What is Orthognathic

(maxillofacial) surgery?
Orthognathic surgery combines orthodontic
treatment with surgery of the jaw to correct or
establish a stable functional balance between
the teeth, jaws and facial structures. The goal
of maxillofacial surgery is to treat any jaw
imbalance and the resulting incorrect bite,
which could adversely affect the cosmetic
(esthetic) appearance as well as the proper
functioning of the teeth. This involves
diagnosis, treatment planning and execution
of treatment, by combining orthodontics and
oral/maxillofacial surgery to correct
musculoskeletal, dento-osseous and soft
tissue deformities of the jaws and associated
structures.
What does “orthognathic” mean?
The word “orthognathic” was coined by
an oral & maxillofacial surgeon and means
“straight jaws”, just as orthodontics mean
“straight teeth”.
Prior to that time, the term
surgical orthodontics or “facial
orthopedics” was used to describe the
field.
 When is orthognathic surgery
required?
Orthognathic surgery is needed when
jaws don’t meet correctly and/or teeth
don’t seem to fit with jaws. The teeth are
straightened with orthodontics, and
corrective jaw surgery repositions the mal-
aligned jaws. This not only improves the
facial appearance (esthetics), but also
ensures that teeth meet correctly and
function properly.
Who needs orthognathic surgery?
There are many different types of
abnormalities of the jaw structures that
can result in facial deformity and improper
bite. These abnormalities in the jaws and
facial bones may be congenital (present at
birth) or developed during growth and
development. They may also be acquired
after birth as a result of hereditary,
environmental influences or trauma/illness
to the face.
 Is this a common problem?
It has been estimated that Dentofacial
(involving the teeth and face) deformities
affect approximately 20% of the
population.
 Who should be evaluated for
possible orthognathic surgery?
Any individual with difficulty in the following areas
should be evaluated for possible orthognathic surgery:

1. difficulty in chewing, biting or swallowing

2. speech problems
3. chronic jaw or TMJ (Temporomandibular joint) pain
4. open bite
5. protruding jaw
6. breathing problems
 Why Have Surgery?
1.When orthodontic treatment alone cannot correct a problem. There are
times when congenital abnormalities, growth disturbances, or previous
trauma have resulted in jaw positions that prevent conventional
orthodontics from achieving a satisfactory functional and esthetic result.
2.To improve jaw function. Correcting this bite frequently helps many
people chew food more normally and eat things that they have been
previously unable to eat.
3.To enhance the long term orthodontic result (stability). In some cases
orthodontic treatment alone can, in fact, produce a good bite relationship
during and immediately after the time of orthodontic treatment. However,
when an underlying jaw abnormality is responsible for the bite problem,
orthodontic movement must sometimes be done in such a way that it will
be difficult to maintain the position of the teeth over a period of time after
the braces have been removed. Surgery can often improve the long term
results in these cases.
4.Reduction in overall treatment time. In some cases there are several
options for treatment including orthodontics alone or a combination of
orthodontics and surgery. In some of these cases the combined
orthodontic surgical approach can be completed in a shorter period of
time since movement of the jaw bone to a better anatomical position may
decrease the amount of orthodontic treatment that is necessary.
 Why Have Surgery?
5.Change in facial appearance. Placement of jaws in the proper
position may often result in a more pleasing facial appearance.
6.Improved breathing. When surgery is performed on the jaw, the
ability to breathe is frequently improved. This type of surgery
often greatly improves problems associated with sleep apnea.
7.Improved speech. Correction of poorly positioned jaws or teeth
may have a positive effect on abnormal speech. Jaw surgery
may need to be combined with speech therapy to correct
speech abnormalities.
8.Improvement in jaw pain. Patients who have jaw joint pain or
pain in their jaw muscles may experience some improvement
after correction of jaw position. While this pain reduction occurs
for many patients, there is no absolute guarantee that correction
of jaw positioning will be able to totally eliminate or reduce pain.
What kind of specialists are involved in
the evaluation for orthognathic surgery?

Successful orthognathic surgery requires the

cooperation of the oral/maxillofacial surgeon,
orthodontist and general dentist. Other
specialists may include periodontists,
prosthodontists, endodontists, neurosurgeons,
ophthalmologist, otolaryngologists, plastic
surgeons and speech pathologist. These
professionals will work as a team to provide the
diagnosis, treatment plan and actual execution
of the treatment.
Who Participates In Orthognathic
Surgery?
When undergoing surgical treatment to correct jaw
abnormalities, a large team of people is involved.
1. The orthodontist and his / her staff
2. The surgeon, surgical assistants and office staff.
3. The anesthesiologist.
4. Operating room personnel.
5. Nurses and other health care professionals who work
in the hospital.
6. On occasion other dental and medical specialists
such as periodontists, endodontists, prosthodontists,
plastic surgeons, and otolaryngologists may be
consulted for specific needs when indicated. If this is
necessary, the reasons will be explained to the patient
and the specialist will be contacted.
 What are the basic goals of
orthognathic surgery?
The specific goal for orthognathic surgery vary
from patient to patient, depending on the actual
diagnosis.
In general, the team will address:

1.Function: Normal chewing, speech, ocular (eye)

function, respiratory function.
2.Esthetics: Establish facial harmony and balance
3.Stability: Avoid short and long term relapse
4.Minimize treatment time: Provide efficient and
effective treatment.
What is involved in the evaluation and
diagnosis of orthognathic surgery?
The most important aspect of overall patient management
is thorough evaluation and diagnosis. Patient evaluation
for orthognathic surgery can be divided into four main
areas:

1. Patient concerns or chief complaints

2. Clinical examination
3. Radiographic and imaging analysis (x-rays)
4. Dental model analysis

After an examination by each of the orthognathic surgery

team members (dentist, orthodontist and
maxillofacial/oral surgeon), a diagnosis and coordinated
treatment plan is prepared. The complete process usually
takes place in several stages over the coarse of one to
two years.
What is involved in the actual treatment
process of orthognathic surgery?
Any general dental maintenance, prevention or
restoration should be performed prior to orthodontic
and surgical intervention. Then, the first stage of
treatment is the alignment of the teeth into a stable
relationship with the underlying jaw by orthodontics,
which prepares the dental arches for the surgical
repositioning. This stage usually takes the longest,
from a few months to over a year. At this stage, the
abnormal bite (malocclusion) may become more
noticeable. Once ready for the surgical procedures,
the orthodontist and maxillofacial surgeon will review
photographs, x-ray and dental models to finalize the
surgical plan. The operation may involve a single jaw
or both jaws (maxilla and mandible). The surgery may
also be combined with other procedures, such as
rhinoplasty (nose correction) or genioplasty (chin
correction) to improve the general appearance of face.
How long is the surgery?
The procedure may take 2-4
hours, depending on the
complexity. Most patients are
kept in the hospital for 2-5 days,
again depending on the specifics
of the procedure and post-
operative condition.
 Hospital Routine For Surgery
1. Pt will be given a time to come to the hospital, usually very early in
the morning on the day of surgery, to check in with the Surgery
Admitting Office.
2. Pt will then be taken to the operating room where the surgery will
be completed.
3. After surgery Pt will be taken to the recovery room where they will
stay for 1 to 2 hours while they wake up.
4. After leaving the recovery room, pt will be taken to their room on
the floor in the hospital.
5. Pt will be discharged from the hospital one or two days after
surgery. This depends on how Pt is feeling, how much swelling they
have, and whether or not they are taking enough liquid orally so that
they do not need IV. In some cases pt may even be discharged the
same day of surgery.
6. At the time of discharge pt will be sent home with:
1.Postoperative instructions.
2.Medications or prescriptions to pick up medication.
3.A Postoperative appointment.
 How long is the recovery?
Most patients return to their normal activities
within a week or two after their surgery. The
surgeon will monitor the healing, and review the
changes in your facial structures and occlusion
(bite). The orthodontist will adjust the braces to
fit the new repositioned jaw. Orthodontic
treatment may continue for several months to
ensure optimal positioning of the teeth.
 Recovery After Surgery

The speed of surgical recovery depends

on several factors including age and the
extent of surgery. After the surgical
procedure patient can expect the following
during their recovery.
 Jaw Movement
Most patients undergoing Orthognathic surgery
will not have their jaws wired together. This will
allow some immediate postoperative jaw
function. Light elastics (rubber bands) will be
used to help your jaw function into a new bite
relationship. Over the first two or three weeks
you will see significant improvement in jaw
movement. Since the jaws are not wired
together this makes it easier to speak, drink, eat,
and perform oral hygiene.
 Diet
For the first few days immediately after surgery
your diet will be a very soft or blenderized diet. At
approximately7 days to 2 weeks after surgery your
diet will consist of foods such as cooked rice,
scrambled eggs, or other soft foods which can be
eaten without extensive chewing. At two to six
weeks after surgery your diet will progress to foods
such as ground beef, small pieces of very soft
meat such as flaky fish, and other foods which
require some chewing.
In most cases your diet will be near normal after six
weeks.
 Physical Activity
You should limit your activity for four to
five days. This usually means staying
around the house with minimal activity.

At about one week after surgery you may

be able to return to some limited activity
such as slightly restricted work activity,
some school activity, and easy leisure
activity. For some patients this may be
delayed for up to two weeks depending
on the type of surgery and how quickly
you recover after surgery.
 Potential Risks And Complications
Associated With Surgery
As with any type of surgical treatment, certain risks must be
considered and these should be weighed against the potential
benefits. We would not recommend an operation to you if we did not
feel strongly that the benefits far outweigh any risks associated with
surgery. However, it is important for you to understand that the risks
associated with Orthognathic surgery may include the following:

I. Side effects of any surgical procedure. These actually are not risks
but side effects usually associated with any type of surgery:

a. Discomfort / postoperative pain as a result of the surgery itself

b. Swelling
c. Bleeding. Since most jaw surgery is performed through incisions
inside the mouth, it is impossible to put a dressing over this area.
d. After surgery some bleeding occurs, just as when teeth are taken
out.
 Potential Risks And Complications
Associated With Surgery
1. Infections with jaw surgery are rare, generally easy to treat, and usually
resolved quickly. However, infection may result in more severe
consequences such as improper healing and the need for further
surgery.
2. Damage to normal structures such as gum tissue, bone, or teeth. Again,
this type of problem is extremely rare.
3. Numbness or decreased sensation after surgery. Since jaw surgery is
performed to the face, bruising of these nerves sometimes results in
some decrease feeling in certain parts of the face. In the case of upper
jaw surgery this usually occurs around the nose and upper lip. In
lower jaw surgery this occurs around the lower lip and chin. While this
may feel strange in the immediate post operative period, this
numbness also helps decrease the amount of pain which you will feel
after surgery. This decreased feeling is usually temporary. However, in
a few patients there may be some permanent loss of feeling.
4. Risks associated with anesthesia. General anesthesia is very safe
particularly in elective surgery cases such as Orthognathic surgery.
The anesthesiologist will discuss all aspects of your anesthetic care
prior to your surgery.
What are some examples of jaw abnormalities?

Mandibular retrusion (small chin)

Mandibular prognathism (large chin)
Maxillary retrognathia/hypoplasia
(flat upper lip)
Maxillary vertical excess/hyperplasia
(gummy smile)
Apertognathia (open bite)