Orthognathic surgery refers to the surgical correction needed to fix substantial abnormalities of the maxilla (upper jaw), the mandible (lower jaw), or both. The abnormality may be a birth defect, a growth defect, or the result of traumatic injuries to the jaw area.
Orthognathic surgery is performed by an oral and maxillofacial surgeon to correct malocclusion (bad bite) in cases where routine orthodontic treatment has not or will not be effective. Orthognathic surgeries include surgical treatment of the upper jaw, lower jaw, chin, or some combination of the above.
There are several classifications of malocclusion (the improper coming together of teeth) which may require orthognathic surgery:
Class I Occlusion – This malocclusion means that the lower front incisors sit directly behind the upper front incisors when the patient bites down. This is consideredthe ideal bite and is usually the goal of orthodontic treatments.
Class II Malocclusion – This is identified when the lower front incisors lie significantly behind the upper front incisors during the biting process, in some cases hitting the soft tissue on the palate behind the upper incisors. This is commonly referred to as an overbite and can cause discomfort, bone damage, excessive wear of the front teeth, jaw joint problems and tooth loss.
Class III Malocclusion – This is commonly known as an underbite and occurs when the lower front incisors and lower jaw are positioned beyond the upper teeth, making the lower jaw much more prominent than the upper jaw.
Reasons for orthognathic surgery
The malocclusion of the teeth can create greatly destructive forces among the five powerful muscles that control the closing and opening of the jaw. These muscles generate a tremendous force when clenching, grinding or chewing. Misalignment can seriously damage the function and aesthetic appearance of the teeth in many ways if left untreated, such as:
Tooth Wear – In the case of an overbite, the pressure and wear on the teeth is not spread evenly. This can also lead to Temporomandibular Dysfunction (TMD), migraine headaches, and tooth loss.
Chronic Jaw, Muscle Pain & Headache – The misalignment of the teeth alters the way the facial muscles interact. In some cases, the meniscus cartilage, which acts as a buffer between the jawbones, can be painfully damaged.
Loose Teeth – When uneven pressure is continually exerted in unintended places or soft tissue is damaged by an overbite, adjacent teeth may become loose in their sockets which causes pain and reduces proper function.
Tooth Sensitivity – As teeth become damaged by constant use, the enamel becomes thinner and the nerves are less protected. This lack of protection can lead to sharp pains when hot or cold foods are eaten.
Difficulty Swallowing, Chewing, or Biting Food – Each can be associated with muscle pain and/or poor alignment of the upper and lower jaws.
What does orthognathic surgery involve?
Typically your orthodontist identifies you as a candidate for orthognathic surgery. They will perfrom a complete photographic analysis including panorex x-rays, cephalometric x-rays, models, impressions, and radiographs. Your orthodontist will refer you for a consultation with Dr. Fairbanks the two will work together and consider how the corrective surgery will impact both proper jaw function and the aesthetic appearance of the entire face.
Either orthodontic braces (or in some select cases invisalign retainers) are necessary to align the arches and straighten the teeth prior to the surgery. During maxillary and mandibular surgery, the upper jaw is moved and may be secured in position using tiny plates, wires, rubber bands and screws. Orthognathic surgery will require a general anesthesia in a hospital setting. You will be admitted to the hospital following surgery for 1-2 nights. Pain medication will be prescribed as necessary, and you’ll be given post treatment advice for your recovery. Plan for 10-14 days of recovery time before resuming work or classes. You will be restricted to a soft/non-chew diet for at least 6 weeks following surgery and activity will restricted.