Jaw Surgery (Orthognathic Surgery)

Jaw Surgery - Bradley A. Cherry - Cherry OMS

Orthognathic surgery is needed when jaws don’t meet correctly or if the teeth don’t fit with the jaws. Teeth are straightened with orthodontics, and corrective jaw surgery repositions a misaligned jaw. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly.

People who can benefit from orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Injury to the jaw, birth defects such as cleft lip or palate and altered facial growth patterns are some of the main causes of orthognathic problems. Patients with cleft lip or palate often require orthognathic surgery in their late teen years.

If you are a candidate for jaw surgery, Dr. Cherry works closely with your dentist and orthodontist during your treatment. The actual surgery can move your teeth and jaws into a new position that results in a more attractive, functional dental-facial relationship.

Consultation

If surgery is necessary, Dr. Cherry explains what the advantages and disadvantages are, what is entailed in surgery, and what you can expect during the preoperative and postoperative periods. Risks and complications are also discussed with you. Dr. Cherry keeps explanations simple and uses your X-rays and dental casts to demonstrate the problems. Solutions for the problems are discussed in general terms and the need for surgery explained. The importance of preoperative alignment of the teeth and the possibility of the bite not improving, or even getting worse, during this phase is explained to you.

Treated cases with similar problems are used to demonstrate specific treatment objectives. For most patients, the treatment time is extremely important; but it is preferable not to give a specific length of time. It is important, however, to give you a general idea of the length of treatment and a treatment profile explaining various phases of the treatment, the sequence of the stages, and the time each phase could take. Dr. Cherry alerts you to factors – such as bone density, periodontal disease, patient cooperation, age and tooth extractions – that might influence the treatment time and surgical precision.

Procedure

Maxillary Osteotomy (Upper Jaw) “LeFort”

A maxillary osteotomy is performed to correct any of the following issues:

  • Significantly receded upper jaw
  • Crossbite
  • Excess or deficiency in upper jaw vertical height (too much or too little of the teeth are showing)
  • Open bite (apertognathia)

In this procedure, Dr. Cherry makes bone cuts inside the mouth above the teeth and below both eye sockets; so the entire top jaw, including the roof of the mouth and all upper teeth, can move as one unit. The teeth and jaw are moved forward until the upper and bottom teeth fit together properly.

Once the jaw is realigned, tiny screws and bone plates hold the bone in its new position. These screws are smaller than a bracket used for braces and become integrated into the bone structure over time.

A person who has an open bite (apertognathia) has difficulty chewing, due to a significant space between the upper and lower front teeth when the molars are completely touching. This gap results from excess bone growing only above the molars. What is normally a flat, even surface is angled instead; so the upper teeth do not touch when a person bites down. To remedy this condition, surgeons shave away or remove the excess bone.

Mandibular Osteotomy (Lower Jaw)

A significantly receded lower jaw (retrognathia) can be corrected by a procedure called mandibular osteotomy (bilateral sagittal split ramus osteotomy).

In this procedure, Dr. Cherry makes cuts behind the molars and lengthwise down the jawbone so the front of the jaw can move as one unit. As a result, the jaw slides smoothly to its new position. Screws hold the jawbone together until it heals.

Chin Surgery (Genioplasty)

A severely receded lower jaw is often accompanied by a deficient chin. This condition can be remedied with a procedure called genioplasty (mandibular anterior-inferior border osteotomy). Typically, Dr. Cherry can alter the jaw and restructure the chin during the same surgery.

Postoperative Recovery

The following information is provided to ensure that many of the details of postoperative care are covered prior to your surgical procedure. This will ensure a smooth and uneventful recovery. It has been our experience that the more information and preparation patients have prior to their surgery, the more easily they are able to manage their postoperative care.

  • Keep your head elevated on two pillows for two weeks. This position helps to decrease facial swelling.
  • Do not chew anything; your diet should be fluids only. For the first several days, use a syringe that injects the fluids into your mouth.
  • Take medications also by syringe. You may advance your diet as you choose, remembering to protect the operative areas. Adequate nutrition and maintaining body weight is important for recovery.
  • Plan to eat small “meals” at least six times per day. Allow extra time at first.
  • Apply Vaseline® to your lips, as needed.
  • Brush your teeth gently the first week with a soft toothbrush and your choice of toothpaste. Do not brush the gums until the second week. Always protect the incision sites until they are healed.
  • Use a decongestant nasal spray to dry up the oozing and open the nasal passages. Use this decongestant for only three days. Otherwise, rebound swelling may occur in the nasal tissues, making breathing more difficult.
  • Use a saline nasal spray, such as Ocean®, to break up any blood or mucous clots in the nose. This infusion can be done over the sink in whatever amounts and as often as desired.
  • Use a humidifier at night, aiming the vaporized water gently across the face to help keep the nasal passages moist.
  • Apply ice to the face for the first 24–36 hours to decrease the amount of swelling. After this time, it may be continued as a comfort measure but is no longer necessary. Heat may be applied after 36 hours if it is comforting.
  • Do not use mouthwashes containing alcohol unless they are diluted in a 1:3 ratio with water, because the alcohol will irritate the incisions.
  • Rinse with warm salt water, either by cup or with the feeding syringe, beginning the day after surgery and continuing for seven days. Dilute ½ teaspoon of salt in 1 cup of lukewarm water.
  • Shower or bathe the day after surgery if you want to. Make sure that you can sit in the shower or have someone with you to steady you. After surgery, it is not uncommon to feel light-headed upon standing, especially while taking a warm shower. You may use regular soap and shampoo, even if there was a bone graft taken from the scalp or hip. If a hip graft was taken, then a shower is preferable so the donor site (site of bone removal) is not soaked in bath water. Cleaning after surgery will lift your spirits.
  • Do not lift anything over 10 pounds for two weeks. Contact sports should be avoided for at least eight weeks. Make sure to ask your surgeon any other questions you might have regarding activity.
  • Avoid sun exposure, and use a sunblock with at least SPF 20; since darkening of any incision on the skin can occur for up to six months.
  • Keep wire cutters with you at all times if your teeth are held together with wires.
  • Call your surgeon with any questions or if you experience any of the following: temperature is over 101°F, excessive bleeding or rapid swelling occurs, pain is unrelieved by prescribed pain medications, breathing is difficult, you experience a sudden shift of the bite or bones.
  • Take one daily multiple vitamin with iron, and 1,000 mg of vitamin C in four 250 mg doses, for six weeks following surgery.

Risks & Side Effects

Like any surgery, jaw surgery poses some health risks. Most of these are rare, but you should be aware that surgery can be unpredictable.

  • Bleeding
  • Infection
  • Nerve injury (permanent numbness of the lip, tongue, cheek, etc.)
  • Relapse, or return to original jaw positioning
  • Damage to teeth
  • Scarring
  • Temporomandibular (TMJ, or jaw joint) problems
  • Nasal-airway obstructions
  • Nonunion (inadequate closure of the bone)
  • Sinusitis (swelling of the nasal sinuses)