Orthognathic surgery

Orthognathic surgery, also known as corrective jaw surgery, is a branch of oral and maxillofacial surgery that focuses on correcting conditions of the jaw and face related to structure, growth, sleep apnea, TMJ disorders, malocclusion problems owing to skeletal disharmonies, or other orthodontic problems that cannot be easily treated with braces. This surgical procedure aims to improve the patient's ability to chew, speak, and breathe and to enhance facial aesthetics. Orthognathic surgery can involve the upper jaw (maxilla), lower jaw (mandible), or both.

Indications

Orthognathic surgery is recommended for individuals with significant skeletal discrepancies that affect their oral function or facial aesthetics. Common indications include:

• Malocclusion that cannot be corrected by orthodontics alone, such as severe overbite, underbite, crossbite, and open bite.
• Congenital abnormalities such as cleft palate or syndromic conditions affecting the jaw.
• Facial asymmetry or deformities resulting from trauma or disease.
• Obstructive sleep apnea that cannot be managed by non-surgical means.
• Temporomandibular joint (TMJ) disorders when less invasive treatments have failed.

Preoperative Evaluation

A comprehensive preoperative evaluation is crucial for the success of orthognathic surgery. This includes:

• Detailed medical and dental history.
• Clinical examination.
• Imaging studies, including X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI).
• Orthodontic assessment and treatment planning, often involving the use of dental braces before and after surgery to ensure proper alignment of the teeth.
• 3D modeling and surgical planning to predict the outcome and guide the surgical process.

Surgical Procedure

Orthognathic surgery is performed under general anesthesia and involves the following steps:

• Incisions are made inside the mouth to minimize visible scarring.
• The jawbones are cut, moved, modified, and realigned to the desired position.
• Bone plates, screws, wires, or rubber bands may be used to secure the jaws in their new position.
• The incisions are sutured closed, and the patient is moved to recovery.

Postoperative Care

Postoperative care is essential for healing and includes:

• Hospital stay for 1 to 3 days to monitor recovery.
• A diet of liquids and soft foods for several weeks.
• Pain management with prescribed medications.
• Regular follow-up visits for monitoring healing and removing any non-dissolvable sutures.
• Continued orthodontic treatment to refine the bite.

Risks and Complications

As with any major surgical procedure, orthognathic surgery carries risks, including:

• Infection
• Blood loss
• Nerve damage, potentially leading to altered sensation
• Problems with jaw joint function
• Need for additional surgery

Outcome

The outcome of orthognathic surgery is generally positive, with significant improvements in oral function, facial symmetry, and appearance. Most patients report a high degree of satisfaction with the results, which can also lead to enhanced self-esteem and quality of life.

See Also

• Oral and maxillofacial surgery
• Dentofacial orthopedics
• Cleft palate
• Temporomandibular joint dysfunction