Our Summary

This study looked at the impact of two different approaches to orthognathic surgery, which is a procedure that corrects 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 first approach, known as the surgery-first approach (SFA), involves doing the surgery before orthodontic treatment, like braces. The second, known as the orthodontics-first approach (OFA), involves doing the orthodontic treatment first then surgery.

The researchers wanted to see if one approach was better than the other in terms of improving the patient’s facial appearance. They took 3D pictures of 40 patients’ faces before and after their surgeries and asked five experts to rate the changes in appearance using a special scale called the Global Aesthetic Improvement Scale (GAIS).

They found that both the SFA and OFA approach led to similar improvements in facial appearance. Additionally, they found that the GAIS score was related to several factors, including upper lip projection, chin prominence, facial proportions, paranasal hollowing, lip competence, mandibular projection, and facial profile. However, the score was not related to the specific surgical details.

They also found that the overall GAIS score was associated with the gender and experience level of the person doing the rating. In simple terms, this means that the SFA approach is just as good as the OFA approach when it comes to improving facial aesthetics.

FAQs

  1. What is the surgery-first approach (SFA) in orthognathic treatment?
  2. How does the aesthetic outcome of the surgery-first approach (SFA) compare to the orthodontics-first approach (OFA)?
  3. What factors significantly correlated with the Global Aesthetic Improvement Scale (GAIS) score?

Doctor’s Tip

A helpful tip a doctor might tell a patient about orthognathic surgery is to ensure they have realistic expectations about the outcome of the procedure. While orthognathic surgery can significantly improve facial aesthetics and overall appearance, it is important to understand that the results may take time to fully manifest and may not be immediate. Patience and adherence to post-operative care instructions are key in achieving the best possible results.

Suitable For

Patients who are typically recommended orthognathic surgery are those with severe malocclusion, facial asymmetry, difficulty chewing or speaking, obstructive sleep apnea, temporomandibular joint disorders, and aesthetic concerns related to the position of the jaws and teeth. These patients may have tried orthodontic treatment alone but have not achieved the desired results, leading to the recommendation for orthognathic surgery to correct skeletal discrepancies and improve facial aesthetics and function.

Timeline

  • Initial consultation with orthodontist and oral surgeon to discuss treatment options and goals
  • Preoperative orthodontic treatment to align teeth and prepare for surgery
  • Pre-surgical orthodontic records and planning for surgery
  • Orthognathic surgery performed to correct skeletal discrepancies in the jaw
  • Postoperative orthodontic treatment to finalize occlusion and alignment of teeth
  • Follow-up appointments with orthodontist and oral surgeon to monitor progress and ensure proper healing
  • Final assessment of facial aesthetics and satisfaction with treatment outcome

After orthognathic surgery, patients may experience some swelling, bruising, and discomfort in the first few weeks. It is important to follow postoperative instructions provided by the surgical team to promote proper healing and minimize complications. Patients will continue with orthodontic treatment to finalize their bite and alignment of teeth. It may take several months to a year for full healing and final results to be achieved. Regular follow-up appointments with the orthodontist and oral surgeon will be necessary to monitor progress and ensure the success of the treatment. Overall, orthognathic surgery can significantly improve both the function and aesthetics of the face, leading to better oral health and overall quality of life for the patient.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with orthognathic surgery?

  2. What is the expected recovery time after orthognathic surgery?

  3. How will my bite and facial aesthetics be improved after the surgery?

  4. Will I need to wear braces before and/or after the surgery?

  5. How long will the results of the surgery last?

  6. Are there any alternative treatment options to orthognathic surgery?

  7. How many orthognathic surgeries have you performed, and what is your success rate?

  8. Will I need to follow a specific diet or lifestyle changes before or after the surgery?

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

  10. How much will the surgery cost, and will insurance cover any of the expenses?

Reference

Authors: AlOtaibi NM, Liu CH, Benington PCM, Ayoub AF. Journal: Br J Oral Maxillofac Surg. 2023 Dec;61(10):666-671. doi: 10.1016/j.bjoms.2023.08.213. Epub 2023 Sep 12. PMID: 37863725