Oral Surgery

Orthognathic Surgery

The purpose of orthognathic surgery is to correct functional and esthetic problems that are due to underlying skeletal deformities.  Corrective jaw surgery is needed if a patient has a skeletal problem or discrepancy that is not likely to be corrected by orthodontic tooth movement alone.  These are abnormalities of the facial bones, specifically the jaws and associated teeth.

Jaw discrepancies can be corrected by the following ways:

1. Growth Modifications
1. Orthodontic treatment that influences the growth of jaws during child developmental years and adolescent growth spurts.
2. This treatment is limited in adult patients.
2. Camouflaging the problems by orthodontic tooth movement (which usually requires extractions) so that the teeth occlude or fit correctly although the skeletal problem remains.
3. Surgical correction of the jaw discrepancy.

Based on malocclusion (bad bite) studies, approximately 5% of the most severe malocclusions would require orthognathic surgery.  This indicated that there are over 1 million people in the United States with one or more skeletal problems.

These skeletal problems include:

1. A severe overjet ( a.k.a. overbite) - Class II Skeletal Pattern
2. A severe underbite - Class III Skeletal Pattern
3. A severe openbite - Vertical jaw discrepancy
4. A severe deepbite - Vertical jaw discrepancy
5. Excessive wide jaws - Transvere jaw discrepancy or skeletal crossbite
6. Excessive narrow jaws - Transvere jaw discrepancy or skeletal crossbite

These severe malocclusions may cause many functional problems such as the inability to chew food properly, speaking problems, sleeping and breathing problems and facial muscle dysfunctions such as headaches and joint (TMJ) pain.

Orthognathic surgery provides us with that opportunity to improve both functional and cosmetic problems at the same time.  Our goal is to create a harmonious relationship of the jaws and teeth and most importantly, create pleasing soft tissue esthetics and an overall improvement in one’s facial profile.

The success of orthognathic surgery is formulated by a team approach.  This would include your orthodontist, your dentist and an oral and maxillofacial surgeon.  It is important for our team to listen to the patient’s request, their concerns and expectations and know their level of motivation for treatment.

Diagnostic records are extremely important in the surgical decision process.  Orthodontic records (cephalometric radiograph, panoramic radiograph, study models and facial and intraoral photographics) in conjunction with computerized digital imaging are used to evaluate existing problems and to establish an accurate diagnosis and treatment plan.

The sequence of treatment events:

1. Initial consultation with your orthodontist
2. Diagnostic records for presurgical orthodontic analysis
3. Consultation with an oral and maxillofacial surgeon
4. Insurance predetermination (usually covered by major medical insurance)
5. Presurgical Orthodontics
   1. Wearing braces
   2. Usually lasts for approximately 12-18 months
6. Orthognathic surgery, recovery and rehabilitation
1. Braces remain on during surgery
2. Recovery and “rehab” to be determined by the surgeon
7. Post surgical orthodontics
1. Wearing braces
2. Usually lasts approximately 6-12 months
8. Removal of Braces
1. Deliver upper and lower retainers
9. Final Records
1. Same as initial diagnostic records
2. Enables us to evaluate before and after results
10. Final Dental Work
1. May include restorations, crowns, veneers and/or bleaching as prescribed by your dentist.

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