Orthognathic Surgery

What Is Orthognathic Surgery?

Orthognathic surgery is treatment performed to realign the jaws. This treatment  restores normal function and often stops the progress of local disability, enhances the quality of life, and boosts self esteem for those patient’s with dentofacial deformities.

Who Is A Candidate For Orthognathic Surgery?

Most individuals who become orthognathic surgical patients are aware of their problem prior to the diagnosis.  As our jaws mature through the course of normal growth and development, it is possible for the growth of one of the jaws to become altered or cease growing. For any number of reasons the jaws can remain disproportionate in size and shape. The cause of this disharmony and disproportionality is often important when determining a final treatment plan and can be a result of any or all the following:

  • An unfavorable genetic expression of growth
  • A history of trauma
  • An abnormal or exuberant activity of a growth center from an unknown cause (e.g., the TMJ region)
  • Tumor or other pathology

The majority of jaw disproportionalities are a result of an unfavorable genetic expression of normal growth. As a result, most treatment plans are directed at the return to balanced function and esthetics once an individual has reached skeletal maturity. Three of the more common disproportionate expressions of growth can be seen in examples demonstrated in the accompanying figures. (Figure 1 – Mandibular Prognathism, Figure 2 – Mandibular Retrognathia, & Figure 3 – Vertical Maxillary Hyperplasia).

[fig 1][fig 2][fig 3]

 

Why Bother with Orthognathic Surgery?

As loved ones, parents or friends, we have grown to know the individual who is a sufferer from this condition and like the way he or she looks to us. Additionally, it doesn’t often readily appear that this individual is suffering to any great degree.

A long standing misconception of orthognathic surgery is that treatment in this area is directed solely or principally at improving facial appearance. In reality,  while the creation of balanced function is nearly always beneficial to one’s appearance, it is not the main reason why patients are encouraged to proceed with treatment.  There are numerous medical benefits and many of the potential consequences of skeletofacial disability that are treated with orthognathic surgery are avoided or never realized if  a patient undergoes treatment at an early age. The medically based needs for surgery include but are not limited to:

1.  The inability to chew food properly

2.  Myofascial Pain Dysfunction (MPD or painful spasm of the muscles of jaw function and dysfunction of the jaw)

3.  Temporomandibular Joint Disease

4.  Speech Impairment or Pathology

5.  Periodontal Disease as an accelerated consequence of occlusal trauma

6.  Structural Dental Disease (tooth fracture, attrition and/or early tooth loss)

There are two “quality of life” benefits that are instantly gratifying for the patient. These include “feeling good” and “looking good.” If you have ever been bothered by the slightest interference in your bite, you will immediately recall how uncomfortable it can be. Compound that inconvenience with the inability to bring your front teeth together to incise food.  Surgery can fix this problem and result in the ultimate in “feeling good,” to that patient. Physical appearance is important to most all of us. The improvement in appearance achieved by restoring facial balance through orthognathic surgery can mean an invaluable boost to one’s self confidence and overall feeling of well being. It is not an uncommon story to witness a self-conscious, insecure and shy patient become more confident and outgoing and gain a higher self-esteem.

How Is Orthognathic Surgery Performed?

Orthognathic surgery usually first involves a period of  nine to fourteen months of orthodontic treatment, meaning braces.   The orthodontist plays a big part in the success of treatment. Orthodontic appliances are not removed prior to surgery and serve as an aid to the surgeon during the surgical procedure.  There is usually a post-surgical period of orthodontics that varies from one patient to the next.  Orthognathic surgery is a hospital based operation. The patient is admitted on the day of surgery and can expect to be discharged the day after the surgery is performed.  The surgical procedures today are usually performed completely within the mouth. At one time, the patient’s teeth were wired shut for seven weeks. Today, the patient can usually resume jaw movement such as speaking, yawning and coughing almost immediately. The limitation of jaw function asked of nearly all patients is to soften their diet for four to six weeks following surgery to allow for a period of bony healing.

Orthognathic surgery is a “realignment of your jaw.”  All surgeries are planned through the use of skeletal analyses, sketches, mock up surgeries on plaster models and computer imaging.  The operating doctor makes precise templates that are utilized during surgery to position the jaws.  With the use of technical instrumentation and tried and true surgical techniques, the jaws are precisely repositioned and stabilized using tiny screws, plates and/or wires. These screws and plates are temporarily necessary to help the jaw mends itself into its new position. Because of their biocompatibility, it is hardly ever necessary to remove them at a later date.

What Is It Like to Undergo Orthognathic Surgery?

Orthognathic surgery is a hospital based operation. The patient is admitted on the day of surgery and can expect to be discharged on the first post-operative day. A frequently asked question is whether orthognathic surgery is painful?  The patient will experience a certain number of immediate post-operative inconveniences and discomforts. All patients are counseled to anticipate the following following surgery:

  • Swelling – Simply a result of the trauma of surgery, most swelling from this surgery  will peak in visible size over the course of three to five days. Approximately 85% of the swelling resolves within a ten day period after which the remaining percentage often requires several months of maturation.
  • Nasal and sinus congestion – As a consequence of the surgery and the swelling at the operative site, most patients will experience a five to seven day period of significant nasal and sinus congestion. Resolution of these symptoms is generally parallel with the abatement of visible facial swelling.
  • Difficulty eating and chewing food for the patient the first week following surgery.  The diet for the patient is usually is limited to liquids for the first week.

A short period of convalescence is necessary before the patient can return to normal activities. Even patients presenting the most complex cases are able to return to work or  school within ten days of the surgery. The only prolonged and prescribed physical restriction is for a  patient involved in “contact sports,” who will be asked to refrain from such activity for three months.

What Are The Results of Orthognathic Surgery?

Orthognathic surgery is not a new technique or area of maxillofacial surgery. This form of surgery has been around for many decades and the most recent technology has been practiced for twenty years. Due to the modern instruments and techniques of stabilization, the treatment of a patient undergoing this surgery has become safer, more comfortable and reliable.  A ten hour surgery has been shortened to a three to four hour case. The hospital stay used to last four to six days and now patients are discharged the day after the surgery.

Orthognathic surgery is a common surgery, often with adolescent orthodontic treatment. The results are predictable, stable, an gratifying to the patient. If you have any further questions regarding orthognathic surgery, please contact our office.  Referrals are not necessary.

 Orthognathic Surgery Video