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Orthognathic Surgery

What Is Orthognathic Surgery?

Orthognathic Surgery – “Surgery to create straight jaws” is the literal meaning of orthognathic surgery. It is usually undertaken to improve both the function and appearance of the upper and lower jaws, the teeth and the facial appearance as a whole.        It is undertaken by a team consisting of a Consultant Orthodontist, along with a Consultant in Oral and Maxillofacial Surgery.          Sometimes other professionals need to be involved such as Psychiatrists, Dieticians and Speech and Language therapists.

Orthognathic treatment has been shown to improve oral function, improve both dental and facial appearance and improve health related quality of life. In some cases the results of jaw surgery can be enhanced with the addition of other procedures such as nose surgery (rhinoplasty), chin surgery (genioplasty), or the placement of facial implants.

What Causes jaw problems?

Large, small or asymmetric jaws may develop without a specific cause but often there is a genetic predisposition to uneven jaw size. Other causes include disturbance or jaw growth during development such as after a fracture of the jaw bone in childhood. Some children with specific conditions such as cleft lip and palate, or a syndrome known as hemifacial microsomia are more likely to require this type of treatment.

Usually jaw discrepancies are noted as children grow and becomes more marked at puberty. Usually treatment is undertaken towards the end of growth during late teenage years, although in some cases maybe started earlier. Jaw surgery before the end of growth runs the risk of needing repeating as growth can change jaw shape so your surgeon or orthodontist will delay starting orthodontic treatment until they feel you will be finished growing at the time of surgery.

Is there an upper age limit for treatment?

Adults can also undergo this type of treatment. This maybe indicated for a number of reasons:

They may of been unaware the treatment was available when they were younger and have functional problems with eating or with there occlusion (bite) teeth, or even wish to improve there appearance.

They may ned this treatment due to facial surgery for trauma or other head and neck pathology causing disturbances in the bite (occlusion).

Sometimes we see patients who have had previous camouflage surgery eg a chin implant, or orthodontics to hide a small jaw and who would also benefit from orthognathic surgery.

What problems are caused by abnormal jaw relationships?

Mild jaw deformities and disturbances in the bite are relatively common and usually cause problems with the alignment of the teeth. This can sometimes be treated with the use of braces alone. In the UK this type or treatment is usually carried out by an orthodontist in high street practise. More severe facial deformities and jaw discrepancies cause a number of concerns and these patients are usually treated in a hospital setting with a Consultant Orthodontist and Consultant in Oral and Maxillofacial Surgery working together.

If dental and facial appearance is compromised this can lead to problems with increased stress and difficulty in forming interpersonal relationships, especially during the important formative teenage years. This ultimately reduces quality of life of the patient.

Jaw function can be compromised and this can result in problems with eating, damage to the gums and palate due to a traumatic bite, jaw muscle and jaw joint problems and speech difficulties.

What does Orthognathic Treatment involve?

Patients or there parents usually seek advice initially from their dentist or GP. Older patients may seek advice for camouflage treatment directly from cosmetic surgeons and these patients should really be assessed fully by a Consultant Maxillofacial Surgeon and Consultant Orthodontist prior to proceeding to camouflage surgery so that they can be fully informed of all treatment options and complications before proceeding to surgery.

 

It is recognised that the gold standard for orthognathic treatment is provided in the hospital setting using the team approach. The clinicians working in this setting have all undergone the appropriate training and have extensive experience in this type of treatment. This multidisciplinery team approach allows close communication between all involved in a patients care.

 

Once a problem has been identified a referral can be made and the patient assessed fully by both a Maxillofacial Surgeon and an Orthodontist. This initial assessment will involve a full history and examination. Usually radiographic examination of the face and jaws with either x-rays or CT scans, impressions of the teeth and clinical photographs are undertaken for records and for undertaking cephalometrics (skull radiographic measurements). Using this information computer software programming can simulate proposed tooth and jaw movements to give a guide as to the post treatment outcome.

 

Once a patient has nearly finished growing (usually at 15-18 years of age) treatment planning can be discussed with patients and parents. If the patient then wishes the initial phase of the treatment can start. Prior to any brace treatment all dental work should be completed and oral hygiene should be good. If this is not the case treatment will be delayed until good oral health has been achieved. This is because braces increase the risk of dental decay and can be detrimental if good oral hygiene measures are not undertaken.

Treatment Stages

  1. Pre-surgical orthodontic treatment with braces and any necessary dental extractions. This work is usually undertaken by a Hospital Consultant Orthodontist. Braces are attached to the teeth which are then adjusted on regular basis. This allows the teeth to straighten in each jaw so that the two jaws can fit together properly. At the start of this treatment it maybe necessary to have some teeth removed to make room for the teeth to be moved in the jaws. The commonest teeth to be extracted are the premolar teeth although this may vary. Sometimes heavily filled teeth maybe extracted rather than healthy teeth if it is thought there long term prognosis is not as good as the other teeth. Also at this time if you have wisdom teeth present in the lower jaw, they should also be removed. This is because lower jaw surgery is undertaken in the part of the jaw in which the wisdom teeth lie. If they are left in place the jaw surgery can be less predictable and so are usually removed at the start of treatment in order for bony healing at the extraction site to take place. This initial orthodontic stage usually lasts 12-18 months
  2. Once tooth alignment has been achieved a final surgical plan is made between the maxillofacial surgeon and the orthodontist. Impressions of the teeth are undertaken and using specially trained maxillofacial technicians the planned surgery in simulated on the models of the teeth. This allows acrylic splints to be made which allow the surgeon to correctly position the teeth at the time of surgery. Both immediately prior to, and following the surgery, the frequency of the visits to both surgeon and orthodontist will increase to ensure the preparation for surgery is correct and the immediate post operative position of the teeth and jaws is optimised and maintained
  3. Post-surgical orthodontics. Following surgery there may be some fine adjustments that need to be made to the position of the teeth, therefore the braces usually stay in position until 4-6 months after. Following removal of the braces you will need to wear retainers on your teeth for a year initially and then at night only for many years as teeth will always have a tendency to try and return to the position they came from!

Is it worth it?

Initially you may think this is not for you, as both the treatment time and surgery require significant time off work, discomfort etc. However the end result is that your facial skeleton is healed in its new position and this will remain with you for the rest of your life. Patient satisfaction for this type of treatment is very high despite the long course of treatment involved. There are many patients who have undergone this type of treatment and would be more than happy to discuss their experiences.

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