WHAT IS 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.
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 food
- 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
- SLEEP APNEA
Patients who suffer from sleep apnea by definition have difficulty breathing while sleeping secondary to an upper airway obstruction. This obstruction can be mild, moderate or severe.
The treatment modalities are patient dependent and related to the severity of the obstruction.
The treatments vary from sleeping with a cpap breathing device, surgical correction of the palate and/or the tongue, Jaw repositioning devices and finally repositioning jaw surgery.
EVALUATING YOUR NEED FOR ORTHOGNATHIC SURGERY
In diagnosing your need for orthognathic surgery, our office and the orthodontist will work closely together. The orthodontist is responsible for moving the teeth so they will fit together property after the jaws have been repositioned, and we are responsible for repositioning the jaw(s) so the teeth and jaws are in proper alignment.
Before any treatment begins, an initial consultation will be held to answer any preliminary questions you may have. It is important to understand that your treatment, including pre-surgical orthodontics, orthognathic surgery, and post-surgery healing, may take from several months to two years or more to complete. You should be prepared to make a long-term commitment in order to derive the benefits of orthognathic surgery, and in some cases psychological counseling may be an important part of the treatment process.
After the initial consultation, a thorough examination with facial measurements, photographs, x-rays and dental impressions will be made. A medical history will also be taken to ensure that there are no health problems that would interfere with surgery or the administration of anesthesia. If inputs from other specialists are needed, you will be referred for additional consultations as appropriate. Based on the results of our examination, consultations and other diagnostic procedures we will decide on the course of treatment that is best for you. Depending on the extent of your problem, orthodontic treatment alone may be sufficient, or orthognathic surgery may be indicated.
Steps in Orthognathic Surgery
Orthodontics
Pre-surgical orthodontics will move your teeth into a new position, so they will fit together properly when the jaws are surgically repositioned. After surgery, final orthodontic tooth movement is usually necessary to “fine-tune” your bite. Following removal of your braces, you may be required to wear a retainer.
If you still have your wisdom teeth or your teeth are too crowded, it may be necessary to remove certain teeth prior to beginning orthodontic treatment in order to make space for proper tooth movement.
The Surgical Procedure
Orthognathic surgery is performed in a hospital under general anesthesia. Any required lab tests will also be done prior to surgery.
Orthognathic surgical procedures last anywhere from one to several hours, depending on the amount and type of surgery needed. Other facial bones that contribute to the imbalance may also be repositioned, augmented, or reduced to size.
In most cases, incisions are made inside the mouth and there will be no visible external scars. If it is necessary to make an external incision, care is taken to conceal it in natural skin creases.
Immediately Following Surgery
The length of your hospital stay can be one or more days. You can expect temporary swelling, especially of the lips and cheeks, and perhaps bruising, but this is a normal healing response and should disappear over time. For the first few days after surgery you may experience nasal congestion or sore throat due to the nasal tubes used for anesthesia. Post-operative discomfort is usually not significant and can be controlled with medications.
To aid in healing, your jaws may be prevented from moving with the use of fixation appliances.
While your jaws are fixed and healing, you may consume a liquid diet. During this time period you may lose weight, but this can be regained after the fixation period is over. During the first week after surgery your dietary intake is very important.
Smoking is highly discouraged as it can retard the healing process.
During Healing
You should be able to return to work or school as soon as you feel up to it, often within 4-6 weeks for most people. You will be seen in our office for regular evaluation visits, and it is very important that you keep these appointments. We will monitor your healing, and at the appropriate time, remove fixation devices.
The initial healing phase will take approximately 6 weeks, but completion of the healing process will take 9 to 12 months. During the entire healing phase it is critical that you practice the best oral hygiene. Our office and your orthodontist can assist you in this area.
The orthodontist will usually begin the post-surgical phase of orthodontic treatment 8 weeks after surgery to “fine tune” your bite. In most cases braces are removed within 6 to 12 months following surgery.
Follow-up Care
After your orthognathic surgery and related orthodontic treatment are completed, we will want to see you periodically to monitor you and make sure your teeth and jaws are staying properly aligned. You should maintain your oral health and visit your family dentist regularly, and have any other needed dental work completed.