Orthognathic Surgery

The term "orthognathic surgery" refers to a variety of procedures designed to move the upper and/or lower jaws into a different, more appropriate, position. There are some individuals whose upper and lower jaws do not fit together in an appropriate fashion. This is usually noticed either by disharmonies in their appearance or in difficulties with the way the teeth fit together or both. It may be indicated for functional, cosmetic, or health reasons. It is surgery commonly done on the jaws in conjunction with orthodontic treatment, which straightens the teeth.

Facial imbalances are often present and sometimes recognized by the untrained eye. People with large jaws, or chins, or small jaws or chins, teeth which don't fit together and flat cheekbones are examples of facial characteristics that may be improved by orthognathic surgery. The common maxillofacial deformities and their clinical appearances are the following:

• Protruded Maxilla (upper jaw)
  The upper jaw is protruded beyond the normal limits along with the teeth. The person cannot close his lips (lip incompetence) without effort. The teeth are always visible and in most cases the whole of the gums are visible on smiling (gummy smile). A gummy smile is mainly due to the vertical excess of the maxilla.
• Retruded Maxilla
  This deformity is due to under development of the upper jaw mainly seen in people who have cleft lip or palate. After the surgical correction of the cleft lip or palate at a young age the growth of the maxilla is retarded along with displacement or destruction of the tooth bud. This results in a dish shaped face with a hooked or flaring nose and irregularly aligned, rotated or missing teeth.
• Protruded Mandible (lower jaw)
  In some people there will be extra growth of the lower jaw resulting in a long jaw. Their faces are very long with protrusion of the lower teeth and thick lips. Normally on biting, the lower teeth will be inside the upper teeth while in people with long jaws usually the lower teeth will be outside the upper arch.
• Orthodontic Reasons
  In some people due to developmental deformity or due to hereditary factors the lower jaw is very small resulting in a “bird face”. There is no proper development of the chin.
• Facial Asymmetry
  Sometimes a part of the face maybe overdeveloped or underdeveloped causing one part of the face to be small or large. One side of the face is not in symmetry with the other side giving an unaesthetic appearance.

In most cases where the jaws are being moved, comprehensive orthodontic movement of the teeth may be necessary to prepare the teeth for optimal occlusion or biting positions. Following surgery there is often a short period of orthodontics for subtle and fine detailing of the tooth positions.

Some minor orthognathic surgery procedures can be done in the surgeon's office, but most often they are done in the hospital. Surgery usually lasts three to four hours during which time you will be completely asleep. While you are asleep, incisions are made on the inside of your mouth to expose the bones to be cut. The procedures are then carried out. Screws are used to hold the bones and the teeth may be wired together. The incisions are closed with sutures, and you are ready for recovery.

The length of recovery in the hospital may vary from one to three days following surgery. During the week following surgery, activities should be limited. All strenuous activities and heavy exercise should be avoided the first month after surgery. Swelling is common, and a brief period of facial discoloration is possible.

Facial and dental imbalances have influences on function, health, and appearance. Not treating a functional problem may prevent you from being able to bite and chew your food, close your lips together, and to speak clearly. The health of the teeth, gums and particularly the jaw joint (TMJ) may be in jeopardy if surgery is not done. While not often a primary reason for orthognathic surgery, the appearance of your face may be made to look more balanced or normal. One's facial appearance can influence one's quality of life in many ways.