Our Summary

Orthognathic surgery, which is used to correct deformities of the jaws and face, has been the subject of much debate. As new, less invasive techniques are developed, there are questions about their stability compared to older methods. Traditionally, patients were immobilized for a long time after surgery and wires were used to stabilize the bones. Now, internal fixation (using screws and plates to hold bones in place) is more common, but it’s not clear which method is best. Doctors are trying to find the best balance between effective treatment, minimizing patient discomfort, and efficient use of operating room resources. Key topics in this debate include how to position the jaw joint, treating open bites, pre-bending plates for internal fixation, breaking the jaw into segments for surgery, the order of surgical steps, doing surgery without a splint, and planning the surgery virtually.

FAQs

  1. What are some of the controversies surrounding orthognathic surgery for the correction of dentofacial deformities?
  2. How have less invasive osteotomy designs affected the overall stability of orthognathic surgery?
  3. What measures are being taken to optimize patient outcomes, minimize patient morbidity, and maximize operating room productivity in orthognathic surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about jaw surgery is to follow all post-operative care instructions carefully, including proper oral hygiene, dietary restrictions, and physical activity limitations. Adhering to these guidelines can help ensure a successful recovery and optimal results from the surgery. Additionally, attending all follow-up appointments with your surgeon is important for monitoring your progress and addressing any concerns or complications that may arise.

Suitable For

Patients who may be recommended for jaw surgery include those with severe malocclusion, facial asymmetry, open bites, temporomandibular joint disorders, obstructive sleep apnea, and other dentofacial deformities that cannot be corrected through orthodontic treatment alone. Candidates for jaw surgery typically have completed their growth and have realistic expectations for the outcomes of the surgery. It is important for patients to undergo a thorough evaluation by an oral and maxillofacial surgeon to determine if they are suitable candidates for orthognathic surgery.

Timeline

Before jaw surgery:

  1. Initial consultation with a maxillofacial surgeon to discuss treatment options and determine the need for surgery.
  2. Comprehensive orthodontic treatment to align teeth and prepare the jaws for surgery.
  3. Pre-surgical planning, including virtual simulations and 3D imaging to plan the surgical procedure.
  4. Pre-operative appointments to discuss the surgery, expected outcomes, and post-operative care.
  5. Surgical consent and scheduling of the procedure.

After jaw surgery:

  1. Surgery is performed, typically under general anesthesia, with the use of rigid internal fixation techniques.
  2. Immediate post-operative care in the hospital or surgical center, including pain management and monitoring for complications.
  3. Recovery period at home, with strict adherence to a soft diet and oral hygiene regimen.
  4. Follow-up appointments with the surgeon and orthodontist to monitor healing progress and adjust orthodontic treatment as needed.
  5. Gradual return to normal activities, with the full effects of the surgery becoming apparent over several months as swelling subsides and the jaws settle into their new position.

What to Ask Your Doctor

  1. What specific jaw deformity are you recommending surgery for?

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

  3. How long is the recovery process after jaw surgery?

  4. Will I need to undergo any pre-surgical orthodontic treatment before the jaw surgery?

  5. What type of anesthesia will be used during the surgery?

  6. Will I need to wear braces or a retainer after the surgery?

  7. How long will I need to stay in the hospital after the surgery?

  8. What is the success rate for this type of jaw surgery?

  9. Will I experience any changes in my appearance or speech after the surgery?

  10. What are the long-term effects of jaw surgery?

Reference

Authors: Perez DE, Liddell A. Journal: Oral Maxillofac Surg Clin North Am. 2017 Nov;29(4):425-440. doi: 10.1016/j.coms.2017.07.008. PMID: 28987226