Orthognathic (“orthos” – to straighten, “gnathos” – jaw) surgery means operation of jaws, in the course of which new position for one or both jaws is granted by securing correct interrelation of maxilla and mandible and possibility to achieve correct occlusion with the help of orthodontic treatment. The orthognathic surgery may also be used for treatment of sleep apnea.
Moreover, orthognathic surgery provides a possibility to correct and balance facial features. It is important to note that orthognathic surgery is applied only when the situation cannot be amended with the help of braces.
As we protect privacy of our patients, we are not posting cases of orthognathic treatment on our website. All the information about need for treatment and its possibilities will be provided by the oral and maxillofacial surgeon during the consultation.
Steps of orthognathic treatment
- First visit
- Treatment plan
- Treatment before orthodontics
- Orthodontics before surgical treatment
- Preparation for orthognathic surgery
- Orthognathic surgery
- Post-surgical period
- Post-surgical final orthodontics
Assessment of need for orthognathic surgery
The jaw’s growing is a long-term process, the correct formation of which is affected by traumas, inborn factors, dysfunction of temporomandibular joint, such bad habits as grinding, strong clenching of teeth during the daytime, and other factors. If certain indications are present, orthognathic surgery may serve as an effective treatment of sleep apnea (long-term effectiveness of 95 percent).
Malocclusion (occlusion anomalies) causes numerous problems:
- Difficult biting, chewing and/or swallowing of food in case of reverse and especially open occlusion.
- Chronic pain of jaw or jaw joint, dysfunction of jaw joint and faster wear are caused by irregular position of jaws and overloading. They may be manifested by crunching, cracking joints and decreasing opening of the mouth. The condition may be worsened by grinding at night and strong clenching of teeth during day.
- Melting bone caused by injury of tissues and inflammation while chewing.
- Teeth mobility or gaps between teeth due to melting bone.
- Faster wear of teeth in case of skeletal anomalies of occlusion, in particular in case of especially open occlusion. It is more difficult to restore the worn teeth and they are cracking more often.
- Respiration through the mouth, dry mouth, other disorders of respiratory function in case of reverse or open occlusion, when the mandible is undeveloped or when it is in incorrect position. The lungs get smaller amount of air because of narrowed nasopharynx. At night, when the muscles relax even more, the mandible is retracted even more, the oropharynx gets narrower and person starts snoring. Due to this occlusion anomaly, sleep apnea is also often diagnosed. The person feels fatigue and lack of sleep all the time because of respiration that stops at night and because human organism receives insufficient amount of oxygen. This condition affects negatively all the systems of the organism.
- Disproportionate facial features from the front and from the side, inability to purse the lips naturally, without straining. In case of reverse occlusion, the massive chin and concave upper lip may be noticed, and in case of rear occlusion – small chin and deep chin-lip fold, whereas open occlusion manifests high face, small chin and strained lips, as well as other aesthetical problems.
- Psychological and emotional problems related to facial features.
IMPORTANT: the orthognathic treatment is applied only in the cases when skeletal jaw anomaly is diagnosed resulting in malocclusion and when the orthodontic treatment cannot change the situation essentially.
The dentist, orthodontist and oral and maxillofacial surgeon are working together in order to decide whether orthognathic surgery is necessary. Sometimes doctors of other specialties also get involved in the treatment. They analyse each individual case and form the most effective treatment plan.
The treatment plan is discussed with the patient in detail. The advantages and disadvantages and possible alternatives are distinguished, every step, its benefit and duration are explained. The orthognathic treatment continues for several years and there are no possibilities to stop it or make the essential changes in the course of treatment. Therefore, in order to start orthognathic treatment, it is necessary for the patient to understand the situation in full, to make firm decision and to oblige to continue treatment until the end.
The purpose of combined orthognathic –orthodontic treatment is to restore the structure of jaws and occlusion function and to gain stability and aesthetics. Therefore, the orthodontist uses the braces to align the teeth along the jaws. Afterwards the orthognathic surgery is used to align the jaws.
Steps of orthognathic treatment
The orthognathic treatment usually lasts for 2 years approximately. The patient has to understand that it is a long-term commitment demanding for patience and big motivation.
There are no possibilities to stop orthognathic treatment or make essential changes in the course of such treatment.
1. First visit
During the first visit, the oral and maxillofacial surgeon assesses occlusion, jaws, joint functions, facial features, takes photos of face, teeth and skeletal system and performs the necessary measurements. The purpose of the first visit is to collect information necessary for making the most effective treatment plan.
The doctor asks about health problems that have to be mentioned before starting the orthognathic treatment, as they may correct the course of treatment or become factors determining whether the orthognathic treatment is possible.
During the first visit, the patient receives general information about orthognathic treatment. If necessary, additional tests are prescribed.
It is advised for the patient to bring the gypseous dental models to the first consultation. These models may be made by the dentist. It helps to make the treatment plan quicker.
2. Treatment plan
The treatment plan includes such stages as orthodontic preparation of dental condition, communication between surgeon and orthodontist, and surgical preparation before the orthodontic/orthognathic treatment. The detailed treatment plan is usually made in 2-4 weeks. It is one of the most important parts of the course of treatment.
The prepared treatment plan is discussed with the patient in detail. It is explained to the patient, whether the surgery of one or both jaws is needed, the disadvantages, advantages, possible alternatives are discussed, and the terms of each treatment stage are set. The applied software helps to show to the patient preliminary changes in appearance that could be expected after the orthognathic surgery.
When the orthognathic treatment is started, usually there are no possibilities to stop it, return to previous condition or make the essential changes in the treatment plan.
The orthognathic treatment lasts for several years, thus it is started only if the patient understands the situation and course of treatment in full.
3. Treatment before orthodontics
The patient is informed about all the procedures that have to be performed before the orthognathic treatment. Usually all the wisdom teeth are removed before orthodontics or in the course of orthodontic treatment. It is possible that two or four healthy teeth will need to be removed if the size of dental arch is really unsuitable or if the teeth are bumped. The treatment plan may also include opening of teeth, plastics of soft tissues, orthodontic implants, etc. The dentist has to take preventive care about the teeth and fill them before the orthodontic treatment.
4. Orthodontics before orthognathic surgery
The orthodontic treatment lasts for 12-24 months and the patient is carrying braces on the upper and lower teeth. The purpose of orthodontic treatment before the orthognathic treatment is to align the teeth into regular arches that would be in compliance with each other using the braces and following the treatment plan formed by the oral and maxillofacial surgeon. It is a necessary precondition of orthognathic surgery.
This stage of treatment is used to put the teeth into the position with the help of braces that correct occlusion could be formed during the surgery. Thus the occlusion may seem even worse in this stage; however, it will be restored during the surgery, when the position of jaws is corrected.
The orthodontist informs about orthodontic treatment in detail.
5. Preparation for orthognathic surgery
The main preparation works for the surgery start 1-2 weeks before the orthognathic surgery. The orthodontic treatment is already completed and the dental position cannot change. The oral and maxillofacial surgeon carries out all the preparatory tests and actions necessary to ensure precision of the surgery.
Accurate planning and preparation for surgical treatment take 1-14 days and need 2-6 visits. During the visits, the dental prints are taken, the occlusion is recorded in wax, the photos of face and teeth are taken, the computer tomography is made, the list of necessary health tests is submitted, the received results are analysed, and the necessary clinical measurements of teeth and face are carried out by computer. These data are used to form a precise plan of surgery, and the individual devices for surgery are made and adjusted.
The orthognathic surgery is performed under general anaesthesia in hospital. Before hospitalization, the patient is introduced to precise plan of surgery, the course of surgery, risk, individual risk, possible outcomes and complications are discussed. The patient’s medical history and current condition are assessed additionally before the surgery, the patient is taught about special diet and all the necessary tests are performed. Sometimes consultation with the anaesthesiologist and other doctors is needed before the surgery.
6. Orthognathic surgery
The surgery’s duration depends on the surgery’s type and complexity. It may last from 1 to 6,5 hours. One jaw may be operated in 1-1,5 hours, two jaws – in some 5,5 hours, while the surgery of both jaws and chin lasts about 6-6,5 hours.
The oral and maxillofacial surgeon will indicate the preliminary duration of surgery in advance.
It is important to do the following before the orthognathic surgery:
- The patient must be completely healthy and cannot have had viral infections in airways 2-3 weeks before the surgery. If the patient catches cold before the surgery, it shall be postponed for 2-3 weeks or its time may be agreed upon individually, according to the possibilities.
- It is strictly prohibited to eat before the surgery. If the surgery is scheduled for the early morning, it is allowed to eat until 8 pm in the evening before, and the liquids may be taken until 10 pm.
- It is strictly prohibited to eat or drink in the morning before the surgery. It is a vitally important rule.
7. Post-surgical period
If one jaw is operated, the patient stays in hospital for 1-2 days, and if two jaws are operated – for 2-4 days. Usually the wounds are healed up in 10 days. The mandible heals up in 2 months and the maxilla – in some 4 months.
It is important to know that after the surgery:
- Pain is felt only during the first hours-days after the surgery, but it is easy to control with the help of painkillers and anti-inflammation drugs. The patients feel pain of different intensity. It is partly determined by their perception and psychological condition after the surgery.
- The swelling of face may start on the first day after the surgery and bruises may become evident in the cheeks. The swelling of the face is the biggest on the 2nd or 3rd day after the surgery usually. It is the most difficult period physically and psychologically. The swelling starts decreasing one week after the surgery. It becomes almost invisible after 6-8 weeks.
- In order to stabilize the jaws, the teeth are coupled by elastic rubber bands. The patient may open mouth by 1 cm approximately – it is sufficient for eating and drinking. It is not recommended to open mouth more widely.
- Suture is removed 7-14 days after the surgery. The elastic rubber bands are removed for the first time and the occlusion is checked. It is explained repeatedly, how to clean teeth correctly and how to put the elastic rubber bands on the braces according to the scheme.
- The surgery is performed inside of the mouth, so no scars remain
- The senses of lips and chin’s skin get disordered for all the patients after the orthognathic surgery. The movements of lips or mime remain. The surrounding people do not notice anything. Some numbness is felt in the lips and in the chin, but it passes in some 6-9 months or takes even longer. Formication and itching of the skin are manifested. The senses are restored with time, but sometimes it happens that the senses are not restored completely or at all.
The frequency of visits to oral and maxillofacial surgeon and other additional tests after the orthognathic surgery depends on its complexity and individual case. The purpose of these visits is to assess the surgery’s stability and healing.
Usually the appointments are made:
- Every week for the first two months after the surgery,
- Twice a month during the third and fourth months after the surgery.
After the surgery, when the jaws are healed up completely, the so-called final orthodontic treatment is started. It lasts for 6-12 months. During this period the patient has to come to the oral and maxillofacial surgeon once in 1-2 months or individual appointments should be made with the orthodontist.
After the orthognathic surgery and final treatment by braces, the oral and maxillofacial surgeon determines the frequency of future examinations, and when new diagnostic models will have to be made. It is also very important to go to the dentist regularly and to ensure good care about mouth and teeth.