Corrective Jaw Surgery
also called orthognathic surgery – is performed by an oral and maxillofacial surgeon (OMS) to correct a wide range of minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth. Surgery can improve breathing, chewing and speaking.
While the patient’s appearance may be dramatically enhanced as a result of the surgery, orthognathic surgery is performed to correct functional problems.
The Following Are Some Of The Conditions That May Indicate The Need For Corrective Jaw Surgery
- Difficulty chewing or biting food
- Difficulty swallowing
- Chronic jaw or jaw joint (TMJ) pain and headaches
- Excessive wear of 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
- Birth defects
- Receding lower jaw and chin.
- Protruding jaw
- Inability to make the lips meet without straining
- Chronic mouth breathing
- Sleep apnea (breathing problems when sleeping, including snoring)
Types Of Jaw Surgery
- Maxillary Osteotomy (Upper Jaw) This type of surgery corrects a significantly receded upper jaw, cross bite, or when you have too many or too few teeth showing.
- Lefort 1,2,3 osteotomy
- Mandibular Osteotomy (Lower Jaw) This surgery corrects a significantly receded lower jaw.
Genioplasty (Chin) - Sagittal split osteotomy {BSSO}
- Rapid palatal expansion osteotomy
Surgery
Orthognathic surgery is performed in collaboration with an orthodontist by an oral and maxillofacial surgeon. It frequently includes braces before and after surgery, as well as retainers after braces are removed. Orthognathic surgery is frequently required following cleft palate reconstruction or other major craniofacial anomalies. Coordination between the surgeon and orthodontist is critical to ensuring that the teeth fit properly after surgery.
Planning
A multidisciplinary team, including oral and maxillofacial surgeons, orthodontists, and, on occasion, a speech and language therapist, is usually involved in surgery planning. The surgery usually results in a noticeable change in the patient’s face; occasionally, a psychological evaluation is required to assess the patient’s need for surgery and its predicted effect on the patient.
The main goals of orthognathic surgery are to achieve a correct bite, an aesthetic face, and an enlarged airway. Great care needs to be taken during the planning phase to maximize airway patency.
Technique
All dentofacial osteotomies are performed under general anaesthesia, which renders the patient completely unconscious. General anaesthesia enables surgeons to perform dentofacial osteotomies without involuntary muscle movement or minor pain complaints. The surgery could involve one or both jaws at the same time.
During the surgery, the jaws will be wired together (inter-maxillary fixation) with stainless steel wires to ensure proper bone repositioning. Most of the time, these wires are removed before the patient awakens. Some surgeons, however, prefer to wire the jaws shut instead.
Post-Operation
After orthognathic surgery, patients are often required to adhere to an all-liquid diet for a time.
Weight loss due to lack of appetite and the liquid diet is common. Normal recovery time can range from a few weeks for minor surgery, to up to a year for more complicated surgery. There is often a large amount of swelling around the jaw area, and in some cases bruising. Most of the swelling will disappear in the first few weeks, but some may remain for a few months.
Recovery
All dentofacial osteotomies require an initial healing time of 2–6 weeks with secondary healing (complete bony union and bone remodeling) taking an additional 2–4 months.
The jaw is sometimes immobilized (movement restricted by wires or elastics) for approximately 1–4 weeks. However, the jaw will still require two to three months for proper healing.
Cleaning of the mouth should always be done regardless of surgery to ensure healthy, strong teeth. Patients are able to return to work 2–6 weeks after the surgery but must follow the specific rules for recovery for ~8 weeks.
