended places or soft tissue is damaged by an overbite, adjacent teeth may become loose in their sockets which causes pain and reduces proper function.
Tooth Sensitivity – As teeth become damaged by constant use, the enamel becomes thinner and the nerves are less protected. This lack of protection can lead to sharp pains when hot or cold foods are eaten.
When orthodontic treatment alone cannot correct a problem- There are times when congenital abnormalities, growth disturbances, or previous trauma have resulted in jaw positions that prevent conventional orthodontics from achieving a satisfactory functional and esthetic result.
To improve jaw function- Correcting the bite frequently helps many people chew food more normally and eat things that they have been previously unable to eat.
To enhance the long term orthodontic result (stability)- In some cases orthodontic treatment alone can, in fact, produce a good bite relationship during and immediately after the time of orthodontic treatment. However, when an underlying jaw abnormality is responsible for the bite problem, orthodontic movement must sometimes be done in such a way that it will be difficult to maintain the position of the teeth over a period of time after the braces have been removed. Surgery can often improve the long term results in these cases.
Reduction in overall treatment time- In some cases there are several options for treatment including orthodontics alone or a combination of orthodontics and surgery. In some of these cases the combined orthodontic surgical approach can be completed in a shorter period of time since movement of the jaw bone to a better anatomical position may decrease the amount of orthodontic treatment that is necessary.
Change in facial appearance- Placement of jaws into the proper position may often result in a more pleasing facial appearance.
Improved breathing- When surgery is performed on the jaws, the ability to breathe is frequently improved. This type of surgery often greatly improves problems associated with sleep apnea which can cause or be associated with other serious medical problems.
Improved speech- Correction of poorly positioned jaws or teeth may have a positive effect on abnormal speech. Jaw surgery may need to be combined with speech therapy to correct speech abnormalities.
When the dentist identifies a patient as a candidate for orthognathic surgery, a complete photographic analysis is initially undertaken. This includes panorex x-rays, cephalometric x-rays, models, impressions, and radiographs. Your oral & maxillofacial surgeon, your orthodontist and your dentist will work together and consider how the corrective surgery will impact both proper jaw function and the aesthetic appearance of the entire face. Generally, orthodontic braces are necessary to align the arches and straighten the teeth prior to the surgery, and additionally, retainers may be used after the surgery. During maxillary surgery, the upper jaw is moved and may be secured in position using tiny plates, wires, rubber bands and screws. Surgery on the mandible is performed using bone grafts to align the lower jaw into the correct position. Orthognathic surgery generally requires a general anesthesia and a good deal of aftercare. Pain medication will be prescribed as necessary, and you’ll be given post treatment advice for your recovery. You may also be provided with a modified diet (if required).
No surgical procedure is more rewarding for both patient and surgeon than corrective jaw surgery or orthognathic surgery. In some people, the upper or lower jaw may grow too much or too little, too wide or too narrow. The difference in the size of the jaws can create alignment problems in your bite, joint pain, and facial asymmetry. Whatever the cause, you don’t have to live with the difficulties that may result from this disparity. An improper bite can usually be corrected by orthodontic treatment. However, corrective jaw surgery is recommended when the improper bite is a result of incorrect jaw position.
Orthognathic surgery will realign your jaw, improve your chewing and speaking functions, and restore your facial symmetry. Corrective jaw surgery can be performed before or after orthodontic treatment. One or both jaws may undergo surgery to correct the facial imbalance and restore function.
A thorough clinical examination, along with diagnostic radiographs and models of your teeth, will allow Dr. Dinesh to determine the best surgical approach to give you the desired results.
Dr. Dinesh feels that an open line of communication between all those involved in your treatment is a must to ensure success. That is why from day one Dr. Dinesh will closely coordinate your treatment with you, your family, and your orthodontist.
1. Presurgical orthodontics – the duration of this phase of treatment ranges from 3 to 12 months. During this phase the dental abnormalities are corrected by orthodontist.
2. Surgical correction – the duration of this phase of treatment ranges from 2 to 3 weeks following surgery. During this phase the surgeon will position your jaws in a correct alignment and will be fixed with miniplates to stabilize the jaws in its new position. Following surgery patient will be under care for wound management for next 2 weeks.
Patient will be provided with all the necessary post surgical instructions to be taken care by the patient at home.
3. Post surgical Orthodontics – the duration of this phase of treatment ranges from 3 to 6 months. During this phase of treatment the orthodontist will make final fine correction of teeth following surgery.
Orthognathic surgery is performed in a hospital setting under general anesthesia. You will usually require at least a 24 hour stay in the hospital before you can be discharged.
While in the hospital, Dr. Dinesh will make rounds to see you in the morning and once in the evening. He will provide specific orders to the nursing staff to make sure your care are met and that your stay is pleasant. You will be comforted to know that Dr. Dinesh will be available to handle any emergencies that may arise after you leave the hospital.
As with any type of surgical treatment, certain risks must be considered and these should be weighed against the potential benefits. We would not recommend an operation to you if we did not feel strongly that the benefits far outweigh any risks associated with surgery. However, it is important for you to understand that the risks associated with orthognathic surgery may include the following:
These actually are not risks but side effects usually associated with any type of surgery:
Discomfort/postoperative pain as a result of the surgery itself.
Swelling
Bleeding. Since most jaw surgery is performed through incisions inside the mouth, it is impossible to put a dressing over this area. After surgery some bleeding occurs, just as when teeth are taken out.
Infections are rare, generally easy to treat, and usually resolved quickly. However, infection may result in more severe consequences such as improper healing and the need for further surgery.
Again, this type of problem is extremely rare.
Because jaw surgery is performed on bones of the face, bruising of the nerves within the bone sometimes results in some decreased feeling in certain parts of the face.. In the case of upper jaw surgery this usually occurs around the nose and upper lip. In lower jaw surgery this occurs around the lower lip and chin. While this may feel strange in the immediate post operative period, this numbness also helps decrease the amount of pain which you will feel after surgery. This altered feeling is usually temporary. However, in a few patients there may be some permanent loss of feeling.
General anesthesia is very safe particularly in elective surgery cases such as orthognathic surgery. The anesthesiologist will discuss all aspects of your anesthetic care prior to your surgery.
The speed of surgical recovery depends on several factors including age and the extent of surgery. After the surgical procedure you can expect the following during your recovery.
Most patients undergoing orthognathic surgery will not have their jaws wired together. This will allow some immediate postoperative jaw function. Light elastics (rubber bands) will be used to help your jaw function in a new bite relationship. Over the first two or three weeks you will see significant improvement in jaw movement. Since the jaws are not wired together this make it much easier to speak, drink, eat, and perform oral hygiene.
For the first few days immediately after surgery your diet will be a very soft or blenderized diet. At approximately 7 days to 2 weeks after surgery your diet will consist of foods such as chopped spaghetti, scrambled eggs, or other soft foods which can be eaten without extensive chewing. At two to six weeks after surgery your diet will progress to foods such as ground beef, small pieces of very soft meat such as flaky fish, and other foods which require some chewing. In most cases your diet will be near normal after 6 to 8 weeks.
You should limit your activity for four to five days. This usually means staying around the house with minimal activity.
At about one week after surgery you may be able to return to some limited activity such as slightly restricted work activity, some school activity, and easy leisure activity. For some patients this may be delayed for up to two weeks depending on the type of surgery and how quickly you recover after surgery.
The speed of surgical recovery depends on several factors including age of the patient and the extent of surgery. After the surgical procedure you can expect the following during your recovery.
Most patients undergoing orthognathic surgery will not have their jaws wired together. This will allow some immediate postoperative jaw function. Light elastics (rubber bands) will be used to help your jaw function in a new bite relationship. Over the first two or three weeks you will see significant improvement in jaw movement. Since the jaws do not have to be wired together, it should be easy to speak, drink, eat, and perform oral hygiene.
For the first few days immediately after surgery your diet will be a very soft or blenderized diet. At approximately 7 days to 2 weeks after surgery your diet will consist of foods such as chopped spaghetti, scrambled eggs, or other soft foods which can be eaten without extensive chewing. At two to six weeks after surgery your diet will progress to foods such as ground beef, small pieces of very soft meat such as flaky fish, and other foods which require some chewing. In most cases your diet will be near normal after 6 to 8 weeks.
You should limit your activity for four to five days. This usually means staying around the house with minimal activity.
At about one week after surgery you may be able to return to some limited activity such as slightly restricted work activity, some school activity, and easy leisure activity. For some patients this may be delayed for up to two weeks depending on the type of surgery and how quickly you recover after surgery.
To learn more about this surgical procedure, please contact our office to arrange for an orthognathic evaluation with Dr. Dinesh.