What is Orthognathic Surgery?

When uneven jaw growth occurs, or when injury or birth defects affect jaw alignment, the dental-facial relationship can become imbalanced.  Jaw misalignment can affect chewing, speech, breathing, appearance, and long-term health.  In these cases orthognathic surgery may be required to reposition the jaws.  An Oral and Maxillofacial Surgeon is the specialist best trained to perform these types of procedures.

Orthognathic surgery involves surgical manipulation of  elements of the facial skeleton – upper jaw, lower jaw, nose, cheekbones, chin, and orbital sockets of the eyes – to restore proper anatomic and functional relationships in patients with skeletal anomalies. 

While appearance may be dramatically improved, orthognathic surgery is usually performed to correct functional problems. 

Conditions that might indicate the need for surgery

Specific conditions which indicate that surgery might be necessary include: 

  • crooked, misaligned teeth
  • excessive tooth wear
  • a facial appearance which is not balanced, whether from the front or the side
  • difficulty biting food or chewing
  • receding chin
  • a protruding  jaw
  • sleep apnea
  • excessive showing of gums when smiling
  • excessive mouth breathing
  • jaw or jaw joint paint
  • lips do not meet without effort
  • injury to the face
  • birth defect

Although braces alone can correct certain bite problems, orthognathic jaw surgery may be necessary in conjunction with braces to correct jaw misalignment so that the braces may be effective.  Braces can only move the teeth so far, and if the mechanics are wrong, correction with braces may not be permanent.

Planning for surgery

For patients considering orthognathic surgery, the surgeon uses computer imaging technology and three-dimensional models to illustrate exactly how the jaws will be repositioned.  Comprehensive digital facial and oral photographs, digital X-rays and computer imaging are used to simulate the treatment plan, how the teeth will fit together (occlusion) and general appearance.  This helps the patient understand the surgical process and the anticipated outcome. 

Once the treatment plan is approved, surgical splints are custom-fabricated to ensure a highly predictable result, guiding the surgeon in the operating room.

Treatment will often include a period where braces are placed on the teeth prior to surgery.  This is done to move teeth into position so that they will fit together correctly after surgery. 

Incisions are usually made inside the mouth to reduce scarring.  Depending on the patient’s needs, jaws or other facial bones will be repositioned and stabilized using surgical plates, screws, wires, and rubber bands.   These hold jaws in their new position following surgery.

Braces may remain on the teeth for a period after surgery to ensure stability as the bone heals.

Following surgery

Following surgery, the patient often must eat a modified diet, which can include soft-foods and liquids.  The surgeon provides patients with diet instructions as well as a plan to transition to a normal diet.  Patients must also refrain from smoking and strenuous physical activity.  The patient can usually return to work or school within two to three weeks.  Initial healing takes about six weeks, but complete healing takes between six and twelve months.

The positive impact of surgery

Orthognathic surgery can have a positive and dramatic impact on a person’s quality of life.  Although the goal is to improve function and health, it is not uncommon for patients to experience a more balanced appearance and improved speech.  What could be more satisfying than to do something that improves your health while making you look even better?

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