Orthognathic Surgery (Corrective Jaw Surgery) is performed to correct maxillofacial (jaw and face) skeletal and dental abnormalities, including the misalignment of jaws and teeth. Not only will surgery improve functional problems like chewing, speaking, and breathing, it may also enhance a patient’s appearance.
What is Orthognathic Surgery (Corrective Jaw Surgery)?
Many children with cleft lip/palate and craniofacial differences have jaws that grow at different rates. Whether it is from birth defects or trauma, these patients will come to benefit from corrective jaw surgery. Orthognathic literally means “straight jaw”. This type of surgery will bring the upper and lower jaws into correct position in the face, through cutting and repositioning, resulting in a normal bite. It can be performed after skeletal growth is complete- usually in the mid- to late-teen years. Minor differences in bite or tooth position can be treated with orthodontics (braces) to straighten teeth; however, there is a limit to how far teeth can move safely with braces. More significant movements usually require realigning the jaws (through surgery) so that braces will be successful.
Why perform orthognathic surgery (corrective jaw surgery)?
There are several benefits to corrective jaw surgery. In the facial region, form and function typically go hand in hand, and this holds true for jaw position. Many patients with malpositioned jaws complain of pain when chewing, including TMJ discomfort. Additionally, speech can be affected if the jaws and teeth are misaligned, creating gaps through which air can pass unintentionally while talking, making speech less intelligible. When the upper and/or the lower jaw are set back, breathing can be affected, especially at night. Patients may have snoring and obstructive sleep apnea (blocked breathing leading to lower oxygen levels and lack of restorative sleep). Finally, facial form and smiling will be affected when the jaws are not aligned.
So functionally, patients will benefit by having a better bite, smile, chewing, speaking, breathing, as well as improved facial balance and form.
Who typically has orthognathic surgery (corrective jaw surgery)?
If your child has one of the following conditions he/she may be considered for orthognathic surgery:
- Cleft lip and palate
- Pierre Robin Sequence
- Craniofacial syndrome: Apert, Crouzon, Pfeiffer, Carpenter
- Down Syndrome
- Hemifacial (craniofacial) microsomia
- Jaw growth difference
How long does the process take to correct jaws?
Patients who are potential candidates for jaw surgery are evaluated in the teen years. The best long-lasting results in corrective jaw surgery come in patients who have finished growing, usually mid-teens for girls and late teens for boys. Jaw surgery can be done before growth is complete in more severe cases; however, continued growth may foster a need for a second surgery. Once the patient has been identified as needing jaw surgery repositioning instead of just orthodontics, the patient will begin a process which culminates in proper jaw and bite relationships about 1-1.5 years later. The first part involved pre-surgical orthodontics. The orthodontist will prepare each arch (row of teeth) on the upper and lower jaw, so that when the jaws are repositioned, the bite will be normal. After preparatory orthodontics, the surgery can be completed. After the surgery, the orthodontist will again work on fine tuning the bite relationship with braces. In some patients, a few months prior to surgery, wisdom teeth (third molars) need to be removed to enhance the surgical process and healing.
Orthognathic Surgery (Corrective Jaw Surgery) Details
Upper Jaw Surgery (Le Fort I Osteotomy)
Through an incision, which is inside the mouth, the surgeon will expose the bone of the upper jaw. The upper jaw will then be cut, loosened, and repositioned into the ideal location for that particular patient. Once the ideal position has been achieved, it is held in place through use of thin titanium plates and screws. Sometimes, a bone graft (harvested from hip region) might be necessary to strengthen the result and prevent relapse. A very important part of the operation is making sure that the teeth are lined up so as to give a normal bite. This is achieved by wiring a splint (made of acrylic) onto the upper teeth. The splint is made preoperatively using the stone models of each patient’s teeth. The splint registers the ideal bite relationship to be achieved in surgery. The incision inside the mouth will then be closed with stitches that will be resorbed by the body. The average time for this surgery is about 2 hours.
Lower Jaw Surgery (Bilateral Sagittal Split Osteotomy, BSSO)
Through incisions which are inside the mouth (intraoral), the surgeon will expose the lower jaw in the region behind the teeth. The jaw will be split on each side; this allows repositioning of the part of the jaw with the teeth. Once the ideal bite is restored, each side of the mandible will be fixated with either titanium plates or screws. The average time to complete this surgery is about 2 hours
Chin Adjustment Surgery (Osseous Genioplasty)
In some patients who undergo corrective jaw surgery, an adjustment of the chin position may be recommended to help complete the correction of the facial balance. The incision for this surgery is inside the lower lip. The bone of the chin is typically cut, repositioned and held in a new position with a titanium plate. In some cases a chin implant may be utilized, and this can be discussed with the surgeon. Osseous genioplasty usually requires 30 minutes of time.
What should I expect when undergoing corrective jaw surgery?
Upon waking up after corrective jaw surgery, patients typically notice swelling in the face and lips, along with mild/moderate pain. Swelling in the face is common and usually peaks around 2 days after surgery, before beginning to subside. Bacitracin ointment can be applied to the lips to prevent dying/cracking. Pain after surgery is treated first with intravenous pain medication (narcotic), with a transition to oral pain medication within a day or so of surgery. Nausea will also be treated with medication. Patients will have a diet change after surgery, observing a liquid/pureed diet for several weeks. Oral care consists of a peridex (type of mouthwash) rinse three times a day for one week. Formal teeth brushing can resume about one week after surgery. “Wiring of Jaws”: Initially after surgery, patients will have a couple of elastics (rubber bands) between the jaws for support. Before discharge from the hospital, several more will be added to effectively “lock the jaws” into a bite to support the healing from surgery. A CT scan of the jaws will be completed prior to discharge, to verify the position of the jaws after surgery. Many patients are concerned about breathing after surgery. Patients can breathe through the nose, and around the teeth immediately after surgery. Also, it is not uncommon to spit up some blood for a day or two after surgery.
How long will I spend in the hospital after surgery?
Patients may spend from 1-4 days in the hospital recovering after corrective jaw surgery.
How frequently do I need to come to the clinic after surgery?
Regular checkups are required after corrective jaw surgery. The surgeon and orthodontist will see the patient one week after the operation, with continued weekly/biweekly orthodontist visits for up to 8 weeks after surgery.
How long will it take to recover to normal life after corrective jaw surgery?
Patients usually need pain medication for about one week after the surgery. Almost all of the swelling is subsided by 2 weeks after the operation. By about 2 months after surgery, the bones will be healed, splint will be removed, and jaws will be freely moving, with the patient assuming a normal diet and activity level.
What can go wrong with the surgery, or healing afterwards?
Corrective jaw surgery is performed with the utmost care for the safety, well-being, and pleasing long-term results for the patient. Surgery to reposition the jaws involves bleeding. Almost all the time, this bleeding is of modest amount. On occasion (rare), bleeding is of increased amount and a blood transfusion is given to maintain patient safety. Being perfectionists when it comes to jaw position, we do not finish a surgery unless the jaw position is as close to ideal as possible. However, in a minority of cases, the position of the jaws can change in an unfavorable way long-term after healing has taken place (this is called relapse). With a well-coordinated effort between surgeon and orthodontist, everything will be done to prevent this from happening. Minor relapse can be treated with orthodontics, major relapse with a secondary repositioning surgery.
Why choose the Craniofacial Team of Texas for corrective jaw surgery?
The best results in corrective jaw surgery come from completion of a surgical plan involving detailed coordination of the surgical team with the orthodontist. The Craniofacial Team of Texas is unique in that we have co-location of our surgeons and orthodontist which facilitates creation and execution of unified treatment plan. Additionally, our surgeon cadre includes 3 fellowship-trained Craniomaxillofacial Surgeons, all well versed in corrective jaw surgery, combined with a fellowship-trained Craniofacial Orthodontist. Both the surgeons and orthodontist have tremendous experience dealing with the most complex craniofacial diagnoses, combined with challenging patient types (i.e. Autism), allowing us to provide reliable, consistent results to patients with the most challenging of conditions to a more straightforward bite abnormality.
If you would like more information, please contact the Craniofacial Team of Texas by calling 512-377-1142 or toll free 877-612-7069 to schedule an appointment or complete an online appointment request.