Orthognathic Surgery

What is orthognathic surgery?

Orthognathic surgery is a surgical procedure that is used to correct the position of the jaws. It is nearly always carried out in combination with orthodontic treatment.

Is it just a type of cosmetic surgery?

While having surgery will result in an improvement in facial appearance, orthognathic surgery goes beyond just cosmetic improvement. The underlying mis-alignment of the jaws is corrected which improves the way your jaws come together and function. This can result in improvements in eating, biting, speaking, and of course, self-confidence.

Who carries out the surgery?

This person is an oral and maxillofacial surgeon. Orthognathic surgery is carried out by this highly trained surgeon who is often qualified as both a dentist and a doctor.

Why do I need braces as well?

People who need orthognathic surgery usually also have teeth which are not lined up. Braces are needed in order to straighten the teeth and put them in their ideal position for when your jaws are moved to their ideal position.

Can I just have the braces without the surgery then?

Braces alone will straighten your teeth. Braces can also improve bites which are mildly out of line. If you have a bite which is significantly out of line, your bite will not change with braces alone. In fact, sometimes it can get worse with braces.

Straightening the teeth without correcting the bite can make your teeth more vulnerable to damage and they are highly likely to move back to their original position. If you did have braces without the surgery, you would need to be very good with wearing your retainers for as long as you want your teeth to remain straight.

Which jaw is moved - the upper or the lower?

Before you start any treatment, a series of records will be taken as outlined in Your First Visit. You will then be seen for a joint consultation where you will meet the orthodontist and the surgeon. Detailed analysis of your records will have been carried out prior to this visit. This analysis will determine how the teeth will be lined up and whether the upper or lower jaw needs to be moved. Sometimes, both jaws need to be re-aligned. It is a good idea to bring a close family member or friend with you to this joint consultation. Two pairs of ears are better than one, especially because you will be given a lot of information at this visit. It is also useful to make a list of questions you may want to ask about the orthodontics and the surgery at this visit.

Your orthodontist will take over next and your braces will begin shortly after this visit. When you are almost ready for the surgery, you will have another joint consultation. Another analysis will be carried out and a final plan for the surgery will be confirmed. You will be able to see the final bite on a jaw simulator at this visit.

The surgeon will then take over and book your hospital stay. The braces will remain on your teeth during this time. Once the surgery is completed, you will go back to the orthodontist to have the orthodontic treatment finished.

How long will all this take?

The phase of brace work before your surgery is generally about 12 to 18 months, and then the braces stay on for up to 6 months after your surgery. However, patients usually have their braces removed around 3 months after surgery.

The duration of your surgery will depend on if just one jaw is being moved or both and can vary from 2 to 6 hours.

What does the surgery itself involve?

The surgical procedure is called an osteotomy. Either maxillary (upper jaw), mandibular (lower jaw) or both (bimaxillary). All of the surgery is undertaken while you are asleep under a general anaesthetic. The procedure is carried out from the inside your mouth so you will not usually have any scars on your face or neck.

The gum in your mouth is raised to expose the jaw bones. Special instruments are used to cut the jaw bones in the desired position and then they are moved to the correct position. Special metal screws and plates are used to hold the jaw bones in their new position. The gum is then put back with stitches.

You will remain in hospital from anywhere between 1 and 5 nights until the surgical team are happy with your recovery.

How much time should I take off work/studies?

This depends on how quickly you heal and on whether you have had single jaw surgery or two jaw surgery. The latter takes longer to heal. It also depends on the type of work you do. For example, a student or someone working on the telephone may be able to go back to their routine sooner than someone working with the public face to face. Generally, people will take 2 to 4 weeks off.

What are the risks?

The Risks of Orthodontic Treatment applies to patients having orthognathic surgery since braces will be placed as well. There are a number of risks that you need to be told about the surgery and the surgeon will do this in detail with you at the joint consultation.

In summary, the general anaesthetic carries its own risk and the anaesthetist will explain this to you. In terms of the surgery itself, you will be swollen, tender and bruised after the operation. This will improve within a few weeks. The cleaning in your mouth will be more difficult for a while as your mouth will be sore and you will have to eat soft foods for a few weeks until you are comfortable eating firmer foods. You will also not be able to open your mouth wide and this gradually gets better over a period of months.

A serious risk of orthognathic surgery is numbness of the lips and skin overlying the jaws. This is usually temporary but can sometimes be permanent. The numbness feels a little like the way your lip may feel after you have had an injection at the dentist. The lips and skin will move normally but they will feel different.

What about the screws and plates that are put in my jaws?

These will be left in place for the rest of your life. A small number of them can become infected or start to cause you discomfort due to their prominence. For these reasons they may need to be removed at a later date either with a local anaesthetic or under a general anaesthetic.

I have been told I may need wisdom teeth out before the surgery - is this correct?

If you are having lower jaw surgery, the surgeon may need your lower (and sometime upper) wisdom teeth removed before the operation. This is because the cuts in the jaw are made in almost the exact same position of the lower wisdom teeth. This is usually done at least 6 months before your operation.

How much will it cost?

You will be given two fees, one for orthodontics and one for surgery. If you have health insurance, the surgery may covered by this but the orthodontics generally is not. You may also qualify for NHS hospital treatment and you will be given this option if you are eligible.

Why do I have to wait until I am at least 18 years of age?

We do not reach adult levels of growth until around this age so the jaw bones keep changing until this time. Surgery is delayed until we are sure the jaws are not going to change significantly once they are moved into their correct position.