Orthognathic (Jaw) Surgery

What is Orthognathic Surgery?

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. This may be necessary as a result of congenital abnormalities, growth disturbances or trauma. Correction of these abnormalities generally results in improvement in function such as chewing, speaking and breathing and often enhances facial esthetics.

Whenever a jaw and bite abnormality is severe enough that orthodontics alone cannot correct the problem, surgery is often necessary. In this type of case the orthodontist moves the upper teeth into their best position in relation to the upper jaw and the lower teeth into the best position in relation to the lower jaw. Surgery is then necessary to correct the position of either the upper jaw, lower jaw or both. After the jaws are repositioned, the orthodontist is then able to properly finish the bite into the best possible relationship. Surgery may also be helpful as an adjunct to orthodontic treatment to enhance the long term results of orthodontic treatment, and to shorten the overall time necessary to complete treatment.

In order to help answer some questions which you may have about surgical treatment, the following information is provided.

Why Have Surgery?

There are several reasons why correction of a jaw abnormality through orthodontics and surgery may be beneficial. Some of these reasons are listed here:

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.

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.

Evaluation and Planning Sequence

Initial Evaluation
During this appointment we will discuss your concerns and goals for orthodontic and surgical treatment. We will do a thorough history and clinical examination and obtain the necessary records for complete treatment planning. These records may include:

• Photographs of your face and bite.
• Special radiographs (xrays) designed for evaluation of facial bones.
• Computerized digital photograhs of your face.
• Dental impressions of your teeth so that study models can be made. Many of these records may be completed by your orthodontist and, in some cases, these records can be used rather than repeating the process.

Treatment Planning Consultation
At this time the results of our evaluation and treatment recommendations will be presented to you and any family or friends who you feel should be involved in this process. We will use your photographs, radiographs (xrays), computerized video images and/or models to show you what type of treatment will be necessary. We will also show you illustrations of the type of surgery which we are recommending for you as well as examples of similar cases. We will attempt to answer all of your questions at this time. However, if questions arise in the future please do not hesitate to call us for a phone discussion or to make another appointment to discuss your surgery in person.

On many occasions the initial evaluation and treatment plan consultation may be completed at the same time.

Insurance Preauthorization
In many cases the surgical portion of your treatment may be covered in part by major medical insurance. Our office will help you by obtaining a predetermination for the insurance coverage on the anticipated surgical treatment plan. This will allow you to anticipate any financial obligation not covered by your insurance. Our surgery coordinators will help you with any questions you have regarding insurance coverage.

Treatment Sequence

Preoperative Preparation
(From now until a few weeks prior to surgery) Prior to the time jaw surgery is completed, the orthodontist will place orthodontic appliances (braces) on your teeth. If it is necessary to remove any teeth to help with this alignment, it will be done at this time. The orthodontist will attempt to align the upper teeth properly in the upper jaw and the lower teeth properly in the lower jaw prior to surgery. This may not be completely finished before surgery since it may be impossible to finalize the alignment of teeth until the jaws are placed into their proper position.

Immediate Presurgical Period
(A few weeks prior to surgery)

• During this time the orthodontist will place “surgical wires or hooks” on your upper and lower braces. These wires will have small hooks or wire loops which will be used to help place your teeth in the proper position during surgery and to help hook on small elastic rubber bands or wires after surgery.
• New records will be taken to formulate the final details of your treatment plan. New photographs, models, radiographs (xrays), and digital photographs will be completed a few days or weeks prior to surgery.
• A few days before surgery we will complete a history and physical exam. Your doctor and an assistant will talk with you about the details of surgery and answer any of your questions. You will be given instructions for care after your surgery and prescriptions for any medicines you may need.

Surgical Routine for Outpatient Surgery in our Office or Surgery in the Hospital

• You will be given a time to come to the hospital or the office an hour or two prior to your surgery to complete the checkin process.
• You will then be taken to the operating room where your surgery will be completed.
• After surgery you will be taken to the recovery room where you will stay for 1 to 2 hours while you wake up.
• In many cases you will be discharged from the recovery room. If you are staying overnight in the hospital you will be taken to your room on the floor in the hospital.
• If you stay in the hospital you will be discharged in the afternoon on the day or surgery or the following morning. In some cases a longer hospital stay may be necessary. This depends on how you are feeling, how much swelling you have, and whether or not you are taking enough liquid orally that you no longer require an IV.

Who Participates in the Care of an Orthognathic Surgery Patient?

When undergoing surgical treatment to correct jaw abnormalities, a large team of people is involved.

• The orthodontist and his/her office staff.
• The surgeon, surgical assistants and office staff.
• The anesthesiologist.
• Operating room personnel.
• Nurses and other health care professionals who work in the hospital.
• On occasion other dental and medical specialists such as periodontists, endodontists, prosthodontists, plastic surgeons, and otolaryngologists may be consulted for specific needs when indicated. If this is necessary, the reasons will be explained to you and the specialist will be contacted.

Potential Risks and Complications Associated with Surgery

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:

Side effects of any surgical procedure
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 with jaw surgery
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.

Damage to normal structures such as gum, tissue, bone, or teeth
Again, this type of problem is extremely rare.

Numbness or decreased sensation
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.

Risks associated with anesthesia
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.

Recovery After 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.

Jaw Movement
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.

Diet
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.

Physical Activity

• 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.