Jaw Surgery
What is Jaw Surgery?
In many cases, bite problems and dental crowding can be corrected with orthodontic treatment alone. However, in some cases, skeletal and dental irregularities may be too severe to be solved with braces alone. In such cases, orthodontic treatment needs to be supported by jaw surgery, also known as orthognathic surgery.
Although jaw surgery may sound scary, advances in techniques in recent years have significantly shortened both the duration of surgery and the postoperative recovery period.
Click here to read Mayo Clinic’s article on jaw surgery.
Who is a Candidate for Jaw Surgery?
Patients with severe bite issues and facial asymmetry are candidates for jaw surgery. Jaw surgery can address aesthetic concerns such as forward or backward-positioned jaws, congenital defects, or asymmetric facial structures. Additionally, functional problems related to chewing, sleeping, and other issues caused by incorrectly positioned jaws can be resolved.
Disorders treated with jaw surgery include:
- Open bite
- Forward-positioned lower or upper jaw
- Backward-positioned lower or upper jaw
- Obstructive sleep apnea
- Serious bite problems
- Facial asymmetries
- Inability or difficulty in closing the upper and lower lips
- Cleft lip and palate
- Excessive gummy smile
- Mouth breathing
- Facial trauma
When Should You Start Treatment?
Each patient’s needs can vary. Here, I will provide a brief overview of how the procedures are typically carried out. After your orthodontist examines you and determines that you need jaw surgery, the first step is to visit your dentist to check for any cavities or gum problems before beginning orthodontic treatment.
Once all your dental treatments are complete, you will be ready to start your orthodontic treatment (metal braces, clear braces or clear aligners). Your orthodontist may request various X-rays (panoramic, lateral cephalometric, posteroanterior skull, hand-wrist X-rays, 3D tomography, MRI) to plan your treatment. After your intraoral impressions and photographs are taken, the orthodontist will create a treatment plan based on the data (X-rays, photos, and plaster models). This plan may include upper jaw expansion, tooth extraction from the upper or lower jaw, or other procedures. After the planning is complete, your orthodontic treatment will begin. Click to read our article about orthodontic treatments. The purpose of the orthodontic treatment is to prepare you for surgery. Preparing a patient for orthognathic surgery usually takes between 12 to 24 months, although this period can vary greatly.
When you are ready for surgery, the X-rays, dental impressions, and photographs taken at the beginning will be repeated. This time, your orthodontist will use this data to create a surgery plan specifically for you. Meanwhile, a surgery appointment is arranged with the surgeon. The orthodontist will prepare a surgical splint (mold) based on the planned movements, and during the surgery, the surgeon will move the jaws according to the orthodontist’s mold. After the surgery, which typically lasts 2 to 4 hours, you will stay in the hospital for 1 to 2 days (this decision will be made by the surgeon). Following the surgery, your orthodontic treatment will generally continue for another 5 to 12 months, but keep in mind that this period can vary significantly.
Jaw Surgery Process and Planning
Jaw surgery is not a one-time event; it is a multi-stage process that involves orthodontic treatment before and after the surgery. The entire process can take between two and three years, depending on the severity of the jaw misalignment.
Process
The process begins with pre-surgery orthodontics, which may involve braces or clear aligners to align your teeth for surgery. This phase generally lasts between 12 to 24 months. After the braces align the teeth, the surgery is performed to reposition the upper or lower jaw or both, using techniques such as maxillary osteotomy (upper jaw surgery), mandibular osteotomy (lower jaw surgery), or genioplasty (chin surgery).
Conditions Treated with Jaw Surgery
Jaw surgery is used to correct skeletal discrepancies in the jaw that can lead to functional problems and aesthetic concerns. Common issues treated include:
- Congenital conditions such as cleft lip and palate, Pierre Robin sequence (small lower jaw), and other birth-related jaw deformities.
- Malocclusions like crossbite, underbite, and open bite.
- Growth disturbances, such as excessive jaw growth caused by hormonal imbalances.
- Jaw problems resulting from trauma, facial fractures, or tumors.
- Sleep disorders like obstructive sleep apnea (OSA), where repositioning the jaws can improve the airway during sleep.
Preparation for Jaw Surgery
Before jaw surgery, a thorough pre-surgical workup is necessary. This includes X-rays, CT scans, and dental impressions, which are used to create a 3D model of your jaws as I mentioned above. In some cases, computer-guided treatment planning and temporary orthodontic anchoring devices may be used to speed up the process.
To prepare for surgery, patients often need to adopt a liquid diet and receive general anesthesia for the procedure. The surgeon will use small plates, screws, and rubber bands to secure the jaws in their new position.
Jaw Surgery Procedures
- Maxillary Osteotomy (Upper Jaw Surgery): In cases where the upper jaw recedes, or when treating conditions like open bite or crossbite, the surgeon moves the upper jaw as a unit. The surgeon then secures it with plates and screws.
- Mandibular Osteotomy (Lower Jaw Surgery): This is used to treat a receding or protruding lower jaw. The surgeon cuts the jaw behind the molars, shifts it forward or backward, and secures it with plates and screws.
- Double Jaw Surgery: Sometimes both the upper and lower jaws require surgery for comprehensive correction.
- Genioplasty (Chin Surgery): Often performed alongside mandibular osteotomy, this surgery corrects a small chin by repositioning the chin bone.
Postoperative Care and Recovery
After the surgery, patients typically stay in the hospital for one to two days. Swelling, pain management, and liquid diets are common during the recovery period. Recovery takes time, and it may take up to 12 weeks for the jaw to heal fully. During this period, braces continue to refine the bite, and additional orthodontic treatment may last for 5 to 12 months.
Patients also wear the final surgery splint and elastics for 1-3 months after surgery to help the muscles adapt to the new jaw position. After the braces are removed, patients should wear retainers to maintain the new position of the teeth.
Risks of Jaw Surgery
While jaw surgery can significantly improve malocclusion, facial aesthetics and overall function, as with any major surgery, it comes with some risks. To summarize these risks:
- possible damage to teeth,
- problems in bone healing,
- jaw joint problems,
- numbness in the cheeks and lower lip,
- the need for additional surgeries,
- You may find it difficult to open your mouth as wide as before.
- The original biting problem that caused your jaw surgery could potentially return.
- There is a possibility of scarring.
However, when successful, the surgery can provide lasting relief from issues like aesthetics, sleep apnea, chewing difficulties, and speech problems.
Cases
Here are some examples of jaw surgery cases to illustrate how facial profile, smile, and bite have transformed. The before-and-after photos clearly show the dramatic improvements in jaw alignment, facial symmetry, and overall aesthetics achieved through surgery. These images highlight the positive impact that jaw surgery can have on both appearance and function.
Conclusion
Jaw surgery is a complex, multi-step process that involves both orthodontic and surgical expertise. It can dramatically improve both the function and appearance of the jaw and face, but requires a long-term commitment to treatment and recovery. With advancements in technology, the surgery has become more efficient, leading to shorter recovery times and better results for patients.
