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Orthognathic and Jaw Surgery

Orthognathic surgery, or corrective jaw surgery, is used to correct severe jaw malocclusion (misalignment) that cannot be fully corrected with orthodontics. Surgery involves changing the position of the maxilla (the upper jaw), the mandible (the lower jaw) and/or the alveolar bones (the bones that support the teeth). Proper alignment of the jaws and teeth can improve your ability to chew, speak and breathe. It can also improve the appearance of a person’s smile and facial profile.

What causes jaw abnormalities?

A number of medical diagnoses can cause problems with jaw and facial growth including cleft lip and palate, isolated cleft palate, hemifacial microsomia, Pierre Robin syndrome, craniosynostosis, Treacher Collins syndrome, ectodermal dysplasia, and jaw injury or fracture. However, children without an underlying medical diagnosis can also develop jaw anomalies.

Who is a candidate for orthognathic surgery?

In proper jaw alignment, the upper jaw and teeth project slightly farther than the lower teeth. If the jaws are not properly aligned, you may experience difficulty chewing food, difficulty biting into food, breathing problems or jaw pain. Misalignment of the jaw can also put the teeth at risk for becoming worn down.

Orthognathic surgery may be recommended for you if they have one or more of the following jaw abnormalities:

  • Severe underbite, meaning the lower jaw projects forward beyond the upper teeth. This can be due to a small or underdeveloped upper jaw (common in children with a cleft palate) or a large or overdeveloped lower jaw.
  • Severe overbite, meaning the upper jaw projects abnormally forward beyond the lower teeth, causing the lower jaw to appear receded. This can be due to an underdeveloped lower jaw (common in children with Treacher Collins and Pierre Robin syndromes) or an overdeveloped upper jaw.
  • Open bite, when the upper and lower jaws grow at an outward angle, which prevents the teeth from touching each other properly.
  • Uneven or asymmetrical jaws, meaning one side of the jaw grows at a faster or slower rate than the other, causing jaw or facial asymmetry. The chin may deviate to the left or right (common in people with hemifacial microsomia).

Preparing for corrective jaw surgery

Typically, corrective jaw surgery is performed after the face and jaw have stopped growing. This is necessary to ensure that you do not outgrow the correction. In most cases, the jaw and face have completed growth around 15 to 18 years of age.

Most patients require about 6 to 12 months of orthodontic treatment before surgery to properly align the teeth as well as an additional 6 to 12 months of orthodontic treatment after surgery to finalize the bite. Prior to surgery, your orthodontist will work with your surgeon to plan the surgical movements. Planning is performed with the aid of x-rays, CT scans and computer software to ensure that the jaw movements are customized and

precise. This will also aid in deciding if you will benefit from one or more of these procedures, in order to maximize function of the jaw and teeth and improve outward appearance of not only the jaw but soft tissue as well.

Surgical procedures

You will receive a general anesthetic and be completely asleep during your operation. Once you are asleep a nasal airway will then be placed to allow the team to work and have a stable airway. Surgery can range from two to six hours, and all the incisions are located inside the mouth. Once the jaws are properly aligned, the surgeon will secure the bones of the jaw into place with small plates and screws. An acrylic splint will be placed and wired to your upper jaw. This will allow your bottom jaw to fall into the new bite that was created. Elastic bands will also be in place to secure your bite.

When you awaken your operation will be completed and you will be in the recovery room. Most patients will be in the recovery room approximately two (2) hours before they are awake enough to be safely transported to a hospital room. This is a critical phase of your recovery and family are generally not permitted in the recovery room. You will have ice packs on your face and you will receive 1.V. pain medication as well as medication for nausea as needed. Many patients have very little recollection of the recovery room because of the lingering effects of the anesthetic.

Types of Orthognathic Procedures

► LeFort I, IT & III Osteotomies

Unlike BSSO surgery, Lefort procedures aim to correct facial irregularities by moving the upper jaw and/or the midface. Lefort surgery, depending on the type, can correct a host of problems, including a face that appears too long or too short, a “gummy” smile, and over- or underbites.

► LeFort I osteotomy

The most common of the Lefort procedures, this procedure corrects problems such as a “gummy” smile, long face or overbite by repositioning the upper jaw. Depending on the pa_tient’s needs, the bone of the upper jaw is repositioned, and/or part of the jawbone itself is removed. Plates and screws are then applied to allow bone to grow and heal naturally.

► LeFort II osteotomy

When the midface has a deformity, this procedure may be performed. During this surgery, the upper jaw, as well as some of the facial bone, is repositioned. Lefort II osteotomies aim to correct growth abnormalities in the midface, and problems such as sleep apnea or malocclusions.

► LeFort III osteotomy

This procedure is quite similar to a LeFort II osteotomy, except more facial bone has to be repositioned. It is one of the most common procedures used to treat midfacial hypoplasia, which causes the midface and eye sockets to not develop fully, resulting in a bug-eyed appearance and an underbite.

► Bilateral Sagittal Split Osteotomy (BSSO)

An osteotomy is any procedure in which a bone is cut in order to reposition it or change its length. A bilateral sagittal split osteotomy (BSSO) is a surgery aimed at correcting a lower jawbone that is too short or too long. This procedure can improve functions such as biting or speaking and can radically improve a person’s appearance. Prior to the procedure, an orthodontist applies dental braces to ensure the teeth will be properly aligned following surgery. Once the teeth are aligned, the patient is ready for the BSSO.

During the surgery, incisions are made below the teeth to expose the jaw. The jawbone is then carefully cut on both sides and moved forward or backward to an ideal position. Plates and screws are then applied to allow bone to grow and heal naturally. While many patients can achieve an ideal facial structure with BSSO alone, others choose to undergo an additional chin procedure called genioplasty.

► Genioplasty

When a chin is weak, misaligned or disproportionate to the rest of the face, a genioplasty may be performed.

This procedure takes one of two forms: sliding the chinbone forward or inserting an implant. Prior to a “sliding genioplasty,” an incision is made behind the lower lip. The chinbone is then cut and moved into the ideal position. Plates and screws are inserted to allow bone to grow and heal naturally.

Depending on their cosmetic needs, many patients benefit from chin implants. During the procedure, an implant made of silicone or another soft, flexible material is inserted into the chin through a small incision. The implant may be placed into a pocket or secured to the bone with screws for long-lasting results. This procedure generally takes about 30 minutes to perform, and patients are usually able to return to work and other regular activities the next day.

Many patients opt for a genioplasty following certain other surgeries. This procedure is commonly used to enhance the results of a jaw lengthening procedure or to improve facial balance following a nose surgery.