Our Summary

This research paper focuses on the likelihood of relapse after orthognathic surgery, a type of jaw surgery, particularly in patients with a specific type of jaw misalignment called “Class II”.

In 2007, a group of researchers suggested a “hierarchy of stability” for different types of jaw surgery, but this idea wasn’t backed up by systematic review of evidence. This paper attempts to fill that gap by reviewing clinical trials that compared relapse rates for different surgical procedures in Class II patients.

The research found that surgical procedures involving both jaws, as well as those focused on advancing the lower jaw, appear to have high stability and low relapse rates. Single-jaw procedures on the upper jaw had mostly stable results in the horizontal dimension, but less stability vertically.

However, the researchers caution that the available data is limited and not of high quality. While their findings support the earlier “hierarchy of stability” notion to some extent, more studies are needed to better understand the relationship between the type of surgery and the likelihood of relapse.

FAQs

  1. What is the “hierarchy of stability” in relation to jaw surgery?
  2. According to the research, which types of jaw surgery have the highest stability and lowest relapse rates?
  3. What were the findings in relation to single-jaw procedures on the upper jaw?

Doctor’s Tip

A helpful tip a doctor might give a patient about jaw surgery is to follow post-operative instructions carefully to ensure proper healing and reduce the risk of complications. This may include maintaining a soft diet, practicing good oral hygiene, attending follow-up appointments, and avoiding activities that could put strain on the jaw. It is also important to communicate any concerns or changes in symptoms to the healthcare provider promptly.

Suitable For

Patients who are typically recommended for jaw surgery include those with severe skeletal discrepancies, such as Class II or Class III malocclusions, where the upper and lower jaws do not align properly. These patients may experience difficulties with chewing, speaking, breathing, and facial appearance due to the misalignment of their jaws.

Other patients who may benefit from jaw surgery include those with temporomandibular joint (TMJ) disorders, obstructive sleep apnea, facial trauma, or congenital anomalies. In some cases, orthodontic treatment alone may not be sufficient to correct the underlying skeletal issues, making jaw surgery a necessary part of the treatment plan.

Ultimately, the decision to undergo jaw surgery is made on a case-by-case basis by a multidisciplinary team of oral and maxillofacial surgeons, orthodontists, and other healthcare professionals. The team will assess the patient’s specific needs and goals to determine the most appropriate treatment approach, which may include jaw surgery in combination with orthodontic treatment.

Timeline

Before jaw surgery, a patient typically undergoes a thorough evaluation by an orthodontist and oral surgeon to determine the best treatment plan. This may involve braces or other orthodontic appliances to align the teeth properly before surgery. The patient will also undergo various tests and imaging studies to assess the structure of the jaw and plan the surgical procedure.

During the surgery, the oral surgeon will make incisions inside the mouth to access the jaw bones. They will then reposition the jaw bones to correct the misalignment and secure them in place using plates, screws, or wires. The incisions are then closed, and the patient is monitored closely in the recovery room before being discharged home.

After the surgery, the patient will experience some pain, swelling, and discomfort, which can be managed with pain medication and ice packs. They will need to follow a liquid or soft diet for several weeks to allow the jaw to heal properly. Follow-up appointments with the oral surgeon and orthodontist will be scheduled to monitor the healing process and adjust any orthodontic appliances as needed.

Over time, the patient will gradually transition back to a normal diet and resume regular activities. The orthodontic treatment may continue for several months to fine-tune the alignment of the teeth. It is important for the patient to follow all post-operative instructions and attend all follow-up appointments to ensure a successful outcome.

Overall, jaw surgery can significantly improve the function and appearance of the jaw, but it is important for patients to be aware of the potential for relapse and to follow all recommendations for long-term stability.

What to Ask Your Doctor

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

  1. What type of jaw surgery do you recommend for my specific case of jaw misalignment?
  2. What are the potential risks and complications associated with jaw surgery?
  3. What is the expected recovery time and post-operative care needed after jaw surgery?
  4. How likely is it that I will experience relapse after jaw surgery, and what factors can affect the stability of the results?
  5. Are there any alternative treatments or non-surgical options that I should consider before opting for jaw surgery?
  6. Can you provide me with information about your experience and success rates with performing jaw surgery?
  7. Will I need to wear braces or use orthodontic appliances before or after jaw surgery?
  8. How long will the effects of jaw surgery last, and are there any long-term considerations I should be aware of?
  9. What can I do to ensure the best possible outcome and reduce the risk of relapse after jaw surgery?
  10. Are there any specific lifestyle changes or dietary restrictions I should follow before or after jaw surgery to promote healing and prevent complications?

Reference

Authors: Eckmüller S, Paddenberg E, Hiller KA, Proff P, Knüttel H, Kirschneck C. Journal: BMC Oral Health. 2022 Dec 15;22(1):605. doi: 10.1186/s12903-022-02636-x. PMID: 36517840