Our Summary

Orthognathic surgery is a procedure that corrects conditions related to the structure of the jaw and face. It’s usually performed on adults, but it’s increasingly being done on children too. However, we didn’t know much about how safe it was for children, or what risks might be involved for younger patients.

In this study, we looked at data from the American College of Surgeons National Surgical Quality Improvement Program which included orthognathic procedures done on children in 2018. We found that about 7.8% of these surgeries had complications, including excessive bleeding, surgical site infection, and pneumonia.

Children with any existing health conditions, especially those affecting the lungs, nervous system, or muscles, were more likely to experience complications. Also, the risk of complications was significantly higher for children below 6 years old, including higher rates of infection, pneumonia, and the need for additional surgeries.

We also found that some specific types of orthognathic surgeries took longer for older children than for younger ones. However, there was no significant difference in the rate of complications between surgeries that involved only one jaw and those that involved both jaws.

Interestingly, we found that children who had a specific type of surgery (bilateral sagittal split osteotomies) before they were 13.5 years old were over seven times more likely to experience complications.

In conclusion, orthognathic surgery is generally safe, but young children (especially those under 6 years old) are at a higher risk of complications. Therefore, careful consideration and planning are necessary when these surgeries are done on younger patients.

FAQs

  1. What is orthognathic surgery and who typically undergoes this procedure?
  2. What are the risks or potential complications of orthognathic surgery in children?
  3. Does the risk of complications vary between different types of orthognathic surgeries?

Doctor’s Tip

A helpful tip a doctor might tell a patient about orthognathic surgery for children is to ensure that the child is in good overall health before undergoing the procedure. It’s important to discuss any existing health conditions with the surgeon and anesthesia team to minimize the risk of complications. Additionally, parents should be aware that younger children may have a higher risk of complications and may require extra monitoring and care post-surgery. Follow-up appointments with the surgeon and regular dental check-ups are also important to ensure proper healing and long-term success of the surgery.

Suitable For

Overall, patients who are typically recommended for orthognathic surgery include those with:

  1. Severe malocclusion (misalignment of the teeth and jaws)
  2. Difficulty chewing, biting, or swallowing
  3. Speech problems
  4. Facial asymmetry
  5. Sleep apnea or other breathing issues related to jaw structure
  6. Temporomandibular joint (TMJ) disorders
  7. Facial trauma or injury affecting the jaw

It is important for patients to undergo a thorough evaluation by an orthodontist and oral and maxillofacial surgeon to determine if orthognathic surgery is the best treatment option for their specific condition. Additionally, patients should be in good overall health and have realistic expectations about the outcomes of the surgery.

Timeline

Before orthognathic surgery:

  1. Patient meets with orthodontist to discuss treatment options and determine if orthognathic surgery is necessary.
  2. Patient undergoes orthodontic treatment to align teeth and prepare for surgery.
  3. Patient meets with oral and maxillofacial surgeon to discuss surgical plan and potential risks.
  4. Patient undergoes pre-operative testing and evaluation to ensure they are healthy enough for surgery.

After orthognathic surgery:

  1. Patient undergoes surgery to correct jaw and facial structure.
  2. Patient is monitored in the hospital for a period of time post-surgery.
  3. Patient may experience swelling, bruising, and discomfort in the days following surgery.
  4. Patient follows a strict post-operative care plan, including a liquid diet and pain management.
  5. Patient attends follow-up appointments with their surgical and orthodontic team to monitor healing and adjust orthodontic treatment as needed.
  6. Patient may undergo physical therapy to regain normal jaw function and improve speech and chewing abilities.

What to Ask Your Doctor

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

  1. What specific type of orthognathic surgery do I need, and why is it necessary?
  2. What are the potential risks and complications associated with this surgery, particularly for someone in my age group?
  3. How experienced are you in performing orthognathic surgery on patients my age?
  4. What is the expected recovery time and process after the surgery?
  5. Will I need any additional procedures or follow-up surgeries in the future?
  6. How will my bite and facial appearance be affected by the surgery?
  7. What are the alternatives to orthognathic surgery, and why is surgery the recommended treatment for me?
  8. How should I prepare for the surgery, including any pre-operative instructions or tests?
  9. What can I expect in terms of pain management and post-operative care?
  10. Are there any long-term effects or considerations I should be aware of after the surgery?

Reference

Authors: Kalmar CL, Carlson AR, Patel VA, Zapatero ZD, Kosyk MS, Taylor JA, Swanson JW. Journal: J Craniofac Surg. 2021 Nov-Dec 01;32(8):e798-e804. doi: 10.1097/SCS.0000000000007843. PMID: 34238876