Orthognathic surgery is a term describing a procedure used by oral and maxillofacial surgeons to surgically correct facial skeletal growth abnormalities. Abnormal facial growth can present in many ways. The mid-face (maxilla) can be underdeveloped (hypoplasia), it can be too narrow (transverse constriction), or it can be too large (maxillary excess). Similarly, the lower jaw (mandible) can be over-developed (prognathic), asymmetric, or too small (hypoplastic). These abnormal growth patterns can present either as an isolated problem or present in combination with each other.
Skeletal growth abnormalities lead to a myriad of dental and medical problems for the patient. Dentally, abnormally formed facial bones can lead to severe dental crowding and poor occlusion, which many times leads to premature tooth loss due to either trauma or disease. Many of these patients can present with temporomandibular joint disorders and pain.
Medically, because the upper and lower jaws do not line up properly, patients have difficulty eating and maintaining proper nutrition. The facial muscles attempt to align the poorly aligned jaws leading to muscle pain and migraines. Underdevelopment of the mid-face leads to nasal airway obstruction and resultant oral breathing. Under-development of the upper and/or lower jaws also can lead to moderate-to-severe sleep apnea. Another disorder commonly seen is speech abnormalities. Due to altered facial appearance, many patients suffer from psychosocial and self-confidence issues.
Treatment of abnormal skeletal growth is coordinated through a team of oral and maxillofacial surgeons, orthodontists, and general dentists. Due to the abnormally positioned facial bones, the teeth are usually not in their correct positions and have to be properly aligned by the orthodontist to allow the oral and maxillofacial surgeon to properly position the maxilla and mandible. There are a few cases where the surgery is performed early in the treatment.
Orthodontic movement of teeth is always much faster following surgery; therefore, performing surgery early may shorten the entire treatment time. After completion of the surgical and orthodontic treatment, the general dentist steps in to complete the case by repairing damaged or missing teeth. Usual treatment time ranges from 18-24 months.
Orthognathic surgery has taken a quantum step forward over the past few years due to the introduction of computer technology and virtual surgical planning. Rather than plain film radiographs and surgical stone models, we are now able to digitally enter the patient’s radiograph and facial structures into a computer program and perform virtual surgery in a virtual surgical suite. Once treatment is finalized, we use laser printing to produce custom surgical guides and splints to help guide the position of the facial bones during and after surgery. This now allows the surgeon to compare different types of surgical plans and fine-tune the skeletal movements to optimize the outcome for the patient.
Orthognathic surgery is performed in a hospital setting utilizing general anesthesia. It usually requires an overnight stay. As with any surgery, there is some soreness and swelling following surgery. In most cases,we are able to rigidly fixate the skeletal bones with titanium plates and screws. This prevents, in most cases, the need to wire the patient’s jaws together. Even though the patient has freedom of movement of the jaws, we recommend that they maintain a liquid-to-soft diet for about six weeks until initial healing is complete. The surgeon must be careful to avoid vital structures, such as adjacent teeth or nerves that give feeling to the face. The surgeon and orthodontist carefully plan and execute the case so that the orthognathic surgery result is stable long-term.
Orthognathic surgery, for the vast majority of patients, is a life-changing event that greatly enhances their quality of life both functionally and aesthetically.
If you feel that you may be in need of orthognathic surgery, contact your local orthodontist or oral and maxillofacial surgeon for a consultation.