Orthognathic surgery is
surgerySurgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason...
to correct conditions of the
jawThe jaw is any opposable articulated structure at the entrance of the mouth, typically used for grasping and manipulating food. The term jaws is also broadly applied to the whole of the structures constituting the vault of the mouth and serving to open and close it and is part of the body plan of...
and
faceThe term face refers to the central sense organ complex, for those animals that have one, normally on the ventral surface of the head, and can depending on the definition in the human case, include the hair, forehead, eyebrow, eyes, nose, ears, cheeks, mouth, lips, philtrum, teeth, skin, and chin....
related to structure, growth,
sleep apneaSleep apnea is a sleep disorder characterized by pauses in breathing during sleep. Each episode, called an apnea , lasts long enough so that one or more breaths are missed, and such episodes occur repeatedly throughout sleep...
, TMJ disorders or to correct orthodontic problems that cannot be easily treated with braces. Originally coined by Dr. Harold Hargis, D.M.D., it is also used in treatment of congenital conditions like cleft palate. Bones can be cut and re-aligned, held in place with either screws or plates and screws.
- Gross jaws discrepancies (Anteroposterior , Vertical and /or Transverse discrepancies).
- Facial Skeletal Discrepancies Associated with Documented Sleep Apnea, Airway Defects, and Soft Tissue Discrepancies.
- Facial Skeletal Discrepancies Associated with Documented Temporomandibular Joint Pathology
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Orthognathic surgery is performed by an
oral and maxillofacial surgeonOral and maxillofacial surgery is surgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region...
almost always in collaboration with orthodontic treatment, often including braces before and after surgery, and retainers after the final removal of braces.
Orthognathic surgery is
surgerySurgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason...
to correct conditions of the
jawThe jaw is any opposable articulated structure at the entrance of the mouth, typically used for grasping and manipulating food. The term jaws is also broadly applied to the whole of the structures constituting the vault of the mouth and serving to open and close it and is part of the body plan of...
and
faceThe term face refers to the central sense organ complex, for those animals that have one, normally on the ventral surface of the head, and can depending on the definition in the human case, include the hair, forehead, eyebrow, eyes, nose, ears, cheeks, mouth, lips, philtrum, teeth, skin, and chin....
related to structure, growth,
sleep apneaSleep apnea is a sleep disorder characterized by pauses in breathing during sleep. Each episode, called an apnea , lasts long enough so that one or more breaths are missed, and such episodes occur repeatedly throughout sleep...
, TMJ disorders or to correct orthodontic problems that cannot be easily treated with braces. Originally coined by Dr. Harold Hargis, D.M.D., it is also used in treatment of congenital conditions like cleft palate. Bones can be cut and re-aligned, held in place with either screws or plates and screws.
Indications
- Gross jaws discrepancies (Anteroposterior , Vertical and /or Transverse discrepancies).
- Facial Skeletal Discrepancies Associated with Documented Sleep Apnea, Airway Defects, and Soft Tissue Discrepancies.
- Facial Skeletal Discrepancies Associated with Documented Temporomandibular Joint Pathology
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Surgeon
Orthognathic surgery is performed by an
oral and maxillofacial surgeonOral and maxillofacial surgery is surgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region...
almost always in collaboration with orthodontic treatment, often including braces before and after surgery, and retainers after the final removal of braces. Orthognathic surgery is often needed after reconstruction of cleft palate or other major
craniofacialCraniofacial may be used to describe certain congenital malformations, injuries, surgeons who subspecialize in this area, multi-disciplinary medical-surgical teams that treat and do research on disorders affecting this region, and organizations with interest in...
anomalies. Careful coordination between the surgeon and orthodontist is essential to ensure that the teeth will fit correctly after the surgery. This coordination often necessitates that the surgeon be trained in dentistry, where complex concepts of occlusion between upper and lower teeth are taught. Unlike Oral and Maxillofacial Surgeons who are trained in dentistry, Plastic Surgeons receive no or minimal training. Thus, it is rare that an Orthodontist would find it appropriate for the surgery to be referred to a non-Oral and Maxillofacial Surgeon.
Planning
Planning for the surgery usually involves input from a multidisciplinary team. Involved professionals are
Oral and Maxillofacial surgeonOral and maxillofacial surgery is surgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region...
s, Orthodontists, and sometimes a Speech and language therapist. As the surgery usually results in a noticeable change in the patient's face a psychological assessment is occasionally required to assess patient's need for surgery and its predicted effect on the patient.
Radiographs and photographs are taken to help in the planning and there is software to predict the shape of the patient's face after surgery, which is useful both for planning and for explaining the surgery to the patient and the patient's family. Advanced software can allow the patient to see the predicted results of the surgery.
The main goals of orthognathic surgery are to achieve a correct bite, an aesthetic face and an enlarged airway. While correcting the bite is important, if the face is not considered the resulting bony changes might lead to an unaesthetic result. Orthognathic surgery is also available as a very successful treatment (90-100%) for obstructive sleep apnea. Great care needs to be taken during the planning phase to maximize airway patency.
Procedure
The surgery might involve one jaw or the two jaws during the same procedure. The modification is done by making cuts in the bones of the
mandibleThe mandible or inferior maxillary bone forms the lower jaw and holds the lower teeth in place. It also refers to both the upper and lower sections of the beaks of birds; in this case the "lower mandible" corresponds to the mandible of humans while the "upper mandible" is functionally equivalent...
and / or
maxillaThe maxilla is a fusion of two bones along the palatal fissure that form the upper jaw. This is similar to the mandible , which is also a fusion of two halves at the mental symphysis. Sometimes , the maxilla is sometimes called "upper maxilla", with the mandible being the "lower maxilla"...
and repositioning the cut pieces in the desired alignment. Usually surgery is performed under
general anaestheticA general anaesthetic drug is an anaesthetic drug that brings about a reversible loss of consciousness...
and using nasal tube for
intubationIn medicine, intubation refers to the placement of a tube into an external or internal orifice of the body. Although the term can refer to endoscopic procedures, it is most often used to denote tracheal intubation. Tracheal intubation is the placement of a flexible plastic tube into the trachea to...
rather than the more commonly used oral tube; this is to allow wiring the teeth together during surgery. The surgery often does not involve cutting the skin, and instead, the surgeon is often able to go through the inside of the mouth.
Cutting the bone is called
osteotomyAn osteotomy is a surgical operation whereby a bone is cut to shorten, lengthen, or change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It is also used to correct a coxa vara, genu valgum, and genu varum...
and in case of performing the surgery on the two jaws at the same time it is called a bi-maxillary osteotomy (two jaws bone cutting) or a
maxillomandibular advancementMaxillomandibular Advancement or orthognathic surgery, also sometimes called Bimaxillary Advancement , or Maxillomandibular Osteotomy .A surgical procedure which moves the jaw top and bottom forward....
. The bone cutting is traditionally done using special electrical saws and burs, and manual chisels. Recently a machine that can make the bone cuts using ultra-sound waves has been introduced; this is yet to be used on a wide scale. The maxilla can be adjusted using a "
Lefort ILeFort fractures are types of facial fractures that are classic in facial trauma. The Le Fort fracture was named after French surgeon René Le Fort , who described them in the early 20th century....
" level osteotomy (most common). Sometimes the midface can be mobilised as well by using a
Lefort IILeFort fractures are types of facial fractures that are classic in facial trauma. The Le Fort fracture was named after French surgeon René Le Fort , who described them in the early 20th century....
, or
Lefort IIILeFort fractures are types of facial fractures that are classic in facial trauma. The Le Fort fracture was named after French surgeon René Le Fort , who described them in the early 20th century....
osteotomy. These techniques are utilized extensively for children suffering from certain craniofacial abnormalities such as
Crouzon syndromeCrouzon syndrome is a genetic disorder known as a branchial arch syndrome. Specifically, this syndrome affects the first branchial arch, which is the precursor of the maxillaand mandible...
.
The jaws will be wired together (inter-maxillary fixation) using stainless steel wires during the surgery to insure the correct re-positioning of the bones. This in most cases is released before the patient wakes up. If the surgeon is not satisfied with the anchoring, he may elect to keep the jaws wired together. This is a considerably recent modification as the usage of the modern types of bone plates reduced the need for wiring the jaws together for a few weeks after surgery as was the case before. Some surgeons prefer to wire the jaws shut anyway to ensure proper healing of the bones, but they are becoming more of a minority among orthognathic surgeons.
Complications
Like any other surgery, there can be some complications like bleeding, swelling, infection, nausea and vomiting. There could also be some numbness in the face due to nerve damage. The numbness may be either temporary, or, more rarely, permanent. In general, complications of this surgery occur, but not frequently.
If the surgery involved the upper jaw, then the surgery could have an effect on the shape of the patient's nose. This can be minimised by careful planning and accurate execution of the surgical plan. Sometimes, this is considered part of the benefit.
Root canal (some teeth have more than one root canal) treatments are sometimes required after surgery, especially when the surgery involves a maxillary osteotomy. In recent years, techniques have been created that may help reduce the need for root canal surgery, however, it is still a common complication that can occur.
Post operation
After orthognathic surgery, patients are often required to adhere to an all-liquid diet. After time, soft food can be introduced, and then hard food. Diet is very important after the surgery, to accelerate the healing process. Weight loss due to lack of appetite and the liquid diet is common, but should be avoided if possible. Normal recovery time can range from a few weeks for minor surgery, to up to a year for more complicated surgery.
For some surgeries, pain may be minimal due to minor nerve damage and lack of feeling. Doctors will prescribe pain medication and prophylactic antibiotics to the patient. Many doctors recommend that the patient rent a specialized machine that circulates cold water through pads on the face to help the swelling go down. Most of the swelling will disappear in the first few weeks, but some may remain for a few months.
The surgeon will see the patient for check-ups frequently, to check on the healing, check for infection, and to make sure nothing has moved. The frequency of visits will decrease over time. If the surgeon is unsatisfied with the way the bone is mending, he may recommend additional surgery to rectify whatever may have shifted. It is very important to avoid any chewing until the surgeon is satisfied with the healing.
See also
- Craniofacial surgery
Craniofacial surgery is a surgical subspecialty of oral and maxillofacial surgery, plastic surgery, and ENT that deals with congenital and acquired deformities of the skull, face, and jaws. Although craniofacial treatment often involves manipulation of bone, craniofacial surgery is not...
- Oral and maxillofacial surgery
Oral and maxillofacial surgery is surgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region...
- Orthodontics
Orthodontics is a specialty of dentistry that is concerned with the study and treatment of malocclusions , which may be a result of tooth irregularity, disproportionate jaw relationships, or both...
- Surgery
Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason...