If you are a health-conscious person, then you understand how important it is to follow a healthy diet and exercise program regularly. However, being healthy also involves good oral health, and this can be compromised if you experience things like jaw pain, difficulty with chewing or swallowing, or you suffer from an under-bite (large lower jaw) or an overbite (small lower jaw).
Jaw or Orthognathic surgery can help alleviate a number of functional dental issues, and can dramatically improve the cosmetic appearance of both your teeth and jaws. But how do you determine if you need corrective jaw surgery?
What is corrective jaw surgery?
Also known as Orthognathic surgery, corrective jaw surgery is performed by Specialist Surgeons who are trained in the field of Oral and Maxillofacial Surgery. This form of surgery aims to correct a range of facial and dental deformities, including the mal-alignment of jaws (facial asymmetry, maxillary excess, mandibular deficiency/retrognathia, mandibular excess/prognathia), altering the position of the chin point, improving nasal appearance, enhancing tooth and smile aesthetics (correcting gummy smiles, improving smile lines), correcting functional problems like difficulties with speech, breathing and eating. In combination, these changes often also result in an improvement of the individual’s appearance generally.
Oral and maxillofacial surgeons often work in conjunction with Orthodontists (dentists who deal primarily with malpositioned/crooked teeth), whereby treatment is staged, with the teeth being straightened prior to definite Orthognathic surgery. The final plan for surgery is dictated by the individual patient deformity and is customised to achieve the best possible outcome for the patient.
What’s involved in jaw surgery?
In the first instance, some patients will already be aware of their own unusual facial shape or altered bite and then seek out the treatment advice from Specialist Surgeons. Most patients will present to Specialist Surgeons after consultation with an Orthodontist, where they have been told that ‘braces’ (straightening of teeth) alone will not be stable after completion of Orthodontic treatment. The addition of Orthognathic surgery to the treatment plan is necessary to stabilize the Orthodontic treatment and reduce the risk of the teeth becoming crowded again (Orthodontic relapse), thus requiring a redo of the long and costly Orthodontic treatment. Orthognathic/corrective jaw surgery is a long and meticulous process, which normally starts with an in-depth consultation with your Specialist Oral and Maxillofacial Surgeon. The planning for surgery involves computer-based virtual surgery utilising 3-D modelling of the face and jaws. CT scan data is used to create a software-based 3D model of the individual’s facial structure. These models are then used to rehearse and refine the surgical plan, thus enhancing surgical accuracy, reducing complications, allowing for the creation of custom surgical guides, speeding up the procedure and optimising the final results for the patient.
Orthognathic surgery may involve the lower jaw (mandible), upper jaw (maxilla), chin, cheek bones (zygomas), nose (septo-rhinoplasty) and jaw joints (TMJ) in various combinations or in isolation. All procedures are performed under full general anaesthetic (asleep) as in-patients in Hospital. Incisions for access to enable osteotomy (cutting) of the bones of the face are concealed within either the mouth, nose or facial skin creases to reduce the chance of visible scarring. The bones that have been cut (osteotomised) jaw can then be moved to their planned new positions and held in place using mini-plates and screws. The plates and screws allow the bone to heal back to their original strength. The plates and screws are usually not visible, not painful and not needed beyond 10-12 weeks post-surgery; however, it is rare for patients to request their removal.
Genioplasty or chin repositioning surgery can also be performed at this stage to correct under or over-sized chins, and thus improve the facial profile and enable lip seal over the teeth (lip competence).
Nasal profile and shape changes can occur as a result of Orthognathic surgery, but sometimes planned surgical reshaping of the nose and internal structures (septo-rhinoplasty) is suggested to assist with nasal breathing and /or to harmonise the nasal appearance with the facial shape.
After Orthognathic surgery, there will often be a need for further Orthodontic fine tuning and adjustment (3-6 months) of the teeth to ensure the upper and lower teeth mesh together properly, thus allowing you to bite in the correct alignment.
What happens after surgery?
Once the Orthognathic surgery is completed, most patients will be accommodated in Hospital for 2-4 days. It is highly unlikely that your jaws are ever wired together at any stage. During the first 2 weeks, facial swelling reaches its peak and begins to settle during the third week after surgery. Once 4 weeks have elapsed, most patients are looking more normal, feeling more comfortable and able to eat a wider range of foods.
As with any major surgery, your Specialist Surgeon will detail a post-surgery recovery plan that includes pain relief medications, suggested range of foods to eat, oral hygiene tips and advice on home care. A suggested timetable for return to school or work would also be discussed.
While the thought of invasive procedures and having corrective or cosmetic jaw surgery is both intimidating and time-consuming, most patients feel the benefits of Orthognathic surgery are life changing and well worth the time and effort.
Why would I need corrective jaw surgery
Your facial shape and relative position of your jaws (facial harmony) play a vital role daily life functions, allowing you to breathe, eat, speak and swallow comfortably. Facial harmony also dictates that your teeth are properly supported by the jaws and should work seamlessly with the rest of your jaw joints (TMJ) and facial muscles.
Some patients will present with a size discrepancy between the top and bottom jaws; having experienced abnormal growth (too fast, too slow or one-sided) in one part of the face. In a harmonious, healthy and normally functioning face and jaws, the upper teeth will close over the lower teeth and have regular contact between them without gaps in the dental bite. Any gaps at the front of the mouth (overjet/overbite) represent the most common issues addressed with corrective jaw surgery and are often referred to as either an under-bite or an over-bite.
An underbite occurs when you close your mouth and your lower front teeth appear in front of your upper teeth, and in many cases the problem stems from your lower jaw being positioned too far forward (prognathia) and your upper jaw being too far back. In patients with an overbite, the lower teeth are hidden beneath the upper teeth and this problem relates more to the lower jaw being too small and too far back (retrognathia).
What are some of the symptoms I should look for?
Potential Orthognathic surgery patients may become aware of any combination of the following functional issues –
- Difficulty chewing certain foods – any food that requires a cutting action by the front teeth
- Excessive and uneven wear of the teeth – as some teeth touch together whilst others don’t at all
- Noises and/or pain from the jaw joints (TMJ)
- The inability to seal your lips meet over the teeth without straining your chin muscles
- Chronic mouth breathing and dry / inflamed gums – due to limited ability to breathe through your nose
- Breathing problems when sleeping including snoring (Obstructive Sleep Apnoea)
- An unbalanced facial appearance from the side or front – chin or nasal deviation; small recessive chin
- An ‘open bite’ (lack of contact of the teeth when the jaw is closed normally)
- A ‘cross bite’ (where a tooth or teeth are offset toward the cheek or tongue more than other teeth)
- Jaw or jaw joint pain and chronic headaches
Wondering if you need corrective jaw surgery? Contact the experts at the Dental Implant & Specialist Centre today on (07) 5503 1744.