Do not confuse Orthognathic surgery with orthodontic therapy (Braces). While Orthodontic treatment (Braces) can correct many problems if only the teeth are involved Orthognathic Surgery maybe required if the jaws (bone) also need repositioning. When planning an Orthognathic surgical case, the general dentist, orthodontist and oral surgeon will work closely with one another to set the stage for optimum post surgical results in regards to both function and esthetics.
Ortho means straighten and gnathia means jaw and hence, Orthognathic surgery means straightening of the jaw(s) by surgery. An Oral & Maxillofacial Surgeon practices Orthognathic surgery.
The conditions which require Orthognathic surgery are often referred to as "bad bites". There are many types of "bad bites", with some having a greater effect on facial esthetics than others. The common maxillofacial deformities and their clinical appearances are the following:
- Protruded Maxilla (Upper jaw) : The upper jaw is protruded beyond the normal limits along with the teeth. The person cannot close his lips (lip incompetence) without effort. The teeth are always visible and in most cases the whole of the gums are visible on smiling (gummy smile). A gummy smile is mainly due to the vertical excess of the maxilla.
- Retruded Maxilla : This deformity is due to under development of the upper jaw mainly seen in people who have cleft lip or palate. After the surgical correction of the cleft lip or palate at a young age the growth of the maxilla is retarded along with displacement or destruction of the tooth bud. This causes a dish shaped face with a hooked or flaring nose and irregularly aligned, rotated or missing teeth.
- Protruded Mandible (Lower jaw) : In some people there will be extra growth of the lower jaw resulting in long jaw. Their faces are very long with protrusion of the lower teeth and thick lips. Normally on biting the lower teeth will be inside the upper teeth while in people with long jaws usually the lower teeth will be outside the upper arch.
- Retruded Mandible : In some people due to developmental deformity or due to hereditary factors the lower jaw is very small resulting in a "bird face". There is no proper development of the chin.
- Facial Asymmetry : Sometimes a part of the face maybe overdeveloped or underdeveloped causing one part of the face to be small or large. One side of the face is not in symmetry with the other side giving an unaesthetic appearance.
- Akylosis of Tempromandibular Joint (TMJ) : Injury during birth or trauma or infection at a young age to the temporomandibular joint will result in restricted mouth opening and reduced growth of the mandible.
- Nasal Deformity : Nasal deformities are often seen along with deformities of the jaw. Some common deformities of the nose are: deviated nasal septum, flared or constricted ala of the nose, saddle nose, hooked nose, asymmetrical nose, etc.
These conditions may cause many functional and psychological problems. The good news is that they need not be permanent. Improvement, and often correction, can be attained with the proper procedure. It is a cosmetic surgery and the surgeon envisages changing the face of a person from distortion to proportion. The results of Orthognathic surgery can have a dramatic and positive affect on many aspects of your life.
After the initial examination a thorough examination with facial measurements, photographs, x-rays, and dental impressions will be carried out. A complete medical examination will follow. This rules out any health problems that would interfere with the surgery or the administration of General Anesthesia.
The Oral & Maxillofacial Surgeon and the Orthodontist will work closely together during your treatment. Orthodontic treatment (braces) is started before surgery. The teeth are moved and repositioned into proper alignment before surgery if necessary.
Preparing for Surgery
The Orthognathic Surgery will take place in a hospital under general anesthesia. You will be admitted to the hospital one day prior to surgery and will be advised on dietary conditions for the days leading up to surgery. You will probably be required to stay in the hospital for a week or so until you have recovered from the surgery. You may need blood transfusion during the surgery. You will then undergo a full medical checkup. You should as always, maintain a good standard of oral hygiene before and after surgery.
Orthognathic Surgery lasts anywhere from 1½ hours to several hours depending on the type of surgery needed. Incisions are made inside the mouth during surgery and there will be no visible external scars. However if external incision has to be made, as in surgeries of the temporomandibular joint , care is taken to conceal it in