10 things that you should know about orthognathics [jaw surgery]

What is the definition of orthognathic or jaw surgery in general?

Jaw surgery, also known as orthognathic surgery is a procedure performed on patients who suffer from jaw misalignment, improper jaw bite and temporomandibular joint [the TMJ is a joint in the face that allows your jaw to move] disorders.

Misaligned jaws can cause a number of problems to the mouth and facial structure and effects basic activities like chewing and swallowing. More advanced cases may result in long term health complications.

Jaw bone problems are either present at birth (genetics) or are caused by injuries or other medical conditions later in life. In such cases a corrective jaw surgery may reposition all or part of the upper jaw, lower jaw and chin to restore function and overall facial aesthetic.

What are the different types of jaw surgery?

Jaw surgery corrects problems that make your jaws stick out too much or too little, making your facial features appear unbalanced. There are three types of jaw surgery:

• Maxillary osteotomy. This surgery is done when your upper jaw sticks out too much or too little. Maxillary osteotomy also treats an open bite and cross bite. Once a patient (child or adult) is diagnosed with a dentofacial deformity that may merit a surgical correction, a comprehensive evaluation by a surgeon and orthodontist is paramount.
• Mandibular osteotomy. This surgery is done when your lower jaw sticks out too much or too little.
• If you have a problem that affects both jaws, the surgery is called bilateral osteotomy or double-jaw surgery.

Why do I need an orthodontist prior to a jaw surgery?

An orthognathic surgery isn’t a single event. It is a series of processes that includes orthodontic treatment to prepare the teeth before a jaw surgery, the surgery itself, recovery phase from surgery followed by further orthodontic treatment for up to a year after the initial surgery. All in all, a jaw surgery can take between two and three years, depending on case complexity. A collaborative approach between the orthodontist and maxillofacial surgeon is imperative to successfully devise and execute a comprehensive treatment plan with predictable outcomes.

Common orthodontic procedures preceding an orthognathic surgery are braces, Invisalign, or other corrective treatment suitable for patients who have significant bite problems.

An orthodontist will work with an oral and maxillofacial surgeon to best determine the treatment plan that is right for each patient. The orthodontist generally handles the braces or Invisalign portion, while the oral surgeon performs the operation.

Conventionally, you need an orthodontist before surgery and a typical orthodontic treatment may take six to 12 months before an orthognathic surgery. If required, you continue with a few more months of orthodontics post- surgery.

What are the planning and preparation like prior to an orthognathic surgery?

Thanks to advanced dental technology, oral and maxillofacial surgeons are able to scan and print 3D models which is helpful in pre-surgery planning. The oral surgeon is able to virtually and digitally reposition your jaws to achieve the best result. It is also an invaluable aid in providing comprehensive patient education.

What is the surgery length and hospital stay?

Orthognathic surgeries may take anywhere from two to 4 hours or more depending on complexity. You may need to stay a night for observation or you can go home the same day or within 23 hours.

Can we remove the wisdom teeth at the same time?

Yes, wisdom tooth can be removed at the same time. This saves you an additional procedure ahead of time and allows you to recover within the same recovery period.

Are there additional procedures that we do at the same time or concurrently with jaw surgery?

Possible facial correction procedures includes chin fat grafting to help with contours and aesthetics, skeletal augmentation where implants are added to the cheekbones or other parts of the jaw or face to enhance symmetry.

Will the nose change as a result of jaw surgery?

In terms of appearance, the nose may get better, stay about the same or get worse. The oral surgeon would need to anticipate the change, and if a rhinoplasty is needed, plan that from the outset. A rhinoplasty can be done about three to six months post-surgery (if required).

What holds the jaw in place?

Titanium plates are used to hold the bones together. These plates can stay forever in your jaw in about 95-98% of cases. They don't set off any alarms at airports or have issues with metal detectors. You can have MRIs as well.  You can elect to have them remove once you are completely healed but you don’t have too unless there are inflammation associated with them.

Basically these plates can be removed if you wish or if it is determined to be necessary.

How soon can I expect nerve or sensibility recovery?

In general patients will have some numbness after jaw surgery. The sensations on upper lip and cheeks usually come back in six weeks or about two months. The lower lip and chin may take longer because of the alveolar nerve or the nerve that goes through the lower jaw.
That can be six months or a year, but in 98% of cases, the senses does return. Factors that can help in recovery is age. Those under the age of 40 or so correlates with improved return of sensation. Additionally, medications and post-surgery care can also correlate with nerve recovery.

REFERENCE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805731/

If you need assistance in finding an OMFS (Oral and maxillofacial surgeon), our dental locator site is available on: https://www.toothcare2u.com/dentist_locator/

DISCLAIMER:
The information above should be used as a reference only. Any medical decision should not be taken before consulting a health care professional.
The masculine gender may have been more used in the article, but without prejudice, to make reading easier.
*dependant on teeth condition