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 dental 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.
Jaw growth is a slow and gradual process. Occasionally, something may go wrong with this process and the upper and lower jaws may grow at different rates.
UNEQUAL JAW GROWTH—A CAUSE FOR CONCERN
One or both jaws may grow too much or too little. The resulting abnormality may interfere with proper teeth alignment, speaking and chewing. The tongue and lips may be forced to move awkwardly during speech and swallowing in an attempt to compensate for the jaw mal-relationship. There may be a speech defect or excessive mouth breathing. An improper bite may threaten the long-term health of the gums and teeth. The jaw joint (TMJ) can also be adversely affected by a jaw mal-relationship. In addition, jaws of different sizes—that don’t match—can affect appearance.
When unequal jaw growth is the source of the problem, corrective jaw surgery may be necessary. Orthodontic treatment (braces or other appliances) may also be needed to allow the teeth to align properly. Corrective jaw surgery involves moving all or part of the upper and/or lower jaw into a more favorable position. For example, the entire jaw can be moved backward if it’s too large. The goal of treatment is to improve function and restore facial balance. Some people have facial abnormalities involving just the upper face, cheek bones and nose. These can also be surgically corrected. The bones are repositioned so the facial features are more symmetrical. This is usually accompanied by the return of normal breathing, speaking and eating patterns. After the jaws are moved into their new position, rubber bands or wires attached to the teeth may be used to fasten the jaws together during healing. Alternatively, rigid internal fixation with miniature screws and plates may be used to allow you to open and close your jaws sooner after corrective surgery.
TAKE A CLOSER LOOK
Take a closer look at your bite and appearance. Does your chin stick out? Does it recede? Do your teeth fit together properly? Do you have “buck” teeth? Are your teeth straight? If you suspect there’s cause for concern, have your oral and maxillofacial surgeon examine your face and bite.