Our Summary

This research paper is a review of studies on long-term stability of bone structure in patients with a specific type of dental misalignment (skeletal class III malocclusion) who’ve had corrective jaw surgery. The researchers analyzed 9 studies involving 886 patients who were followed up for 5 to 12.7 years after surgery.

They found that several factors affect the stability of the surgery results, including the patient’s age, their facial structure, the type of surgery performed, and the method used to fixate the bones. Younger patients and those who had a certain type of surgery (bimaxillary) had better results, with less change in jaw length and a stable forward-most point of the upper jaw. Patients with a long face experienced a relapse with a downward rotation of the face, while those with a short face observed an upward rotation.

A specific type of surgery, single mandibular setback, was linked to a decrease of stability, with changes in the lower jaw’s shape. However, genioplasty (chin surgery) was found to be highly stable. Also, the bone below the tongue moved significantly backward and downward, which was linked to changes in the muscles above the hyoid bone but not much change in the jaw position.

Lastly, they found that using small plates to secure the bones during surgery led to higher patient satisfaction and better stability than using screws. However, they caution that these findings should be interpreted carefully due to lack of evidence from advanced three-dimensional imaging.

FAQs

  1. What factors influence the long-term hard tissue stability in patients who have undergone orthognathic surgery?
  2. What are the differences in orthognathic surgery outcomes between young and older patients?
  3. What are some potential risks and complications associated with orthognathic surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about orthognathic surgery is to follow post-operative instructions carefully to ensure optimal healing and long-term stability. This may include proper oral hygiene, avoiding hard or chewy foods, attending follow-up appointments, and wearing any prescribed orthodontic appliances or retainers. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can also contribute to successful outcomes after orthognathic surgery.

Suitable For

Orthognathic surgery is typically recommended for patients with skeletal class III malocclusion who have significant jaw discrepancies that cannot be corrected with orthodontic treatment alone. Patients who may benefit from orthognathic surgery include those with:

  1. Severe underbite or overbite
  2. Difficulty chewing or biting
  3. Speech problems
  4. Breathing problems
  5. Temporomandibular joint (TMJ) pain or dysfunction
  6. Facial asymmetry
  7. Open bite
  8. Facial trauma
  9. Sleep apnea

It is important for patients to undergo a thorough evaluation by an orthodontist and oral and maxillofacial surgeon to determine if they are suitable candidates for orthognathic surgery. The decision to undergo orthognathic surgery should be based on the individual patient’s specific needs and goals, as well as the potential risks and benefits of the procedure.

Timeline

Before orthognathic surgery:

  1. Patient undergoes initial consultation with an orthodontist and oral surgeon to discuss treatment options and plan for surgery.
  2. Patient undergoes orthodontic treatment to align teeth and prepare for surgery.
  3. Patient may undergo pre-surgical orthodontic treatment to correct bite discrepancies.
  4. Patient undergoes pre-surgical evaluations, including imaging studies such as X-rays, CT scans, and facial photographs.
  5. Patient undergoes pre-operative medical clearance to ensure readiness for surgery.

After orthognathic surgery:

  1. Patient undergoes post-operative care, including pain management, monitoring of swelling, and instructions for oral hygiene and diet.
  2. Patient may experience temporary changes in facial appearance, including swelling and bruising.
  3. Patient attends follow-up appointments with the surgical team for monitoring of healing and adjustment of orthodontic appliances.
  4. Patient continues orthodontic treatment to fine-tune bite alignment and ensure long-term stability.
  5. Patient may experience changes in speech and eating patterns as they adjust to their new bite position.
  6. Patient experiences long-term stability of surgical outcomes, with some potential for relapse depending on factors such as age, facial pattern, surgical procedure, and fixation type.
  7. Patient may undergo additional surgical or orthodontic interventions if necessary to address any relapse or further optimize results.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with orthognathic surgery?
  2. What is the expected recovery time and post-operative care for orthognathic surgery?
  3. How will orthognathic surgery affect my facial appearance and function?
  4. Will I need braces or other orthodontic treatment before or after the surgery?
  5. What are the long-term stability outcomes for patients with my specific type of malocclusion?
  6. How will orthognathic surgery impact my bite and chewing function?
  7. Will I experience any changes in speech or swallowing after the surgery?
  8. What are the alternatives to orthognathic surgery for treating my malocclusion?
  9. How experienced are you in performing orthognathic surgery, and what is your success rate?
  10. Can you provide me with before and after photos of patients who have undergone orthognathic surgery for a similar condition as mine?

Reference

Authors: Gaitán Romero L, Mulier D, Orhan K, Shujaat S, Shaheen E, Willems G, Politis C, Jacobs R. Journal: Int J Oral Maxillofac Surg. 2020 Jan;49(1):51-61. doi: 10.1016/j.ijom.2019.02.022. Epub 2019 Mar 27. PMID: 30926299