Orthognathic Surgery
Corrective Jaw Surgery
What is orthognathic surgery?
Let’s define the word and delve a bit deeper.
Ortho = straight
Gnathic = jaws
So all together, it means surgery to make the jaws straight.
Corrective jaw surgery/ orthognathic surgery is used to correct upper and lower jaw imbalance and abnormalities, especially those that cannot be fixed with braces alone. In some cases, the patient’s teeth do not fit together properly (malocclusion), the airway is obstructed during sleep (obstructive sleep apnea), and/or the esthetic balance of the face requires correction. Some of these issues may be caused by congenital conditions, such as cleft lip, cleft palate, and syndromic craniosynostosis. Sometimes, the jaw imbalances happen for unknown reasons. Regardless of the reason, imbalances in the jaw size and position can make it difficult to chew and speak, and can really impair quality of life.
Before you can have orthognathic surgery, generally you must undergo a phase of presurgical orthodontic treatment. The orthodontist aligns the teeth in a way that will yield the best and most stable surgical outcome in the long term. This phase may last between 6 and 18 months. Once the orthodontist has completed this phase, the oral and maxillofacial surgeon will take a cone beam CT scan and use 3D virtual simulation surgery to create cutting-edge, patient-specific splints and models. This technology allows the surgeon to achieve a planned result to within 1 millimeter or less of accuracy.
During surgery, the surgeon will make precise cuts in the jaw bone using the 3D printed splints, and move the bone into its new position. A patient may require moving the upper jaw, the lower jaw, or both. In addition to jaw surgery, at the same time, we can perform a genioplasty, where we reshape, advance or shorten the chin to complement the facial profile.
Recovery
Most patients spend one night in the hospital after jaw surgery. (Patients undergoing a genioplasty alone may return home the day of their operation.) Moderate to severe swelling is expected, and patients will be prescribed antibiotics and pain medications to take at home.
Mini rubber bands are usually placed on your braces to guide you into your new bite. Be sure to keep your teeth and mouth clean. You may need to be on a soft diet for four to six weeks (or more) after the operation, depending on the particular surgery. Several weeks postoperatively, your orthodontist will begin making final adjustments to your teeth. These are the “finishing touches” that will achieve the final result. Once your braces are taken off, it is critical that you wear your retainer(s) as instructed.
After the healing process is over, most patients find it more comfortable to chew and bite, and are thrilled with the change in their appearance.
Frequently asked questions
Can I have corrective jaw surgery without orthodontic treatment?
It depends. Typically, orthodontic appliances are required to move the teeth into the appropriate position before surgery. This can be achieved with either traditional metal braces or clear aligners. The specific orthodontic treatment you choose will depend on your unique situation, and what tooth movements are required. There are some instances in which patients can have jaw surgery without braces.
Can I correct my problem with just orthodontic treatment without jaw surgery?
That also depends! If the problem is mostly due to tooth misalignment, then yes. But if the problem is mostly jaw size or shape mismatch, then trying to fix the problem with braces alone is not a good solution, because the root of the problem is the position of the bone. Trying to fix a bone problem with orthodontic treatment will be unstable in the long run, and has a high rate of relapse. Your orthodontist and surgeon will perform a thorough evaluation and take appropriate radiographic imaging to first make a diagnosis, and then present you with your options.
Is improving my jaw alignment really that important?
Improving the jaw alignment is important for both functional and cosmetic purposes. Uncorrected jaw misalignment puts more stress on your temporomandibular joints (TMJ), and can lead to arthritis and degenerative changes. An unhealthy jaw relationship that is not fixed can also mean the teeth are contacting each other in a way that wears them down and causes chipping, resulting in the teeth breaking down over time. And if you are looking to change the shape of your face, braces alone cannot accomplish this.
I have impacted wisdom teeth. Do they need to come out ahead of time, or can they be taken out during my corrective jaw surgery?
Best is if they are taken out before jaw surgery. The jaw surgery is very technique sensitive, and the wisdom teeth are in the way most of the time. But of course, each patient and situation is unique, and so discuss this with your surgeon for a better answer.
Can I have lingual braces or Invisalign® instead of regular braces?
We can perform orthognathic surgery with all of these options! Talk to your orthodontist about which option is best for your unique situation.
I read that my oral surgeon will use screws and plates in corrective jaw surgery. Are these eventually removed?
They are usually permanent, and do not need to be removed. They will have no impact on your function, and you will most likely not feel them at all, as they are very thin. They also do not affect metal detectors or MRIs. But if they need to be removed for any reason, it is easy to do in the office.
Will my insurance cover jaw surgery, and what is the out of pocket cost of jaw surgery?
Jaw surgery falls under the medical procedure codes. Insurance coverage depends on your particular insurance company and is determined on an individual basis. However, jaw surgery is usually considered a medically necessary procedure, and our office works tirelessly to help get as much covered by your plan as possible. Since every plan is different, this is something we will have to look up once we have your insurance information. We like to initiate that process early, so there are no surprises!