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Orthognathic Surgery |
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Orthognathic surgery is also known as corrective jaw surgery. It is used to treat a variety of facial and jaw abnormalities in which the facial bones and teeth are not correctly developed. This results in difficulty with chewing, speech, and jaw function. In many cases, the facial appearance is affected by this problem. Orthognathic means "straight jaws", and orthognathic surgery corrects these jaw and facial deformities, usually in conjunction with an orthodontist, so that after the jaws are corrected, the teeth will come together properly. Sometimes, braces alone can correct a problem with the bite, but when it is severe, usually orthognathic surgery is required. Abnormal jaw and facial development can be genetic or acquired due to disease or injury. When the jaws are not properly developed or proportioned, problems such as difficulty chewing, jaw and facial pain, speech abnormalities and dental problems can result. Using sophisticated surgical techniques, the facial bones can be repositioned in order to restore proper function and facial appearance.  In
the past, thin wires were used to support the bones in the new positions,
but because this was not stable, the patient also had to endure periods of
6 to 12 weeks of "intermaxillary fixation," or having their
teeth and jaws wired together. Not only was this uncomfortable, but oral
hygiene was difficult and post-operative weight loss was a problem.
Today, miniature titanium plates and screws are used to fixate the facial bones in their new relationship. This is much more comfortable for the patient, but it is also more stable and predictable.
This, in combination with new instruments and anesthetic techniques, has allowed orthognathic surgery to be safer and more effective, and is much easier for the patient to undergo. New advances in orthodontics have also allowed the total treatment times to be shortened. We also use the latest in digital imaging technology, which allows for computerized treatment planning, and visualization of the anticipated surgical changes to the patient's facial appearance. This helps the patient understand both the functional and esthetic benefits of the procedure. In addition, some patients may decide to have other cosmetic procedures done in conjunction with orthognathic surgery to further enhance their facial appearance. These include procedures to the chin, cheeks, eyes, nose, neck and facial skin. If the upper jaw is in normal position, but the lower jaw is retruded, the lower jaw is brought forward to its proper position. Small screws hold the bones in their new positions.
Sometimes, the problem is in both the upper and lower jaws. Here, the upper jaw is brought down and forwards, and the lower jaw is moved back. A combination of plates and screws stabilize the surgical result.
Orthognathic surgery is performed in the hospital or outpatient surgical center. Patients generally stay in the hospital 1-2 nights, depending on the extent of surgery done. Most patients state that the post-operative discomfort is much less than they were expecting. Almost all patients agree that they are happy with the results and would go through the surgery again, without hesitation. The improvement in jaw function and facial appearance is remarkable. Most patients experience a great improvement in their self-confidence and quality of life after orthognathic surgery. |
Patient A This patient was 18 years old. His orthodontist determined that his underbite was due to overdevelopment of the lower jaw, and was too severe to correct by braces alone. He went through about 12 months of braces prior to surgery in order to straighten the teeth within the upper and lower jaws.
His surgery
consisted of a mandibular osteotomy to set the lower jaw into the proper
relationship to the upper jaw and face. About 6 months of orthodontics was
required after surgery to "fine-tune" the bite. Patient B This 23 year old woman was first seen because of pain on both sides of the jaw when chewing. She also awoke with headaches and neck pain. She also had tenderness and clicking of her temporomandibular joints. She was treated successfully with medications and a night guard. It was apparent that her problem was due to an altered relationship between her jaws, which affected the biomechanics of her jaw joints and chewing muscle. She was also unhappy with her facial appearance and felt that it was difficult to bring her lips together without straining.
After 9 months of presurgical orthodontic treatment, she had orthognathic surgery to move her upper jaw (maxilla) upwards, and a genioplasty to advance her chin. Her postoperative orthodontics took about one year. Patient C This 49 year old man needed treatment because of continued growth of his lower jaw through adulthood. His bite became progressively worse, until chewing was difficult. Soon after starting braces, he underwent an outpatient procedure to assist the orthodontist in widening his upper jaw. After one year of orthodontics to align his teeth, surgery was performed. His lower jaw was moved backward and the upper jaw was brought down and forward to properly relate his facial bones and allow his teeth to contact.
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