Jaw Surgery Or Orthognathic Surgery: A Part Of Craniofacial And Plastic Surgery

Jaw surgery or Orthognathic surgery is a part of Craniofacial and Plastic surgery where the bones of the upper or lower jaw or both are moved to either realign the position of teeth or improve the appearance of the face.

The main specialists involved in orthognathic surgery:

Craniofacial & Plastic surgeon
Orthodontist
Speech pathologist

Common reasons to undergo Orthognathic surgery:

To correct malocclusion of teeth – There are many types of malocclusion. It could be where the upper teeth are far ahead of lower teeth which are commonly referred to as ‘Overbite’. It could be where the lower teeth are far ahead of upper teeth which are commonly referred to as ‘Underbite’. There could be a gap between the upper and lower teeth which is commonly referred to as ‘Open bite’.
To improve the appearance of face – Most commonly people seek orthognathic surgery for facial deformities like ‘Dish face’ where the upper jaw is far behind the lower jaw, ‘Weak chin’ where the lower jaw is far behind the upper jaw, ‘Strong chin’ where the lower jaw is far ahead of the upper jaw causing a masculine appearance in a female patient etc.
To improve the smile – People who have ‘Gummy smile’, ‘Excessive teeth show’ etc. also benefit from orthognathic surgery.
Cleft lip and palate deformities – People with cleft lip and palate usually have a ‘Dish face’ deformity and benefit tremendously from orthognathic surgery.
To improve snoring and sleep apnoea – People with snoring and sleep apnoea issues who have failed all previous medical and surgical management can potentially benefit from orthognathic surgery.

Investigations required prior to Orthognathic surgery:

X-ray Lateral Cephalogram – This is an X-ray of the facial bones showing the profile view of the patient. This helps in assessing the actual deformity (Bony and soft tissue).

CT scan, Virtual surgical planning, Splints and 3D models – CT scans of the facial bones are taken and then surgical planning is carried out online with special software which helps the surgeon in planning the actual cuts on the bone, moving the bones to the right position and then fixing the bone with plates and screws. Surgical splints and 3D models are also prepared using virtual surgical planning.

Speech assessment – Moving the jawbones can have an impact on speech and hence a speech assessment before surgery and possible speech therapy after surgery will help in optimizing the result.
Routine blood tests before anaesthesia.

Approaches in Orthognathic surgery:

Orthodontics first approach – This will involve the application of braces and orthodontic dental treatment for a period of 6 months to 1 year followed by surgery. During the orthodontic treatment period, all the compensations of the teeth that are present due to the malocclusion are removed (Decompensation). During this period, you may notice that the deformity of the teeth is getting worsened, but in reality, it is just going back to where it is supposed to be. And once the surgery is done, the alignment of teeth will be normal. Some amount of orthodontic treatment is sometimes required even after surgery.
Surgery first approach – Here the jaw surgery is done first. It is then followed by orthodontic treatment for 6 months to 1 year.
Both approaches are available at Sakra World Hospital.

Types of surgeries:

Lefort I osteotomy – In this operation, cuts are made in the upper jaw (maxilla) and the bone is moved forwards, backwards, upwards or downwards depending upon the deformity and then fixed with titanium plates and screws in the new position.
Bilateral sagittal split osteotomy of the mandible (BSSO) – In this operation, cuts are made in the lower jaw (mandible) and the bone is moved forwards, backwards, sideways or rotated upwards depending on the deformity and then fixed with titanium plates and screws in the new position.
Double jaw surgery – It is a combination of the above procedures which involves surgery on both maxilla and mandible.
Genioplasty – In this operation, cuts are made in the chin (central) region of the lower jaw and the bone moved forwards, backwards, upwards or downwards depending upon the deformity.

All surgeries involve cuts on the inside of the mouth, which means ‘NO EXTERNAL SCARS”!

What does the surgery involve?

Consultation with craniofacial & plastic surgeon, orthodontist and speech pathologist.
Investigations and planning – Takes 4-5 days for surgical planning and preparation of splints and models.
Admission on the day of surgery.
Blood tests and reserving blood for blood transfusion.
Surgery 2-3 hours under general anaesthesia.
Recovery room 2-3 hours.
One night ICU stay which might also involve blood transfusions. ICU stay is for monitoring of the airway and breathing issues.
Shifted to ward and ward stay for 2-3 days.
Rubber bands applied to braces.
Discharge
Soft or semi-solid diet for 3 weeks.
Follow up with Craniofacial & plastic surgeon, orthodontist and speech pathologist.
Return to normal activities after 1 week. Strenuous physical activity after 6 weeks.

Complications expected:

Orthognathic surgery is very safe with the best surgical and anaesthetic practices. In spite of all safety measures, there might be a few complications which need to be understood by the patient.
Blood loss – Blood transfusion is sometimes required.
Breathing difficulties – ICU stay for one night is advised to monitor breathing issues.
Infection – Very rare to have infections due to titanium plates and screws. In case there is an event like that, the plates and screws can be removed easily.
Swelling and bruising – The patient will have a lot of swelling and bruising in the first 48 hours. The swelling and bruising will slowly reduce over a period and completely disappear by 6 weeks’ time.
Numbness and paraesthesia of lips – Some amount of numbness and altered sensation on the lips are present due to impact on the nerves due to surgery. This is usually temporary. In a worst-case scenario, it can take 1-2 years for the sensations to come back.
Loss of tooth – Due to loss of blood supply to the teeth. In such cases, dental rehabilitation is required. This is also a very rare complication.