Our Summary

This paper reviews the contributions of American oral and maxillofacial surgeons to orthognathic surgery, which is surgery to correct conditions of the jaw and face related to structure, growth, sleep apnea, TMJ disorders, malocclusion problems owing to skeletal disharmonies, or other orthodontic problems that cannot be easily treated with braces. The current state of this type of surgery is a result of past innovations and research.

As we’ve gained a better understanding of the biological and surgical principles involved, and started routinely involving orthodontics, we’ve been able to treat dentofacial (teeth and face) problems more effectively.

Technological advances have made a big difference too. For example, we now use rigid internal fixation (a way of fixing broken bones), virtual surgical planning with computer-aided manufacturing of occlusal splints (devices that help patients with jaw problems) and cutting guides, and custom implants. These advances, along with growing global interest in correcting dentofacial and craniofacial (face and skull) deformities, have resulted in treatment that is predictable, efficient, and safe. This is a major improvement compared to the situation 70 years ago.

FAQs

  1. What contributions have American oral and maxillofacial surgeons made to orthognathic surgery?
  2. How have technological advances improved the practice of orthognathic surgery?
  3. How does the current state of orthognathic surgery compare to its state 70 years ago?

Doctor’s Tip

One helpful tip a doctor might tell a patient about jaw surgery is to follow all pre-operative and post-operative instructions provided by the surgical team. This may include guidelines on diet, medication, and physical activity to ensure a successful recovery and optimal outcomes. It is also important to attend all follow-up appointments and communicate any concerns or changes in symptoms to the medical team.

Suitable For

Patients who are typically recommended for jaw surgery are those with severe malocclusion (misalignment of the teeth and jaws), facial asymmetry, difficulty with chewing or speaking, breathing problems, temporomandibular joint disorders, and obstructive sleep apnea. These patients may have congenital conditions, such as cleft lip and palate, or acquired conditions, such as trauma or tumors affecting the jaws. Orthognathic surgery can improve the function and aesthetics of the jaw and face, leading to better overall quality of life for these patients.

Timeline

Before jaw surgery:

  1. Initial consultation: The patient meets with an oral and maxillofacial surgeon to discuss their concerns and goals for jaw surgery.

  2. Pre-operative evaluations: The patient undergoes various evaluations, including dental impressions, X-rays, and possibly a CT scan, to assess the extent of the jaw misalignment and plan for surgery.

  3. Orthodontic preparation: The patient may need to undergo orthodontic treatment to align their teeth before surgery, which can take several months to a year.

  4. Surgical planning: The surgeon works with the orthodontist to create a treatment plan, including the specific surgical techniques to be used and the expected outcomes.

  5. Surgery: The patient undergoes jaw surgery, which can involve repositioning the upper jaw, lower jaw, or both to correct the misalignment.

After jaw surgery:

  1. Recovery: The patient typically stays in the hospital for a few days after surgery to recover and manage pain. They may need to follow a liquid or soft food diet for a period of time.

  2. Orthodontic adjustments: After the initial healing period, the patient continues orthodontic treatment to fine-tune the alignment of their teeth and bite.

  3. Follow-up appointments: The patient has regular follow-up appointments with the surgeon and orthodontist to monitor their progress and ensure that the treatment goals are being met.

  4. Long-term results: Over time, the patient will experience improved facial aesthetics, better bite function, and increased confidence in their appearance.

Overall, the journey from initial consultation to long-term results can take several months to a year, depending on the complexity of the case and the individual patient’s healing process. With advancements in technology and surgical techniques, jaw surgery has become a highly successful and predictable treatment option for patients with dentofacial deformities.

What to Ask Your Doctor

Some questions a patient should ask their doctor about jaw surgery include:

  1. What specific type of jaw surgery do I need and why?
  2. What are the potential risks and complications associated with jaw surgery?
  3. What is the expected recovery time and what can I do to aid in my recovery?
  4. Will I need to have braces before or after the surgery, and if so, for how long?
  5. What are the long-term outcomes of jaw surgery and how will it affect my facial appearance and function?
  6. Are there any alternative treatment options to jaw surgery that I should consider?
  7. How many jaw surgeries have you performed and what is your success rate?
  8. Will I need to be hospitalized for the surgery or can it be done on an outpatient basis?
  9. How much pain can I expect after the surgery and what pain management options will be available to me?
  10. What kind of follow-up care will be needed after the surgery, and how often will I need to see the doctor for check-ups?

Reference

Authors: Bell RB. Journal: J Oral Maxillofac Surg. 2018 Dec;76(12):2466-2481. doi: 10.1016/j.joms.2018.09.006. PMID: 30502870