What is Orthognathic Surgery?
Ortho means straighten and gnathia means jaw and hence, Orthognathic Surgery means straightening of the jaw(s) by surgery. An Oral & Maxillofacial Surgeon carries this out. It is a cosmetic surgery and the surgeon envisages changing the face of a person from distortion to proportion. Orthognathic Surgery is sometimes called “Surgical Orthodontics” because just as an orthodontist repositions the teeth with the help of braces within the oral cavity, the Oral & Maxillofacial Surgeon repositions one or more jaws (skeletal bones) through surgical procedures to produce a much more pleasing appearance and also improved ability to chew, speak and breathe. The main objective of Orthognathic Surgery is the correction of a wide range of minor and major facial and skeletal (jaw) irregularities. The shape of the face depends on the architectural framework of the facial skeleton. Through Orthognathic Surgery the Surgeon could reposition the bones of the face and the jaw to a more aesthetically acceptable position.
Who needs Orthognathic Surgery?
Jaw growth is a slow and gradual process and in some instances the upper and lower jaw or one side of the jaw to the other may grow at different rates. This may cause many functional and psychological problems. Injuries to the jaws at a young age or during birth (delivery) or birth defects may also affect the normal growth and positioning of the jaws. While Orthodontic treatment (braces) can correct many problems if only the teeth are involved Orthognathic Surgery maybe required if the jaws (bone) also need repositioning. The results of orthognathic surgery can have a dramatic and positive affect on many aspects of your life.
The common maxillofacial deformities and their clinical appearances are the following:
Protruded Maxilla (upper jaw):The upper jaw is protruded beyond the normal limits along with the teeth. The person cannot close his lips (lip incompetence) without effort. The teeth are always visible and in most cases the whole of the gums are visible on smiling (gummy smile). A gummy smile is mainly due to the vertical excess of the maxilla.
Retruded Maxilla: This deformity is due to under development of the upper jaw mainly seen in people who have cleft lip or palate. After the surgical correction of the cleft lip or palate at a young age the growth of the maxilla is retarded along with displacement or destruction of the tooth bud. This results in a dish shaped face with a hooked or flaring nose and irregularly aligned, rotated or missing teeth.
Protruded Mandible (lower jaw): In some people there will be extra growth of the lower jaw resulting in long jaw. Their faces are very long with protrusion of the lower teeth and thick lips. Normally on biting the lower teeth will be inside the upper teeth while in people with long jaws usually the lower teeth will be outside the upper arch.
Retruded Mandible: In some people due to developmental deformity or due to hereditary factors the lower jaw is very small resulting in a “bird face”. There is no proper development of the chin.
Facial Asymmetry: Sometimes a part of the face maybe overdeveloped or underdeveloped causing one part of the face to be small or large. One side of the face is not in symmetry with the other side giving an unaesthetic appearance.
Akylosis of Tempromandibular Joint (TMJ): Injury during birth or trauma or infection at a young age to the tempromandibular joint will result in restricted mouth opening and reduced growth of the mandible.
Nasal Deformity: Nasal deformities are often seen along with deformities of the jaw. Some common deformities of the nose are: deviated nasal septum, flared or constricted ala of the nose, saddle nose, hooked nose, asymmetrical nose, etc.
At what age can Orthognathic Surgery be done?
The ideal age for Orthognathic Surgery is after the growth period has been completed. After 18 years for girls and 20 years for boys. Ankylosis of the TMJ is an exception. For this the surgery should be done as early as possible to rehabilitate function and growth of the mandible. If the patient has got psychological problems due to the deformity of the face then the other orthognathic surgeries may be taken up at an earlier age.
What are the steps in Orthognathic Surgery?
Evaluation: After the initial examination a through examination with facial measurements, photographs, x-rays, and dental impressions are made. A complete medical examination is done to rule out any health problems that would interfere with the surgery or the administration of General Anesthesia.
Pre-surgical Orthodontia: The Oral & Maxillofacial Surgeon and the Orthodontist will work closely together during your treatment. Orthodontic treatment (braces) is started before surgery. The teeth are moved and repositioned into proper alignment before surgery if necessary.
Preparing for the Surgery: Orthognathic Surgery is done in a hospital under general anesthesia. Usually you have to get admitted to the hospital one day prior to the surgery. You have to stay in the hospital for a week or so till you have recovered from the surgery. You have to undergo a full medical checkup. You may need blood transfusion during the surgery. You should maintain a good oral hygiene before and after surgery.
Surgical Procedures: Orthognathic Surgery lasts anywhere from 1½ hours to several hours depending on the type of surgery needed.
Incisions are made inside the mouth during surgery and there will be no visible external scars. However if external incision has to be made, as in surgeries of the tempromandibular joint , care is taken to conceal it in the natural skin creases or folds. Meticulous suturing technique can reduce the scar formation.
Sometimes it maybe necessary to remove some of your teeth during surgery to create space to reposition the jaw(s).
What are the Complications of Orthognathic Surgery?
Complications seen in any major surgery under general anesthesia maybe seen in orthognathic surgery. Swelling, pain, nausea, vomiting, bleeding, infection, chest infections, etc are some of the potential risks of any major surgery under general anesthesia. Other complications specific to orthognathic surgery are
1. Loss of sensation resulting in numbness or tingling sensation of the chin, cheek, nose or tongue may occur after surgery. Sensation returns to the affected areas as the nerve fibers regenerate and mend themselves, after a few months of surgery. Rarely some individuals may experience permanent altered sensation.
2. Sinus complications such as sinusitis may occur after surgeries of the maxilla. This may not require any further treatment as it usually corrects it selves after a period of time.
3. Nonvitality of teeth near the osteotomy site are seen rarely. This may require root canal treatment of the involved tooth at a later date.
4. Relapse or unpredicted shifting of the new jaw position occur uncommonly. If it does then further surgical intervention would be necessary.
5. Periodontal infections around the teeth near the osteotomy site may cause mobility of the concerned teeth. This may be corrected by periodontal flap surgery and bone graft.
6. Necrosis of bone is seen very very rarely. This could be due to reduced blood supply to the area and will require surgical removal of the infected bone.
7. Unrealistic expectations by the individual will result in dissatisfaction of the "new" face. Some individuals imagine and attribute all their psychological problems to their facial deformity and will not be satisfied even if good results are achieved. After all, the surgeon is only a human being, he only tries to correct or repair what you already have, and every surgery has its own limitations. Individual satisfaction is very subjective and a positive attitude from the parents and their relatives are very essential.
