Orthognathic Surgery

As human beings, we interrelate most frequently through our facial appearance and facial expression. The face and mouth are logically and practically the first part of the body our eyes contact. As individuals, we have different concerns about our dental and facial presentation. Some patients may be concerned about very minor imbalances or appearance difficulties, such as crooked teeth, while others may be perfectly satisfied and unconcerned about significant facial discrepancies.

Malalignment of teeth or jaws may have significant impact on future jaw/facial function and development. When a problem is suspected, it is appropriate for your dentist to refer you to an orthodontist and/or an oral and maxillofacial surgeon, the surgeons of OMS Consultants, for their analysis and opinion.

Generally, an orthodontist is able to successfully treat dental crowding and intercept growth problems at an early age. In many cases however, it is necessary to consider surgery to change the underlying skeletal or bony structure to provide the ideal facial appearance and function. The surgeons at OMS Consultants are trained to diagnose and treat abnormalities of the facial bones and soft tissues.

Jaw Problems

You should consider the following items when making a plan for your overall treatment:

Functional Problems

• Are you having any problems with chewing or digesting foods?
• Do your teeth interfere while chewing, causing soreness to the soft tissue areas (example, roof of the mouth/cheeks, etc.)?
• Are there any negative effects on your teeth, (example: excess wear, loosening)?
• Do you have concerns about the presentation of your appearance (e.g. are you satisfied with the tooth, lip, bone, nose position, etc.)?

Orthodontic/surgical treatment may be the solution to many or all of the problems which concern you in this area.

But before making any commitment to this type of treatment, you should investigate all aspects of it. You should be clear about the benefits you are hoping to achieve from the proposed treatments, as well as the risks involved. You should be clear about the benefits you are hoping to achieve from the proposed treatments, as well as the risks involved. You should be aware that the treatment time may vary from 1 to 3 years and finally you should be fully aware that as an integral part of the team that will work towards achieving your goals, you must be committed and allow for the time an financial demands of the various treatments.

About your Face:

Facial/Jaw Problems

Facial bones and teeth in general may present distortions or imbalances in the following ways:

A. Mandibular Deficiency

The most common problem is that of a short or retrognathic lower jaw. This type of bite is frequently called a Class II malocclusion. The surgical procedure indicated to correct this problem is advancement of the lower jaw.

B. Mandibular Excess/Maxillary Deficiency

One of the most obvious presentations of a facial bone problem is that of a protrusive or long lower jaw. This is called a prognathic or Class III malocclusion. This type of a problem may also be primarily caused or exaggerated in appearance by a small or underdeveloped upper jaw. The surgical correction for this problem is to set the lower jaw back and/or moving the upper jaw forward.

C. Maxillary Excess / Open Bite

Upper jaw problems most frequently involve excess posterior or back growth of the upper jaw. This may lead to an open bite malocclusion or inability to close the front teeth completely. This makes chewing difficult and may make it difficult to close the lips. To treat this condition, the surgeons of OMS Consultants will level or move the upper jaw to the correct position.

D. Asymmetries / Crooked Jaws

In addition to the above problems, asymmetries or crooked jaws may develop. In such, cases, one side may grow excessively at an early age or one side may not grow as a result of trauma or growth disturbance. If these problems occur at a young age, the overall facial bone structure will develop unevenly. The surgeons of OMS Consultants, or your orthodontist will determine whether jaw development has ceased. Most patients with asymmetries have concerns about the facial appearance and will frequently have chewing difficulties. Various surgical options involving the lower jaw / or upper jaw are available to correct the asymmetry.

Evaluating the bite and Jaws

Your dentist and orthodontist will require certain x-rays, photographs and records to evaluate tooth and gum health and potential tooth movement. In addition, periodically, the surgeons of OMS Consultants will require x-rays, photographs, records and models to plan your surgery. Mock surgery or model surgery is carried out by tracing facial x-rays and transferring movements onto the models of your jaws.

You will be evaluated as your treatment progresses for the final decision on surgical movements. Plastic splints will frequently be constructed from the models to produce a ‘‘holding device’’ for your bite. This will be used during and occasionally after surgery. Various x-ray studies will be needed to diagnose and plan your case. In some cases, computer-assisted drawings and x-ray reconstructions may be utilized to predict your treatment outcome.

Necessary consultations will generally be arranged with any other medical or dental specialist required in your case. Your orthodontist and the surgeons of OMS Consultants will make them aware of the exact type of surgical treatment. The timing of any necessary tooth extractions (e.g. wisdom teeth) will also be decided.

In average cases, preparatory orthodontic treatment occurs over a period of 6 to 24 months prior to surgery.

Timing of surgery is a mutual decision between your orthodontist and the surgeons of OMS Consultants.

Once all essential pre-operative decisions have been made, our office will work with you to arrange booking at the hospital.

The hospital will contact you with details about check in time. Depending on your procedure and your progress, you will normally be discharged from the hospital 1 to 4 days after surgery. Before you leave, you will be assessed and given prescriptions for your necessary medications. Arrangements will be made for several post-operative appointments with the surgeons of OMS Consultants. During those appointments, post-operative records will be taken and your wires and elastics will be removed.

Wires or elastics may be removed immediately after surgery to a few days to a few weeks later, depending on your type of procedure.

Final timing for your return to regular activities or work will be determined. Resumption of any special physical or sporting activities should be discussed with the surgeons of OMS Consultants.

The Surgical Process

Pre-surgery

When you enter hospital prior to surgery, registration and recording of your general history is carried out. Arrangement for the type of room, insurance details and approximate length of stay are made.

Appropriate lab tests are carried out to confirm the state of your health and your suitability for the procedure and for general anaesthesia.

Your medical history and present physical state will be assessed thoroughly. Your particular medical situation may be unique and it is very important to discuss this with your doctors.

You will also be asked to sign a consent form. You must make sure that you understand all the information contained in the form.

Surgery

A general anaesthetic will be used. Although complications such as drug reactions can occur during anaesthesia, the anaesthesiologist and hospital staff are prepared to handle such problems.

Emergencies occur only rarely. The overwhelming majority of orthognathic jaw surgery treatments are successful.

There are many techniques and types of surgery which may be indicated depending on your particular jaw problem. Cuts in the jaw or osteotomies may be carried out on either jaw, or in some cases on both jaws simultaneously.

In addition, cuts may be made within the jaw to move individual parts of the jaw in other dimensions.

Occasionally, grafting with your own bone may be required. Artificial bone or bone substitutes may also be used for correction of certain problems or to promote new bone to heal.

Post-surgery

After the surgery, patients awake in the recovery room. There they will be monitored and observed until they are fit to return to their rooms.

Jaws may be held together with elastics and/or wires. There may also be plastic splints. In many cases, bones may be held internally with small pins, screws or plates. The period of jaw wiring may vary depending on your particular type of surgery. This again should be discussed with your doctor. In many instances, elastics will be used at the time of surgery and it will be necessary for the patients to learn how to apply and remove them. This should be reviewed with the surgeons of OMS Consultants and with your orthodontist.

Virtually all patients will have some swelling after the soft tissue and bone incisions are made. A pressure dressing or ice pack may be used for a period of time to control this. They are generally removed before you are discharged from hospital.

Medications to control infection, nausea, and swelling are frequently used immediately after the surgery. Pain control medications will also be ordered as required.

Home care will also be discussed thoroughly. Appropriate instructions dealing with liquid and soft diets as well as oral hygiene will be provided. Depending on your age, health and type of surgery, extra help or home nursing may be recommended. Nausea or vomiting are rare but can be managed with the jaws together. It is rare to have to open the jaws urgently, but on discharge from hospital, you may be provided with instructions and/or cutters. Untoward occurrences such as bleeding when at home are rare but should be reported immediately. Contact numbers including the surgeons of OMS Consultants and/or local health centers should be kept nearby.

Risks & Complications

Orthognathic surgery outcomes are generally very positive. However, as with any surgery, complications may occur. The following are some of the possibilities.

During surgery and after, intravenous medications including antibiotics, steroids and pain medications will frequently be administered. Although reactions to these medications are rare, they may occur.

Infections are an uncommon complication but are still possible. There may be poor bone healing or relapse and rarely second surgeries may be necessary. Gum recession or loss of teeth have been known to occur, although infrequently. Weakness of facial muscles, jaw stiffness or muscle spasms may arise on occasion and may require treatment such as physiotherapy. A change or deterioration in temporomandibular joint function is also possible in some cases.

Most patients experience some numbness following jaw surgery. In the vast majority of patients, this is temporary but in a few cases, there may be permanent numbness. You should discuss this with the surgeons of OMS Consultants.

Transfusions are rare for these procedures but again the eventuality should be discussed with the surgeons of OMS Consultants. In many regions, auto-donation of blood is now routinely carried out and plans will have to be made a few weeks prior to your surgery, if this is your desire.

If bone grafting is used in your case, there may be another surgical site where grafts are harvested from. Care of these areas should be discussed with your doctor.

Conclusion / Benefits

Orthognathic surgery has allowed many people of all ages to greatly improve the health and function of their teeth and jaws. In combination with orthodontic care, moving jaw and facial bones to a more harmonious position can improve chewing, speech and appearance in a positive way.

It should be remembered that thousands of people have benefited from these procedures. The vast majority have gained significantly in function and appearance. As a potential patient, be sure to take the time to study and review the information made available to you. This is elective surgery and the choice to proceed is yours. It is essential for you to be aware of the risks and benefits of these procedures before making your informed decision.

Your oral and maxillofacial surgeon is extensively trained in these areas of surgery and is available to help you in reaching decisions.

Please review our section on post-operative instructions.