What is Orthognathic Surgery? Orthognathic surgery has been referred to as surgical orthodontics because the oral and maxillofacial surgeon uses the surgical procedure to reposition the upper and lower jaws. This can be compared to an orthodontist correctly repositioning the teeth. The overall goal for orthognathic surgery is to correct and align minor and major facial and jaw irregularities. This not only improves facial appearance but also ensures that the teeth meet correctly and function properly.

Orthognathic surgery is performed using the team approach in which the patient, the orthodontist, and the oral and maxillofacial surgeon have integral roles.

Who needs Orthognathic Surgery?

People who can benefit from orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is a gradual process and in some instances the upper and lower jaws may grow at different rates. The result can be a host of problems that can affect chewing, function, speech, long-term oral health, and appearance. Injury to the jaw and birth defects can also affect jaw alignment and position. Orthodontics alone can correct many bite problems if only the teeth are involved, orthognathic surgery may be required if the jaws also need repositioning.

Difficulty in the following areas also need repositioning:

Chewing
Biting or swallowing
Speech problems
Open bite
Protruding jaw
Unbalanced facial appearance
Facial injury
Birth defects
Receding chin
Inability to make lips meet without effort

Any of these can exist at birth or may be acquired after birth as a result of hereditary or environmental influences, or trauma to the face.


Examining your need for Orthognathic Surgery

In assessing your need for orthognathic surgery, the oral and maxillofacial surgeon and the orthodontist will work closely together to formulate the proper treatment plan. The orthodontist is responsible for aligning the teeth so they will fit together properly after the jaws have been repositioned. The oral and maxillofacial surgeon is responsible for surgically repositioning the jaws so the teeth and jaws are in the new proper alignment.

Prior to any treatment, an initial consultation will be held in order to get acquainted and answer any questions that you might have. It is very important to understand that your treatment, including presurgical orthodontics, orthognathic surgery, post-surgery healing, as well as post-surgical orthodontics may take from several months to two years or more to complete.

In order to appreciate the full benefits of combined orthodontic and orthognathic treatment, a long-term commitment is recommended and required. Prior to the initiation of treatment, a thorough examination with facial measurements, photographs, x-rays, and dental impressions will be made. After reviewing the results of your examination, consultations, and other relevant diagnostic procedures, you and the surgical team will decide upon the course of treatment which is personalized to meet your needs. Based on the extent of your surgical needs, orthodontic treatment may have to be augmented with orthognathic surgery.

Surgical procedures can range from minor movement of one jaw to repositioning of both the upper and lower jaws. During these consultations you are encouraged to ask any questions that you might perceive as relevant to your treatment.


Technology and Orthognathic Surgery

Presurgical Orthodontics

Prior to the surgical movements of your lower and upper jaw, the presurgical orthodontic phase of treatment, which usually lasts 6 to 18 months, will be completed. During this time you will be regularly followed by your orthodontist for any necessary adjustments and ongoing evaluation.

During this portion of the treatment plan your teeth will be moved into new positions. Often, the bite seems to be getting worse rather than better. You must keep in mind that the orthodontist is moving your teeth to coincide with the proposed surgical treatment. Only after the surgical treatment has been completed, your teeth will fit together in a more ideal position.

After orthognathic surgery has been completed it is often necessary that minor adjustments to the bite will be made by the orthodontist. If wisdom teeth are present at the initial consultation and the decision has been made to undergo orthognathic surgery either in the upper or lower jaws, it is highly recommended that these wisdom teeth be removed at least six months prior to the proposed procedures. By doing this the surgical time will be shortened and the surgical results will be more predictable.


Presurgical Records

After the presurgical orthodontic phase of your treatment has been completed, the oral and maxillofacial surgeon will meet with you to finalize the surgical procedure. During this visit, a new set of dental records will be obtained which will include a cephalometric film, a panoramic film, as well as new models of the teeth in the upper and lower jaws. This information will aid the oral and maxillofacial surgeon in finalizing the surgical movements as well as creating a surgical splint which will serve as a guide for proper intraoperative jaw positioning.


The Surgical Procedure

Orthognathic surgical procedures can range from one to several hours depending on the intricacy of the surgery required.

In lower jaw surgery, the rear portion of the mandible behind the teeth is separated and the tooth-supporting portion is moved forward or backward as dictated by the presurgical workup. In upper jaw surgery the maxilla can be repositioned forward, backward, or it can be raised or lowered.

In almost all cases the incisions required for this type of surgery are made within the mouth and there will be no visible external scars.


Postoperative Healing

The immediate post-surgical healing phase is one of the most important parts of your treatment. During this time it is very important to follow the instructions given to you by your oral and maxillofacial surgeon. During this time you can expect temporary swelling especially of the lips, cheeks, and perhaps bruising, but this is a normal healing response and will disappear over the first 7 to 14 days.

In the first few days after surgery you may experience a sore throat or nasal congestion due to the nasal tubes used for anesthesia. This postoperative discomfort is not usually significant and it may be controlled with medications.

During this time you might experience a drop in weight, however, this can be regained after the initial bone healing has been completed. During the first week after surgery your dietary intake is very important and we will advise you on different supplements which are available for you. You will receive a dietary consult while in the hospital and a supplementary pamphlet on different nutritional supplements which you can use. As always, if you should have any questions during this time, please feel free to ask your surgeon. He or she will be more than happy to discuss any concerns that you might have with you to your satisfaction.

The initial healing phase will take approximately six weeks, however, the completed healing process will require approximately 9 to 12 months. During this healing phase it is very important that you practice the best possible oral hygiene.

The post-surgical orthodontic treatment phase will commence approximately four to eight weeks post surgery. The orthodontist will be able to make minor adjustments to ensure that your new bite and your teeth are in the best possible relationship. Usually this phase requires 3 to 12 months after which your orthodontic appliances will be removed.


Follow-up Care

After the completion of your orthodontic and orthognathic treatment, your surgeon and your orthodontist will still need to see you periodically to monitor you and make sure your teeth and jaws are staying in their new proper position.