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Orthognathic Surgery

Despite the rather large possibility of modern orthodontics in dealing with complex malocclusions, particularly related to improper relationship of skeletal structures (upper and lower jaws) and successful implementation of the principles of qualified camouflage treatment, we have to consider, in some cases, an option of combination of treatment (surgery + orthodontics).

Often in our practice we are confronted with cases where the achievement of an ideal relationship of the teeth of the upper and lower jaws with orthodontics is not in harmony with the patient’s face or does not guarantee the stability of the result. This makes the treatment process defective and inadequate for our patients.

This is especially true for adult patients whose jaw growth has stopped and we are not able to carry out a modification of the growth of both the upper and lower jaws.

Orthognathic surgery (orthos - straight, gnathos - jaw)

This is the section of the maxillofacial and plastic surgery, aimed at achieving the harmony of occlusion (bite), the external aesthetic parameters (the face), and also macro and mini aesthetics of the smile. Thus the purposes of orthognathic surgery coincide exactly with orthodontics. The differences are only in the method and increase of the possible limits of correction of serious skeletal disorder of the jaws positions in relation both to each other and to the base of the skull and soft tissues.

Orthognathic surgery achieves the improvement of the aesthetic and functional parameters (improvement of respiratory function, mastication, TMJ, diction, and treatment of snoring and apnea during sleep).

Orthognathic surgery provides an opportunity to move one or both jaws - back and forth, up and down, rotate them both clockwise and counterclockwise. Thus, according to the scheme, planned in advance, of moving the upper jaw and chin, the soft tissues are respectively moving in the chin, cheeks, lips and nose tip.

The main provisions and the tactics of orthognathic surgery:

1. Orthognathic surgery may be performed no earlier than at the age of 18. At this age, the growth of the jaws is finished, which eliminates the possibility of a relapse associated with continued growth of the jaws.

2. Successfully combined surgical and orthodontic treatment in all cases without exception requires integration of preoperative orthodontic preparation, the main objective of which is to eliminate dentoalveolar compensation and alignment of the teeth in the correct position with respect to the basis of the relevant bone.

Pre-operative period is usually from one year to eighteen months, during which you need to wear braces system, which can only be removed 3-5 months after surgery, with full achievement of the ideal contact of the upper and lower jaws.

3. Patients seeking help from orthognathic surgery are mainly interested in the final aesthetic result. Therefore, our planning must be based on an analysis of the soft tissues rather than bony structures.

4. All operations are performed under general anesthesia and can last from 1 to 6 hours - depending on the treatment plan and the amount of bones, requiring surgical correction.

5. In some cases, it is required not only to separate one or the other jaw, but also to separate the jaw itself into several parts (eg, segmentation of the maxilla to expand it).

6. All operation discissions are made in the mouth, leaving no external scars on the skin.

7. All detached parts of the jaw are fixed with special titanium plates.

The main types of orthognatic surgery

  • Osteotomy of the maxilla (Le Fort I)

During this procedure, the surgeon holds the bone intraoral incisions above the teeth and below both eye sockets, which allows moving the entire upper jaw (including the mouth roof and the upper teeth) as a whole. The upper jaw is moved and positioned by means of a special splint made in advance according to the treatment plan. This guarantees its correct position in proportion to the mandible as well as in relation to soft tissues.

  • Osteotomy of the mandible (Dal Pont and Obwegeiser)

The surgeon does the incision of the bone bihind the molars and along the jaw downwards so that the lower jaw can be moved as a unit. As a result, the jaw glides to a new location. Titanium plates hold the jaw together while it heals.

  • Genioplasty

It involves cutting off the chin part of the lower jaw and moving it in the desired direction along with aligning the face midline.

It should be noted: if the primary goal of treatment is to improve the aesthetics, it is advisable, along with orthognatic treatment, to plan for the plastic surgery of the nose and facial soft tissues. Integration of orthognathic and plastic surgery - is a modern and very rational tendency to the solution of any need of each patient.

Instructions prior to general anesthesia and surgery

  • It is forbidden to eat or drink anything (including water) for eight (8) hours before the scheduled time of surgery.
  • It’s not allowed to smoke for at least 12 hours prior to surgery. Ideally - to reduce or stop smoking as soon as possible during the preoperative period.
  • Contact lenses, jewelry, and dentures must be removed before the operation.
  • If you get sick – catch a cold, have sore throat, upset stomach or intestines - please tell your surgeon.
  • If you are taking any routine medication, please consult your surgeon prior to surgery for further instructions.

Possible symptoms of post-operative period

  • Temporary swelling and bruising (especially the lips and cheeks)
  • Nasal congestion and pain in the throat
  • Nausea
  • Temporary numbness of the operated areas (for 1-5 months)
  • The difficulty of communication (especially the first week)
  • Weight loss (10%)
  • Difficulties with appropriate oral hygiene

Possible complications after orthognathic surgery

In addition to the typical risks connected with general anesthesia, there is little risk associated with orthognathic surgery. Nevertheless, the risks may include permanent numbness of the face due to nerve damage, but it is a rare complication. To minimize the risks, follow all instructions related to the recovery period, issued by your doctor.