Orthognathic surgery combines maxillofacial surgery or jaw surgery with orthodontics. The ideals of this type of surgery are to improve one’s bite and make chewing easier. The surgeries done are designed to correct misalignment of the jaw and make the jaw fit together properly. Facial imbalances such as an underbite, overbite or cleft palate can be corrected using orthognathic surgery. Orthodontics are used to correct malocclusions of the teeth and to improve gummy smiles, where large areas of gums are showing when a person smiles. TMJ disease can be corrected or prevented using orthognathic jaw surgery. Patients who have jaw problems that can’t be treated with orthodontics alone have orthognathic surgery to correct the jaw abnormality so the teeth work properly.
Surgery on the upper jaw is called a maxillary osteotomy and surgery on the lower jaw is called a mandibular osteotomy. A patient can have one or both of these surgeries at the same time in order to correct the alignment of the upper and lower jaw and to improve the functionality of the upper and lower jaw. The surgery is generally done using incisions inside the mouth so that there is no external scarring visible.
The term “orthognathic surgery” was first coined by Dr. Harold Hargis, a Doctor of Dentistry. He was the first to consider cleft palate as part of orthognathic surgery. The surgery is used to treat dental problems that can’t be treated with orthodontic treatments alone. Bones are cut and re-aligned and then held in place as part of the surgery using screws, plates or screws.
The various indications for orthognathic surgery include the following:
- Discrepancies between the upper and lower jaw alignment, which can be vertical, transverse or antero-posterior
- Facial skeletal abnormalities that result in airway problems, sleep apnea or soft tissue problems
- TMJ pathology that causes facial skeletal discrepancies.
Orthognathic surgery is done by an oral and maxillofacial surgery specialist or a craniofacial surgery specialist and is aided by an orthodontist who straightens and aligns the teeth. Braces are often placed before the surgery and after the surgery are complete. There are retainers used as well, often after the braces are completed and removed. Orthognathic surgery is also a part of repairing cleft lips and cleft palates. The orthodontist and the orthognathic surgeon work together to align the bite and teeth.
The surgeon who does the surgery needs to have training in dentistry as well. Oral and maxillary surgery specialists are often trained in dental procedures so they can identify what is a normal bite and how to achieve one. This allows the maxillofacial surgery specialist to work best in conjunction with the orthodontist to achieve the best in a normal bite.
It requires a great deal of planning by a multidisciplinary team. Sometimes a speech and language therapist is included along with the maxillofacial surgery specialist and the orthodontist. There may need to be molds of the face created so the anatomy of the person’s face is well understood and the surgery can be planned. X-rays need to be taken as well as photographs and software exists that can predict how the person will look after the proposed surgical procedure. The patient can see what he or she will look like after the procedure is over with.
The primary goal of orthognathic surgery is to get a normal bite and a face that looks as pleasant as possible. The airway may need to be enlarged. In fact, orthognathic surgery can correct obstructive sleep apnea in 90 to 100 percent of cases. Both the upper and lower jaws may need surgery in order to enlarge the airway. A nasal tube is used to intubate the patient because the mouth needs to be easily accessed. Bones are cut for greater patency of the airway and the individual can breathe more easily in their sleep.