Orthognathic Surgery (Corrective Jaw Surgery)
Orthognathic Surgery is a unique endeavor in facial surgery: a patient’s appearance and occlusal function can be improved significantly, impacting the patient’s sense of self and well-being. Successful outcomes in modern orthognathic surgery rely on close collaboration between the surgeon and the orthodontist across all stages of treatment, from preoperative planning to finalization of occlusion.
Corrective jaw surgery is performed by an Oral and Maxillofacial Surgeon (OMS) to correct a wide range of minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth. Surgery can improve chewing, speaking and breathing. While the patient’s appearance may be dramatically enhanced as a result of the surgery, orthognathic surgery is performed to correct functional problems.
Conditions that may indicate the need of corrective jaw surgery
Difficulty chewing or biting food
Chronic jaw or jaw joint (TMJ) pain and headaches
Excessive wear of the teeth
Open bite (space between the upper and lower teeth when the mouth is closed)
Unbalanced facial appearance from the front or side
Receding lower jaw and chin
Inability to make the lips meet without straining
Chronic mouth breathing
Sleep apnea (breathing problems when sleeping, including snoring)
"Surgery First" Method
Surgery First is a surgical methodology that has revolutionized the field of orthognathic surgery in recent years. It is defined as an alternative to the conventional procedure "orthodontics, orthognathic surgery, orthodontics".
Thus, Surgery First is presented as a methodological and technical revolution mainly for four reasons:
1. The patient does not need an orthodontic treatment before orthognathic surgery: the orthodontic treatment that the classic procedure requires for some patients a reason not to undergo surgery. Now, thanks to this protocol, all patients who have their teeth well aligned and the only thing that is corrected is the existing disharmony between their jaw and maxilla, they can do without pre-surgical orthodontics.
2. The treatment time is shorter: orthodontics prior to orthognathic surgery does not exist and, therefore, the total time of treatment is reduced, approximately, year and year and a half.
3. The patient can choose the most convenient time for orthognathic surgery: the classical methodology depends irremediably on an orthodontic treatment prior to surgery lasting approximately one year. The candidate for Surgery First, free of presurgical orthodontics, can choose the most convenient time for orthognathic surgery.
4. The patient can enjoy the surgical results after the orthognathic surgery: with Surgery First, the patient in his new aesthetic a few days after the intervention, when the inflammation disappears. In addition, post-surgical orthodontic treatment is much shorter than in the traditional method.
About Orthognathic Surgery
Orthognathic surgery to reposition the maxilla, mandible, or chin is the mainstay treatment for patients who are too old for growth modification and for dentofacial conditions that are too severe for either surgical or orthodontic camouflage.
Today’s orthognathic surgical treatment for dentofacial deformity consists of standard orthognathic procedures to correct jaw deformity, as well as adjunctive procedures to improve hard and soft tissue contours. These adjunctive procedures include an osseous versus alloplastic genioplasty, septorhinoplasty, and suction lipectomy of the neck.
A collaborative approach between the orthodontist and maxillofacial surgeon is imperative to successfully devise and execute a comprehensive treatment plan with predictable outcomes.
Orthognathic surgery to treat jaw discrepancy and malocclusion may be viewed variably by insurance carriers. Often, “medical necessity” is difficult to establish and substantiate. For some patients, the out-of-pocket cost of combined orthodontic and orthognathic treatment is prohibitive. The treating professionals should be aware of this relevant issue when devising and recommending a specific treatment plan.
Typically, most patients will solicit surgical evaluation based primarily on the recommendation of the treating orthodontist. The patient may present to the surgeon, having already implicitly selected a preferred treatment option based on the treatment focus of the orthodontist. In general, orthodontic camouflage approaches to achieve a specific occlusal relationship with disregard to skeletal discrepancy, facial aesthetics, and degree of dental compensation should be discouraged. This is especially true in a patient who places high value on overall facial aesthetic improvement.
Key principles of surgical care and overall patient care include psychologic preparation of the patient; good preoperative and postoperative nutrition; preservation of blood supply to the mobilized teeth and jaw segments; protection of bone, neurovascular structures, and teeth; appropriate postoperative wound management; fixation of bony segments; proper control of occlusion; and rehabilitation to full jaw function.
Orthognathic Surgery Secuence of Treatment
Once a patient (child or adult) is diagnosed with a dentofacial deformity that may merit a surgical correction, a comprehensive evaluation by a surgeon and orthodontist is paramount. The maxillofacial surgeon examines the patient, reviews all available records, and discusses with patient and family the available treatment options. The surgeon focuses this discussion on achieving both functional (occlusal) and facial aesthetic goals. An orthodontist acquires complete records, including lateral and Panorex radiographs, facial and occlusal radiographs, dental models, and centric bite impressions.
Preoperative orthodontics holds as its basic objective the leveling and alignment of teeth over basal bone. Some specific goals may include correcting (reversing) dental compensation, establishing proper incisor inclination and transverse arch width, and maintenance of the dental midline.
The Orthognathic Surgery
May include Maxillary or Mandibular Surgery, or both. Concomitant intranasal surgery with septoplasty and reduction of the inferior turbinate may be required to improve nasal airflow dynamics. Genioplasty and neck liposuction may also be considered in select patients to improve the overall aesthetic outcome.
Postoperative orthodontic treatment usually starts 4 – 6 weeks after the operation. Once final detailing of occlusion is completed by the orthodontist, a postorthodontic retention phase begins. Is important to counsel the patient period of recovery and the expected course of rehabilitation.
Orthognathic Surgery Success cases
Age: 27th / Suffering: Class II dentofacial deformity with vertical excess of the maxilla.
Orthognathic Surgery Success cases
Age: 27th / Suffering: Class III with asymmetry (retreatment).