What is Corrective Jaw Surgery (Orthognathic Surgery)?
Orthognathic surgery is sometimes called “Surgical Orthodontics” because, just as an orthodontist repositions teeth, an oral and maxillofacial surgeon uses orthognathic surgery to reposition one or both jaws. Just as “orthodontics” means “straight teeth,” “orthognathic” means “straight jaws.”
In fact, because moving the jaws also moves the teeth, orthognathic surgery is usually performed in conjunction with orthodontics so that the teeth are in proper position after surgery. The objective of orthognathic surgery is the correction of a wide range of minor and major facial and jaw irregularities, and benefits include an improved ability to chew, speak, and breathe. In many cases an enhanced appearance can also result.
Who needs orthognathic surgery?
People who can potentially benefit from orthognathic surgery include those with an improper bite and those with jaws that are positioned incorrectly. Jaw growth is a slow and 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.
While orthodontics alone can correct many “bite” problems if only the teeth are involved, orthognathic surgery may be required if the jaws also need repositioning.
The following are some of the conditions that may indicate a need for orthognathic surgery:
- difficulty chewing or biting into food
- difficulty swallowing
- speech problems
- chronic jaw pain
- excessive wearing of teeth
- open bite (space between upper and lower front or back teeth when mouth is closed)
- unbalanced facial appearance
- facial injury or birth defects
- receding chin
- protruding jaw
- inability to make lips meet without effort
- chronic mouth breathing with dry mouth
- sleep apnea (breathing problems when sleeping such as snoring)
Unequal growth of the jaws, injury, or birth defects can produce problems and symptoms that require treatment by a team that usually includes an oral and maxillofacial surgeon, and orthodontist, and sometimes your dentist. In order to determine if you are a candidate for orthognathic surgery, an evaluation of your condition by this team in necessary.
Phases of Orthognathic Surgery
In most cases pre-surgical orthodontic treatment is necessary to move your teeth into a new position prior to your surgery. During your surgery, adjustments will be made to your jaw to reposition them so that they fit together properly. Because your teeth are moved into a position that will be correct after surgery, you may think that your bite is getting worse rather than better during this phase of treatment. If you still have your wisdom teeth or other crowding, it may be necessary to remove certain teeth prior to beginning orthodontic treatment in order to make space for proper tooth movement.
As your pre-surgical orthodontic treatment nears completion, an appointment with Dr. Pitts will be necessary to make final preparations for the surgical procedure. Additional records will be taken. Dr. Pitts will look at your models and the most recent x-rays of your teeth and jaws to “simulate” surgery in order to finalize the surgical movements of your jaws. In other words, he will be doing several mock surgeries on paper as well as surgical models to insure that his predictions will give you the optimum final results.
Preparing For Surgery
Dr. Pitts will see you one more time in his office prior to your surgery. At this appointment he will do a history and physical as is required by the hospital before admission. Dr. Pitts will review your most recent health information and collect basic data about your current physical health. Orders for any tests that may be necessary prior to surgery are written up and a surgical consent form is signed.
You will receive a packet of information that you will take with you to the hospital upon admission. In most cases, you will check into the hospital on the day of your surgery. Your anesthesiologist will discuss the general anesthetic procedure to be used. In addition to the general anesthesia that is given to “put you to sleep,” you will be receiving intravenous fluids and medication to prevent dehydration and infection, and to minimize pain and swelling. It is very important that you adhere to any medication schedule or diet prescribed by your surgeon.
The Surgical Procedure
The orthognathic surgery itself will take several hours depending on the amount and type of surgery needed. Certain movement may require the jaws to be separated into several parts, with bone added or removed to achieve the proper alignment and stability. Other facial bones that contribute to the imbalance may also be repositioned, augmented, or reduced in size. For almost all orthognathic cases, incisions are made inside the mouth and there will be no visible external scars.
The most common types of procedures used are:
Mandibular Osteotomy –
(Also called a Mandibular Split) – Allows for moving the lower jaw back or forward to create a more stable bite and improve esthetics. This procedure can also be used to rotate the jaw if necessary.
Maxillary Le Forte Osteotomy –
Allows for repositioning of the upper jaw (maxilla). The jaw can be cut into pieces, if necessary, to reposition bony segments in their most ideal positions.
Another frequent procedure is a Genioplasty. A genioplasty can be used for repositioning the chin for a better esthetic result. It can be performed as a separate procedure, or can be performed at the time of your orthognathic surgery.
Immediately after surgery
You will be moved to the recovery room until the general anesthesia has worn off. Your family may not be allowed in the recovery room, but they should be able to visit you shortly thereafter. An IV will be attached to your arm to provide required medications and nutrients until you are able to take sufficient liquids by mouth. Medications may be administered to control post-surgical discomfort. The length of stay in the hospital can be one or more days.
You can expect temporary swelling, especially of the lips and cheeks. Bruising may also result. These conditions are a part of your body’s normal healing response and should disappear during your initial recovery time. To aid in healing, your jaws may need to be prevented from moving. This is done with the use of fixation appliances. In many cases the jaw sections are held together during the healing period by small screws and surgical plates placed by Dr. Pitts. Additionally, in some cases wires are used to hold the bones together and keep the jaws from moving during healing.
After your surgery, you can expect that your teeth will be wired together for one week. While your jaws are in fixation and healing, you will need to consume a liquid diet. Some weight loss may occur during this time but can be regained after the fixation period is over. During the first week after surgery your diet is extremely important. If necessary, you may need to supplement your diet with liquid vitamins or diet supplement drinks (example would be Ensure). A blender can be used to liquefy almost any food to provide a balanced diet. Initially, drinking through a straw can be challenging. We’ve found a product that helps you consume adequate amounts of fluids and pureed food. It is called a Zip-n-Squeeze bag. Checking out books on smoothies and juicing is also a good idea. The more varied and satisfying your diet is, the better your experience will be. Good nutrition is very important.
Smoking is highly discouraged post-operatively for any surgical procedure, but especially following orthognathic surgery. Smoking can unnecessarily inhibit the healing process.
Strenuous activities should be avoided during the first few post operative weeks during healing.
When you leave the hospital
You should be able to return to work or school as soon as you feel like it. Most patients are back to their normal routine within 1-2 weeks.
Your appearance may have changed somewhat due to the repositioning of your jaws and associated swelling. Friends and family may show signs of surprise, but it won’t take long for them to adjust to the new you.
You will see Dr. Pitts and your Orthodontist for regular evaluation visits. It is extremely important that these appointments are made in a timely manner and kept. Dr. Pitts will monitor your healing which will allow him to determine the appropriate time to remove any fixation devices that may have been used.
The initial healing process will take approximately 6 weeks. The compete healing process may take anywhere from 9 to 12 months. It is important to maintain a high level of oral hygiene during the entire healing process. The Orthodontist will usually begin the post-surgical phase of orthodontic treatment 8 to 12 weeks after surgery to make any minor adjustments to your bite that may be necessary. In most cases braces are removed within 6 to 12 months following surgery.