What Is Corrective Jaw Surgery?
Orthognathic surgery (jaw surgery) is needed when your jaws don’t meet correctly and/or your teeth don’t seem to fit with your jaws. While teeth are straightened with orthodontics, corrective jaw surgery repositions a misaligned jaw. This not only improves facial appearance but also ensures that teeth meet correctly and function properly.
Corrective jaw surgery can assist in becoming healthier. It will improve the exterior appearance of the jaw line as well. Numerous symptoms can help an individual determine if they may need corrective jaw surgery. Having difficulty with chewing and swallowing food, chronic jaw joint pain that often also creates headaches, constant mouth breathing which also may affect sleep apnea, spaces between the upper and lower sets of the teeth when the mouth is closed, and problems closing the lips together without causing pain or strain can be hints that corrective jaw surgery is needed.
Difference Between Upper & Lower Jaw Surgery
Lower and upper jaw surgeries vary based on each individual. If surgery is completed on the lower jaw, the rear part of the jaw is usually separated from the front part of the jaw. This is in the sagittal plane, therefore, called bilateral Sagittal split osteotomy. The bones slide on top of each other. Therefore, there is never a gap in between. The front area is actually supports the teeth and will allow for the lower portion of the jaw to be moved forward or backwards. This repositions the tooth-bearing area. The surgeon will then insert screws and surgical plates to reposition the bone segments.
Upper jaw surgery differs from lower jaw surgery in that the surgeon will separate the tooth-bearing area of the jaw so that the base of it can be moved down, up, forward, and backward. The jawbones are able to be moved specifically where the patient needs them to be. As in lower jaw surgery, screws and surgical plates are utilized to fasten the jaw to the new position that it was moved to. Some patients may need bone to be added to or removed from the jaw. Others may need it reshaped. Upper jaw surgery recovery may involve a bite guide so that the bite alignment remains correct during recovery.
How Do You Prepare For Orthognathic Surgery?
Dr. Jamali suggests seeing a surgeon first to determine if you are a good candidate for surgery. If so, then Dr. Jamali will assist you in choosing a qualified orthodontist to start the presurgical orthodontic treatment. You will discuss the options of different types, length and cost of orthodontic treatment with your orthodontist. In our office, we do many cases with Invisalign. Dr. Jamali will then discuss your case with the orthodontist and plan the surgery. At this point, it will be decided if you would need to remove your wisdom teeth or bicuspids. You will be informed about all the details.
The next phase is to start your presurgical orthodontic treatment. This may take anywhere from 6-24 months depending on the case. Orthodontic treatment assists in straightening the teeth prior to and after the surgery is completed. It is important that the patient’s bite is aligned and when the jaw is being repositioned.
Once your surgeon feels that the teeth are properly aligned, the surgery would take place. This is performed in the hospital. Patients are typically given a general anesthesia prior to surgery. The duration of the surgery depends on the procedure being done and the complexity of the case. Then, there is the post-surgical orthodontic treatment which should take anywhere between 4-6 months.
Jaw surgery is usually not a procedure that is completed on children. Usually, the surgery is only appropriate after an individual has stopped growing and the jaw and skeletal features are fully grown. The typical age that females stop growing is 15, and males typically stop growing at the age of 18. There may be other circumstances involving children who have birth conditions or severe orthodontic problems where surgery is needed at an earlier age.
Why Is Jaw Surgery Performed?
Individuals who have an improper bite, an imbalance in facial features, or sleep apnea may be candidates for orthognathic surgery. Those who have jaws that are not positioned in the correct way can also benefit from this procedure. As an individual ages, the jaws begin to form and position themselves. The rate that this occurs varies with every individual, and the upper and lower jaws may grow at different rates. This growth difference can produce problems in terms of function, including speech and chewing problems. The jaw may also produce facial irregularities, which can affect an individual’s appearance. Birth defects can influence the alignment of the jaw, which also may require corrective surgery.
Dr. Majid Jamali is the chosen specialist to speak on orthognsthic surgery at RealSelf
“Misaligned jaws can affect function and airway, and contribute to facial aesthetic deformities, such as asymmetry, high angle mandible (steep jawline), vertical maxillary excess (overgrowth that results in a gummy smile), open bite, overbite, and underbite. The muscles of the face and the temporomandibular joint (TMJ) may become sore as a result of these conditions.”
What Conditions Can Influence The Need For Jaw Surgery?
Most of our patients have had some sort of orthodontic treatment already in their past. Orthodontists worldwide often mask skeletal issues by correcting the bite. This is only OK in cases of mild dentofacial deformities. In moderate and severe cases, as the patient ages, they realize that “something is off” with their profile.
Patients that are usually seen in our office have the following issues:
- Birth defects
- Chronic jaw or jaw joint (TMJ) pain
- Involuntary mouth breathing
- Inability of the lips to come together without straining
- Trauma or injury to the jaw or face
- Open bite (space between the upper and lower teeth when the mouth is closed)
- Gummy smile (VME)
- Protruding jaw
- Receding lower jaw and chin
- Tumor or pathology affecting the jaw
- Sleep apnea
Any of these symptoms can exist at birth, be acquired after birth as a result of hereditary or environmental influences, or as a result of trauma to the face. Before any treatment begins, a consultation will be held to perform a complete examination with X-rays. During the pre-treatment consultation process, feel free to ask any questions that you have regarding your treatment. When you are fully informed about the aspects of your care, you and your dental team can make the decision to proceed with treatment together.
What Can You Expect During Corrective Jaw Surgery?
Jaw surgery usually takes place in a hospital setting under general anesthesia usually Dr. Jamali prefers his patients to stay no longer than one night stay in a hospital facility. The surgery is completed inside the mouth. This eliminates scarring on the exterior areas of the face including.. Orthognathic surgery will involve cuts being made in the jawbone. This allows the surgeon to position the jaw in the correct place to eliminate problems the patient is currently experiencing.
Repositioning and properly aligning the jaw will involve the use of screws and plates securing the jaw in the new position. In some cases, new bone may need to be added to the jaw. The bone and new jaw position will be secured temporarily with titanium plates and screws. The timeline for surgery really depends on the extent of it. Dr. Jamali is one of the few surgeons in the country who will complete all the surgery himself, rather than a learning resident/fellow.
We always make the patients aware that the first week of the jaw surgery is uncomfortable. This procedure is usually not that painful surprisingly. However, due to swelling and blood clots in the sinuses, patients feel uncomfortable. In our experience, the patient improves 20-30% on 2nd week, 70-80% on the 3rd week. Once the 3rd week is past, the public would not notice that any procedure has taken place.
During the 1st week, you will experience swelling around the cheeks, lower jaw and nose. Some bruising is normal and depends on the individual. Dr Jamali is one of the few surgeons that DO NOT WIRE the teeth shut after surgery. He feels this is unnecessary with today’s advancement in hardware.
What Are The Potential Side Effects?
After jaw surgery, you may experice some of these side effects:
Discomfort: Most of this is experienced during the first week.
Swelling: It will subside dramatically after 3rd week.
Infection: This is rare. You have to adhere to the directions and complete your antibiotic regimen
Bleeding: Some oozing is normal. If active bleeding occurs from nose (rare), contact our office.
Nausea: This is very rare. We try to avoid narcotic medications as mulch as possible.
Vomiting: If you have to vomit, tilt your neck forward, so the contents of your stomach come out safely. Again nausea and vomiting a rare in our patients.
Dr. Majid Jamali is the chosen specialist to speak on orthognsthic surgery at RealSelf
“Rare risks include damage to teeth, relapse, failure of the hardware, and TMJ issues,” says Dr. Jamali.
What Is The Follow Up And Recovery Like For Jaw Surgery?
Patients are usually seen in the office for a follow up 10 days after the surgery. Radiographs will be taken on this session. Based on the individual case, Dr. Jamali will see his patients 3-4 times during the first month post surgery, until he feels comfortable to send the patient to the orthodontist again.
We recommend adhering to liquids for the first 6 weeks, then soft diet for the second 6 weeks. At the end of 12 weeks post surgery, the patient can return to a regular diet.
Please note that it will take 5-6 months for the bone to heal completely. During this period, contact activity is prohibited. During the first week, we encourage walking inside the house only. Lightheadedness is normal during the first week. It will take a few days for your body to build up the blood that has been lost during the surgery. Keep your head elevated 30 degrees during this period. Periodic icing to the face may make you more comfortable. Limit your walks to 1 mile between the 2nd-3rd week.
Before and After
What Are The Potential Risks Of Orthognathic Surgery?
The main risks for lower jaw surgery is numbness to lower jaw, chin, lips. This could last from a few days to months. Rarely, it could result in a permanent numbness. In our practice this is rare and rates around 1%. Upper jaw surgery results in 2-3 months of numbness in midface area. Chance of permanent numbness is extremely low.
Failure of the bone to heal in the correct position: With use of screws and plates this is rare.
Further growth: If the lower jaw is protruding, Dr. Jamali waits for the patient to mature completely, then proceed with the surgery. Occasionally further radiographic examinations are required prior to surgery.
Bone healing with scar tissue and not calcifying: In a healthy patient this issue is rare. It usually occurs in a patient that uses his or her teeth to chew in the healing process.
Can Your Voice Change After Jaw Surgery?
The simple answer is yes. However, this depends on what kind of condition you have and what type of surgery is performed. The tongue and teeth are instrumental in pronunciations of certain letters. As you start to reconstruct your jaw and move things around, it can cause some vocal changes. You may experience speech and voice adjustments as these can be the effects of functional surgery. The difference in jaw positioning or shape can have an effect on voice frequencies.