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Mandibular Osteotomy

What does the operation involve ?

Mandibular Osteotomy: The operation is undertaken through an incision made at the back of the mouth in the gum by the molar teeth to gain access to the jaw. The lower jaw is then cut in an oblique fashion with a small saw to allow it to be broken in a controlled manner. It is then moved into its new position, which has been predetermined during surgical planning with the aid of models of your teeth. A small plastic wafer is attached to the teeth to allow the new position of the lower jaw to be determined, which is then fixed into place with small metal plates and screws. These are made of titanium that is a very inert metal and safe to be used in the body. The gum is stitched back into place with dissolvable stitches.

mandibular

What can I expect after the operation?

When you wake up from the operation you will have some small elastic bands between the upper and lower teeth. These are to help guide your teeth into their new position and therefore you will not be able to open your mouth fully.

If you have had mandibular segmental surgery (i.e if your bottom jaw has been sectioned further) then you will have a small plastic wafer attached to your lower teeth as well as elastic bands between your upper and lower jaw. In this case the wafer is usually removed a week following surgery, although in some cases can be longer. You will be advised if this is likely prior to surgery.

This is not a very painful operation and when you initially wake up you will feel the area around the jaws to be numb. However you will find your mouth and jaws feel generally uncomfortable in the first 2-3 weeks following surgery. Regular simple painkillers are usually needed initially and these will be given to you to take home from hospital.

Swelling usually gets worse up to 4 days following surgery and will then gradually start to settle. Using cold compresses can reduce this and sleeping propped upright for a few days. Most of the swelling has usually disappeared after a fortnight but there is often some subtle swelling that can take several months to disappear although only you and your family are likely to notice this.

It is also necessary to make sure that the area heals without any infection and so you will be given antibiotics whilst you are in hospital that will be continued for a few days when you return home. You will also be given an antibacterial mouthwash, this should be used twice daily, morning and night. Hot salt water rinses after meals will also help keep the wounds clean and reduce debris with the mouth.

It is likely that you will have a small amount of bleeding from the mouth for a few days following surgery. A sore throat and difficulty swallowing can also be expected.

Frequent Q&A'S

  • What About Eating?Initially you will be on a very soft diet and you will need a food processor at home to help with food preparation. After the first week or so you will be able to take soft foods. Normal eating usually returns over a 6-8 week period.
  • How long will I be in hospital?Usually patients go home the following day after surgery, however sometimes two nights maybe indicated depending on home circumstances. You will be seen again in clinic one week following your surgery.
  • What About returning to work and sports?This varies from person to person and also depends on what kind of job you do. We recommend that most people have about three weeks off work. It takes 6-8 weeks for bones to heal fully therefore we advise that you don’t undertake heavy manual work or contact sports during this healing phase. It is important to remember that you will not be able to drive or operate machinery for 48 hours after your general anaesthetic.

What are the possible problems?

There are potential complications with any operation. Fortunately with this type of surgery complications are rare and may not happen to you. However it is important that you are aware of them and have the opportunity to discuss them with your surgeon.

  • Bleedingduring surgery the risk of significant bleeding is low, but there is a risk of approximately 1% of needing a blood transfusion. This would only be given if absolutely necessary. If there was significant bleeding during surgery there is a small chance that a small incision may need to be made in a crease in the neck in order to gain access to blood vessels to stop the bleeding.
  • Following surgery some oozing from the cuts inside your mouth on the night of operation is normal and to be expected. Often you will notice slight bleeding from your nose as well which may take a week or so to settle. Again this is normal and nothing to be concerned about.
  • Numbnessyour bottom lip will be numb and tingly after the operation, similar to the sensation after having an injection at the dentist. This numbness may take several months to disappear and in a minority of patients there may be some permanent changes in sensation of the lower lip.
  • Infection the small plates and screws that hold your jaw in its new position are usually left in place permanently. Occasionally they can become infected and need to be removed but if this happens it is not normally a problem until several months after surgery.
  • Adjustment of the bite in the weeks following surgery it is often necessary to put elastic bands on your orthodontic braces to guide your bite into its new position. Rarely a second small operation may be required to reposition the fixing plates and screws if your new bite is not quite right.
  • Non-union occasionally bones don’t heal as they should and if this does happen sometimes a second procedure is indicated. Problems like this are more likely to occur in smokers or in those who are immunosuppressed eg diabetics.
  • Depression it is very common for patients to feel depressed in the initial phases of healing after an operation. Facial appearance has changed and sometimes patients find this somewhat difficult to deal with initially. This is more so in older patients. It is advisable to have some books or DVD’s at home so that you can occupy yourself during the recovery period. Once the swelling settles and eating becomes easier then most patients feel more comfortable with their new appearance.

 

  • What about follow-up?

A review appointment will be arranged before you leave hospital to see both the surgeon and orthodontist usually a week following surgery. You will need to come back regularly during the initial healing phase to ensure that your bite is maintained in its new position and for adjustment of the elastic bands between your teeth.

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