If you are a health-conscious person, you understand how important it is to regularly follow a healthy diet and exercise program. However, being healthy also involves good oral health. This may be difficult if you are experiencing jaw pain, have misaligned jaws, have a facial asymmetry or abnormality after trauma or disease, have difficulty chewing or swallowing, or suffer from obstructive sleep apnea.

But how do you determine if you need corrective jaw surgery?

Who performs 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 techniques.

Oral and maxillofacial surgeons sometimes work in conjunction with orthodontists — dentists who deal primarily with malpositioned or crooked teeth. This is because often braces alone isn’t a long-term solution for straightening teeth; thus the need for a consultation with a Specialist surgeon and orthognathic surgery will be added to a patient’s staged treatment plan.

Orthognathic surgery will stabilise the orthodontic treatment and reduce the risk of the teeth becoming crowded again, which is known as an orthodontic relapse. It also alleviates a redo of what can be a lengthy and costly orthodontic treatment. The final plan for surgery is dictated by an individual patient’s needs and is customised to achieve the best possible outcome for them.

Why would I need orthognathic surgery?

Your facial shape and your jaw’s relative position (known as facial harmony) plays a vital role in daily life functions, allowing you to breathe, eat, speak, and swallow comfortably. Facial harmony also allows your teeth to be adequately supported by your jaws and work seamlessly with the rest of your facial muscles and jaw joints (known as your temporomandibular joints or TMJs).

Jaw or orthognathic surgery can help alleviate various functional dental issues and facial and dental deformities and dramatically improve the cosmetic appearance of both your teeth and jaws.

Underbite or overbite

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 a patient’s mouth represent one of the most common issues addressed with corrective jaw surgery. These are often referred to as an “underbite” or an “overbite.”

An underbite occurs when a patient closes their mouth, and their lower front teeth appear in front of their upper teeth. In many cases, the problem stems from the lower jaw being positioned too far forward (known as prognathia) and the 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 (known as retrognathia).

Some patients will also present with a size discrepancy between the top and bottom jaws after having experienced abnormal growth (too fast, too slow or one-sided) in one part of the face (known as facial asymmetry).

Other functional or aesthetic issues

Patients can also benefit from orthognathic surgery if they suffer from one or more of the following:

Difficulty chewing or biting certain foods, typically any food that requires a cutting action by the front teeth

  • Difficulty swallowing
  • Excessive and uneven wear of the teeth because some teeth are touching together whilst others don’t touch at all
  • Noises and/or pain from the jaw joints (often caused by TMJ disorders)
  • The inability to seal the lips over the teeth without straining the chin muscles
  • Chronic mouth breathing and dry / inflamed gums due to a limited ability to breathe through the nose
  • Breathing problems when sleeping including snoring and obstructive sleep apnoea
  • An unbalanced facial appearance due to chin or nasal deviation, a small recessive chin, or a protruding jaw
  • An “open bite” due to a lack of contact with the teeth when the jaw is normally closed
  • A “crossbite” where a tooth or teeth are offset toward the cheek or tongue more than other teeth
  • Mal-aligned jaws — facial asymmetry, maxillary excess, mandibular deficiency/retrognathia or mandibular excess/prognathia
  • Facial injuries or congenital disabilities
  • Jaw or jaw joint pain and/or chronic headaches
  • A “gummy” smile or excessive smile lines

Types of jaw surgery

Orthognathic surgery may involve the lower jaw (mandible), upper jaw (maxilla), chin, cheekbones (zygomas), nose (septorhinoplasty) and jaw joints (TMJ) in various combinations or in isolation. There are three main types of jaw surgery:

Upper jaw surgery (maxillary osteotomy)

Upper jaw surgery is performed to correct a significantly receded or protruding upper jaw, crossbite, open bite, or midfacial hypoplasia (receded mid-facial and nasal shape or profile). During the procedure, the maxilla (the bone attached to your upper teeth) is detached from the base of the nose and cheekbones. The entire top jaw (including the roof of your mouth, upper teeth and structures supporting the nose) is then repositioned to fit appropriately with your lower teeth and facial shape. The result corrects the dental bite, adjusts the smile line (the lip drape across the teeth), reshapes the nasal profile (the tip and septum), and improves nasal breathing.

Lower jaw surgery (mandibular osteotomy)

Lower jaw surgery can correct a receded (hypoplastic) or protruding (hyperplastic) lower jaw. The procedure involves detaching the jaw joints (TMJs) from the bone housing the teeth and chin. Next, the tooth-bearing jawbone is moved into a new position, either forward or backwards, depending on the best adjustment and bite alignment. This type of surgery can correct the dental bite, improve the profile of the lower face, and correct crooked chins (deviations or asymmetries).

Chin surgery (genioplasty)

Chin surgery can enlarge a small chin (or a severely receded lower jaw), correct chin asymmetry or allow lip closure over the teeth (known as lip competence). This type of procedure can be performed in combination with or without surgery to the upper and lower jaws. The result improves the profile of the lower face and allows for the correction of crooked chins.

What are the stages of corrective jaw surgery?

Orthognathic or corrective jaw surgery can be a lengthy and meticulous process, which generally starts with an in-depth consultation with your specialist oral and maxillofacial surgeon. The three main stages of orthognathic surgery typically include:

Stage 1 – Pre-surgical orthodontic treatment

Depending on your individual requirements, the first stage may involve an orthodontist levelling and aligning your teeth with braces. This alignment process can take between twelve to eighteen months. However, this phase is not required for every patient and will be decided upon after your initial consultation.

A specialist oral and maxillofacial surgeon will then assess your facial structure and carry out 3D “virtual” surgery on your CT scans before considering an actual operation. The results of this planning will allow for the creation of custom-made surgical guides and templates to assist in making sure that surgery proceeds according to your needs. These custom guides can reduce the operating time (and therefore reduce the time you are under anaesthetic), operative complications are minimised (nerves and vital structures are preserved), and surgical accuracy is optimised.

Stage 2 – Surgical treatment

An operation date is then scheduled to surgically reposition your upper jaw, lower jaw, chin or nose (or combinations of these) to achieve an ideal alignment between your teeth and jawbones (your chin, nose and lips). Jaw surgery is performed in hospital, where you will be an in-patient for two to three days. The procedure will be performed under full general anaesthetic (you are asleep) and takes approximately two to four hours to complete.

Most procedures involve osteotomy, which are incisions that are made inside the mouth to enable the cutting of the bones of the face. Because these areas are concealed within either the mouth, nose or facial skin creases, the chance of visible scarring is significantly reduced. The bones that have been cut from the 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 its original strength. They are usually not visible, not painful and not needed beyond ten to twelve weeks post-surgery.

After orthognathic surgery, there will often be a need for further orthodontic fine-tuning and adjustment of the teeth for a period of three to six months. This will ensure the upper and lower teeth mesh together correctly and allow a patient to bite in the correct alignment.

Stage 3 – Post-surgical orthodontics

If you started with orthodontic treatment (Stage 1), you will typically need to wear braces for three to six months after surgery. Once your braces have been removed, your orthodontist may recommend using a retainer to maintain the position of your teeth and prevent relapse. If you didn’t require braces in Phase 1, then you won’t need them after surgery.

What happens after surgery?

Once the orthognathic surgery is completed, most patients will stay in hospital for two to four days to ensure they have access to effective pain relief. After being released from hospital, the pain will be well controlled with scripted tablet medication, which may be needed for an additional seven to ten days after surgery.

During the first two weeks, facial swelling reaches its peak and begins to settle during the third week after surgery. Once four weeks have elapsed, most patients are looking more normal, feeling more comfortable and are able to eat a wider range of foods. The initial healing of jawbones usually takes six to eight weeks, although the complete healing process can take up to 12 weeks. Once fully healed, the bone is as strong as it was before surgery, and there are usually no limits to a patient’s sporting activities.

As with any major surgery, your specialist surgeon will detail a post-surgery recovery plan that includes pain relief medications, a suggested range of foods to eat, oral hygiene tips and home care advice. A suggested timetable for a return to school or work would also be discussed.

How to improve the recovery process

After undergoing jaw surgery, wound healing and your recovery will require extra energy and good nutrition. Your ability to eat anything will also be reduced because chewing will be uncomfortable, and your ability to open your jaw will be limited by facial swelling. However, you can improve your chances of an easier and quicker recovery if you:

  • Take your pain medications as directed
  • Make sure you get plenty of rest
  • Report any problems early
  • Start to slowly move around again once you feel stronger

Your diet

Following corrective jaw surgery, your body will require sufficient nutrition and vitamins for proper bone and tissue healing, so consuming a diet of soft, easy-to-eat (semi-fluid consistency) foods is essential. High protein, calorie-rich foods are ideal and modified foods can be slurped from a spoon or sucked through a straw. These include a blend of meats, dairy foods and vegetables like milkshakes, scrambled eggs, yoghurt, smoothies, soups and broths.

You should also rinse your mouth out post-meals three times a day with a mouth rinse or warm salty water, then carefully brush any teeth that you can comfortably reach with a baby toothbrush.
Orthognathic surgery complications

As with any surgery, there is a risk of complications, so it is important to consider the risks versus the benefits before embarking on any procedure. However, when performed by experienced specialist surgeons using the latest planning and surgical techniques, the risks of long-term issues are low. Short-term complications can include:

  • Mild to moderate pain
  • Swelling
  • Bruising
  • Temporary numbness of your lips and chin
  • Tingling, especially near the chin, nose, lips, cheeks or tongue
  • Minor bleeding from the nose and/or mouth
  • Jaw joint (TMJ) pain or limited movement
  • Infection at the incision sites
  • Nausea or vomiting

However, 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.

Wondering if you need corrective jaw surgery? Contact the experts at the Dental Implant & Specialist Centre today on (07) 5503 1744.