Orthognathic (Maxillofacial) Surgery

What is Orthognathic (maxillofacial) surgery?

Orthognathic surgery combines orthodontic treatment with surgery of the jaw to correct or establish a stable functional balance between the teeth, jaws and facial structures. The goal of maxillofacial surgery is to treat any jaw imbalance and the resulting incorrect bite, which could adversely affect the cosmetic (esthetic) appearance as well as the proper functioning of the teeth. This involves diagnosis, treatment planning and execution of treatment, by combining orthodontics and oral/maxillofacial surgery to correct musculoskeletal, dento-osseous and soft tissue deformities of the jaws and associated structures.

What does “orthognathic” mean?

The word “orthognathic” was coined by an oral/maxillofacial surgeon and means “straight jaws”, just as orthodontics mean “straight teeth”. Prior to that time, the term surgical orthodontics or “facial orthopedics” was used to describe the field.

When is orthognathic surgery required?

Orthognathic surgery is needed when jaws don’t meet correctly and/or teeth don’t seem to fit with jaws. The teeth are straightened with orthodontics, and corrective jaw surgery repositions the mal-aligned jaws. This not only improves the facial appearance (esthetics), but also ensures that teeth meet correctly and function properly.

Who needs orthognathic surgery?

There are many different types of abnormalities of the jaw structures that can result in facial deformity and improper bite. These abnormalities in the jaws and facial bones may be congenital (present at birth) or developed during growth and development. They may also be acquired after birth as a result of hereditary, environmental influences or trauma/illness to the face.

Is this a common problem?

It has been estimated that dentofacial (involving the teeth and face) deformities affect approximately 20% of the population.

Who should be evaluated for possible orthognathic surgery?

Any individual with difficulty in the following areas should be evaluated for possible orthognathic surgery:

1. difficulty in chewing, biting or swallowing

2. speech problems

3. chronic jaw or TMJ (temporomandibular joint) pain

4. open bite

5. protruding jaw

6. breathing problems

What kind of specialists are involved in the evaluation for orthognathic surgery?

Successful orthognathic surgery requires the cooperation of the oral/maxillofacial surgeon, orthodontist and general dentist. Other specialists may include periodontists, prosthodontists, endodontists, neurosurgeons, ophthalmologist, otolaryngologists, plastic surgeons and speech pathologist. These professionals will work as a team to provide the diagnosis, treatment plan and actual execution of the treatment.

What are the basic goals of orthognathic surgery?

The specific goal for orthognathic surgery vary from patient to patient, depending on the actual diagnosis.

In general, the team will address:

Function: Normal chewing, speech, ocular (eye) function, respiratory function.

Esthetics: Establish facial harmony and balance

Stability: Avoid short and long term relapse

Minimize treatment time: Provide efficient and effective treatment.

What is involved in the evaluation and diagnosis of orthognathic surgery?

The most important aspect of overall patient management is thorough evaluation and diagnosis. Patient evaluation for orthognathic surgery can be divided into four main areas:

1. Patient concerns or chief complaints

2. Clinical examination

3. Radiographic and imaging analysis (x-rays)

4. Dental model analysis

After an examination by each of the orthognathic surgery team members (dentist, orthodontist and maxillofacial/oral surgeon), a diagnosis and coordinated treatment plan is prepared. The complete process usually takes place in several stages over the coarse of one to two years.

What is involved in the actual treatment process of orthognathic surgery?

Any general dental maintenance, prevention or restoration should be performed prior to orthodontic and surgical intervention. Then, the first stage of treatment is the alignment of the teeth into a stable relationship with the underlying jaw by orthodontics, which prepares the dental arches for the surgical repositioning. This stage usually takes the longest, from a few months to over a year. At this stage, the abnormal bite (malocclusion) may become more noticeable. Once ready for the surgical procedures, the orthodontist and maxillofacial surgeon will review photographs, x-ray and dental models to finalize the surgical plan. The operation may involve a single jaw or both jaws (maxilla and mandible). The surgery may also be combined with other procedures, such as rhinoplasty (nose correction) or genioplasty (chin correction) to improve the general appearance of your face.

How long is the surgery?

The procedure may take 2-4 hours, depending on the complexity. Most patients are kept in the hospital for 2-5 days, again depending on the specifics of the procedure and post-operative condition.

How long is the recovery?

Most patients return to their normal activities within a week or two after their surgery. The surgeon will monitor the healing, and review the changes in your facial structures and occlusion (bite). The orthodontist will adjust the braces to fit the new repositioned jaw. Orthodontic treatment may continue for several months to ensure optimal positioning of the teeth.

(Optional)- see diagram

What are some examples of jaw abnormalities?

Mandibular retrusion (small chin)

Mandibular prognathism (large chin)

Maxillary retrognathia/hypoplasia (flat upper lip)

Maxillary vertical excess/hyperplasia (gummy smile)

Apertognathia (open bite)