What is Orthognathic Surgery?
Orthognathic surgery (Corrective Jaw Surgery) is the use of surgical procedures to correct imbalance in the upper and lower jaws. These procedures may be used to treat an abnormality where the teeth do not fit together properly (malocclusion), to treat airway obstruction when a patient is asleep (obstructive sleep apnea), or to improve the balance and appearance of the face. Often patients who are undergoing orthodontic treatment with braces may find that an imbalance of their jaws make it impossible for their bite to be corrected without repositioning the jaws. Treatment with orthognathic surgery is carried out with combined management between an orthodontist and a surgeon.
What Kinds of Conditions are Treated with Orthognathic Surgery?
As many as 15% of patients have dental and jaw abnormalities that cannot be corrected with braces alone and may be candidates for orthognathic surgery. Patients undergoing braces with an orthodontist may wish to discuss if they will require orthognathic surgery as part of their treatment.
Additionally, many craniofacial syndromes and conditions such as cleft lip and cleft palate, syndromic craniosynostosis (Apert, Crouzon, Pfeiffer, Muenke, Saethre-Chotzen, etc.), Hemifacial microsomia, Treacher Collins syndrome, Miller syndrome and Nager syndrome cause imbalances of the upper and lower jaws that are improved with orthognathic surgery.
What are the Benefits of Orthognathic Surgery?
Patients may suffer significant wear and injury to their teeth over time if they have a condition where their teeth do not fit together properly (malocclusion). In cases with significant malocclusion, surgery may been needed to place the jaws in the correct position in order to achieve a normal bite that will improve the appearance and life span of the teeth.
Patients who have significant trouble breathing at night (obstructive sleep apnea) may benefit from having their jaws advanced to open their airway in the back of their throat. Patients often have significant improvement or are cured from their sleep apnea when these procedure are performed in the correct patient.
Along with the functional concerns related to a patient’s teeth and breathing, orthognathic operations may dramatically enhance a patient’s appearance. Not all patients experience the same benefit, but correction of significant jaw discrepancies may result in a more harmonious facial balance, and expansion of the facial skeleton often results in changes that make a patient appear youthful for longer.
How are Patients Evaluated for Orthognathic Surgery?
Orthognathic surgery is completed with a team comprised of a surgeon and an orthodontist. The orthodontist uses braces and other appliances to align the teeth appropriately in the upper jaw (maxilla) and lower jaw (mandible). Prior to beginning treatment, the orthodontists will take a series of X-rays, photographs, and dental impressions.
Extensive analysis of these will be used to determine the best treatment plan to align your teeth and improve your appearance. At this time, your orthodontist may discuss with you if they think jaw surgery will be needed to address all of your concerns. Typically, you will make an appointment to meet with your surgeon early during your orthodontic treatment to learn about orthognathic surgery and your suggested treatment. If you think you might need jaw surgery and do not have an orthodontist, we can refer you to a local orthodontist who can assist with your care.
Once the orthodontist is nearing completion of your treatment, a full set of orthodontic records will be taken again so we can plan your operation. This includes X-rays, photographs, and dental impressions. At Johns Hopkins All Children’s Hospital we now have an i-CAT cone beam CT scanner. This instrument allows us to obtain all of the information typically obtained with standard X-rays along with an extensive amount of 3D imaging information without increasing the dose of radiation. The CT scan and 3D-photographs taken in our plastic surgery clinic allows your surgeon to use the latest technology to plan your operation in 3D. All of this preparation is used to create dental splints that permits the surgeon to take their plan to the operating room and perform the operation exactly as it was planned with the orthodontist.
What are the Most Common Orthognathic Procedures Performed?
Le Fort I Osteotomy
This procedures involves separating the upper jaw (maxilla) from the other facial bones. The upper teeth can be then moved forward, rotated, or moved up/down to lengthen or shorten your facial appearance. The upper jaw is placed precisely where the surgeon and orthodontist planned and is then fixed in place with titanium plates and screws. These do not set off metal detectors and do not need to be removed.
Bilateral Sagittal Split Osteotomy
This procedure makes precise cuts in the lower jaw (mandible) on both sides. The lower teeth and chin can then be moved forward, backward, or rotated. The teeth are also precisely placed in their planned location and the mandible is fixed in its new location with titanium plates or screws.
This procedure combines a Le Fort 1 and bilateral sagittal split osteotomy to correct more complex deformities that affect both the upper and lower jaw. Patients with significant facial asymmetry, abnormalities in both jaws, larger distances between their upper and lower teeth, or syndromic conditions may require this operation. Both operations can be safely combined without increasing your recovery time
A genioplasty separates the chin point from the rest of the lower jaw and allows it to be moved forward, lengthened, or shortened without moving the teeth. This operation may be a great option for patients with a weak chin but who do not need braces to improve their occlusion.
What Should I Expect After Having Orthognathic Surgery?
Most patients spend 1 or 2 night in the hospital after jaw surgery. Patients undergoing just a genioplasty often return home the day of their operation. Typically, elastic rubber bands are placed on your braces to guide you into your new bite. Patients may drink after surgery and will need to remain on a soft or pureed food diet for 6 weeks after the operation. It is important to brush your teeth and keep your mouth clean. It is very common to feel swollen after surgery. This will improve after the operation.
Patients have some discomfort that will be helped with pain medications, but patients typically notice numbness and swelling more than pain. This numbness improves in the weeks or months after surgery but sometimes will last up to a year in small areas of your upper or lower jaw that have little functional significance.
Six weeks after your surgery, the orthodontists will begin to make final adjustments to the location of your teeth. Typically, this final stage of treatment requires around 6 months to complete the final bite, but may take longer depending on details of your case. After your orthodontist has removed the braces, it is very important to wear your retainer as they instruct you. Small shifts in the teeth can result in more noticeable changes in how your teeth fit together.
Patients are typically very happy with how their surgery improves their ability to bite and chew and with the changes they see in their appearances. Patients with sleep apnea treated with orthognathic surgery sleep better and may benefit from significant improvement in various medical conditions.