Our Summary

This research paper discusses the complexities associated with orthognathic surgery (surgery to correct conditions related to the jaw and face) in patients who have been born with a cleft lip and palate. These patients often have a unique facial structure, specifically a smaller than average upper jaw, due to the cleft. They also frequently have a history of multiple surgeries and dental differences, as well as unhealed fistulas (abnormal connections between different parts of the body), which can complicate treatment. The paper outlines these challenges and discusses different methods to accommodate and address these issues specifically for this group of patients.

FAQs

  1. What is orthognathic surgery and why might it be necessary for patients born with a cleft lip and palate?
  2. What unique challenges might a surgeon face when performing orthognathic surgery on a patient born with a cleft lip and palate?
  3. What methods are discussed in the paper to accommodate and address the specific challenges associated with orthognathic surgery in patients born with a cleft lip and palate?

Doctor’s Tip

One helpful tip a doctor might give a patient undergoing jaw surgery, especially if they have a history of cleft lip and palate, is to follow a strict post-operative care routine. This may include keeping the surgical site clean, taking prescribed medications as directed, and attending all follow-up appointments with the surgeon. Additionally, the doctor may recommend a soft diet to avoid putting too much pressure on the jaw during the healing process. By following these guidelines, the patient can help ensure a successful outcome and minimize the risk of complications.

Suitable For

Patients who are typically recommended for jaw surgery include those with:

  1. Severe malocclusion: Patients with severe misalignment of the teeth and jaws may benefit from orthognathic surgery to correct their bite and improve their overall facial aesthetics.

  2. Facial asymmetry: Patients with significant asymmetry in the facial structure, such as a protruding or recessed jaw, may benefit from jaw surgery to improve facial harmony and balance.

  3. Obstructive sleep apnea: Patients with obstructive sleep apnea, a condition where the airway becomes blocked during sleep, may benefit from jaw surgery to reposition the jaw and improve airflow.

  4. Temporomandibular joint (TMJ) disorders: Patients with TMJ disorders, such as jaw pain, clicking or popping in the jaw joint, and difficulty opening and closing the mouth, may benefit from jaw surgery to correct the underlying structural issues causing their symptoms.

  5. Cleft lip and palate: Patients born with a cleft lip and palate may require jaw surgery to correct the facial deformities associated with this condition, improve speech and feeding difficulties, and restore normal function and appearance.

Overall, patients who are experiencing significant functional or aesthetic issues related to their jaw and facial structure may benefit from jaw surgery as part of their treatment plan. It is important for patients to undergo a thorough evaluation by a qualified oral and maxillofacial surgeon to determine if they are a suitable candidate for jaw surgery and to discuss the potential risks and benefits of the procedure.

Timeline

Before jaw surgery:

  • Initial consultation with a maxillofacial surgeon to discuss treatment options
  • Orthodontic treatment to align the teeth and prepare for surgery
  • Pre-operative appointments with various specialists, such as a prosthodontist and speech therapist
  • Pre-surgical tests and evaluations to ensure the patient is a good candidate for surgery

After jaw surgery:

  • Recovery period, which may include swelling, bruising, and discomfort
  • Follow-up appointments with the surgeon to monitor healing and address any concerns
  • Continued orthodontic treatment to fine-tune the bite and jaw alignment
  • Possible speech therapy to address any changes in speech patterns post-surgery
  • Long-term follow-up to monitor the results of the surgery and address any potential issues that may arise

Overall, the process of undergoing jaw surgery can be lengthy and complex, but for patients with cleft lip and palate, it can greatly improve their facial appearance, speech, and overall quality of life.

What to Ask Your Doctor

  1. What specific jaw abnormalities do I have that require surgery?

  2. What are the potential risks and complications associated with jaw surgery in my case?

  3. How long will the recovery process be, and what can I expect in terms of pain and discomfort?

  4. Will I need to have any additional dental work or procedures before or after the surgery?

  5. How will jaw surgery affect my speech and eating abilities?

  6. Will I need to wear braces or use any other orthodontic appliances before or after the surgery?

  7. What are the expected long-term results of the jaw surgery, and will I need any additional surgeries in the future?

  8. How experienced are you in performing orthognathic surgery, especially in patients with a cleft lip and palate?

  9. Are there any alternative treatment options to jaw surgery that I should consider?

  10. Can you provide me with before and after photos of previous patients who have undergone similar jaw surgeries for a cleft lip and palate?

Reference

Authors: Roy AA, Rtshiladze MA, Stevens K, Phillips J. Journal: Clin Plast Surg. 2019 Apr;46(2):157-171. doi: 10.1016/j.cps.2018.11.002. Epub 2019 Feb 6. PMID: 30851748