Jaw Surgery (Corrective)

About jaw surgery: As orthodontics is concerned with the correct alignment of the teeth, so corrective jaw surgery - also known as orthognathic surgery - encompasses those procedures that are used to place the jaws in their correct position. Usually the two specialities are carried out in close cooperation and often simultaneously. Close cooperation will therefore take place between your orthodontists, dental surgeon and oral surgeon.

Read the results of Dr John Flood's corrective jaw surgery for Bodyworks »

What is Orthognathic Surgery?

Jaw surgery, or arthognathic surgery, is a well established and recognised field of oral and maxillofacial surgery with many of the procedures being developed as early as the 1920's. Great advances have taken place since the 1960's, perhaps the most important being the introduction of rigid internal fixation methods (small metal bone plates) which have made the practice of wiring the jaws together in the immediate post-surgical recovery period less common.

During your consultations with your doctor it is important that you ask as many questions as you feel are necessary to your understanding of what is a big decision making process. Parents and spouse are also encouraged to attend consultations. During the consultations, your doctor will discuss the diagnosis of your particular case, using your dental records, x-rays and other visual aids as are necessary. The purpose of the pre-operative consultations is to provide you with as much specific information as possible to enable you to understand the contemplated procedures and to allow you to make an informed decision about your treatment.

Jaw Surgery and Orthodontics

Many malocclusions (the improper alignment of upper and lower teeth) are correctable by wearing braces alone. In some situations, however, the upper and lower jaws are of a different size or shape, or are in an incorrect relationship to one another, and in this circumstance orthodontic treatment alone may not be able to align the upper and lower teeth. In this situation your orthodontist may suggest that corrective jaw surgery will be necessary to align the jaws and hence the teeth so that the orthdontic result is not compromised and so that the optimum result is achieved as far as long-term stability, appearance and function are concerned. Following a detailed study of your particular cause using dental models, x-rays and computer tracings and predictions, your orthodontist and oral surgeon will be able to recommend the best programme of combined treatment.

The sequence of treatment

Combined orthodontic and jaw surgery (orthognathic) treatment often takes considerable time to complete and therefore requires great motivation and cooperation from the patient, as well as a close liaison between you, your orthodontist and oral surgeon. Several stages are involved in treatment:

• Treatment planning
• Pre-surgical orthdontics
• Surgical treatment
• Post-surgical orthodontics

The timing of the various stages is usually controlled by your orthodontist but it may be quite possible to organise the surgical treatment around school, work, family and social life.

(A) Treatment planning

Treatment planning begins with an initial consultation with your orthodontist. If jaw surgery is recommended, your oral surgeon and orthodontist will work closely together to plan the programme of treatment, using dental plaster models, x-rays, photographs, computer tracings and predictions. No treatment will be instituted until you are fully informed and have consented to the proposed programme.

(B) Pre-surgical Orthodontic treament

Before jaw surgery can be undertaken it will be necessary to align the teeth in each jaw. Due to the malalignment of the jaws, the occlusion (the way in which the teeth meet) at this stage will not be correct. The purpose of pre-surgical orthodontics is to allow the plaster dental models to be examined so that correct alignment of the teeth is assured at the time of the jaw surgery.

(C) Jaw surgery treatment

Prior to having your braces placed, or even during the pre-surgical phase of orthodontic treatment, it may be necessary to have several teeth extracted. As they would interfere with the main jaw surgery procedure, the most important teeth to be removed are the wisdom teeth, and your oral surgeon will usually carry out this operation. It is advisable to have them removed at least three months prior to the jaw surgery to allow adequate bone healing to take place.

Once your teeth have been sufficiently straightened, you will have another consultation with your oral surgeon so that details of the operation, your stay in hospital and the recovery period are fully understood.

Jaw surgery is performed in a hospital operating theatre under a general anaesthetic. Usually, you will be admitted to the hospital on the day before surgery and be discharged home on the morning of the third or fourth post-operative day. The anaethetist will examine you in hospital and explain what is involved in a general anaesthetic. All modern jaw surgery procedures are carried out through the mouth using high speed air-driven bone cutting saws and titanium mini bone plates and screws. Upper jaw surgery is completed entirely within the mouth as is lower jaw surgery but with a small (3mm) incision made on the side of the cheek. These "stab" incisions are used to insert the bone screws and will heal to an "invisible" scar within a few weeks. When lower jaw surgery is carried out, a thin plastic drain tube may be led out through the cheek on each side to reduce the amount of facial swelling - the drain tubes are usually removed on the second day after the jaw surgery. Immediately at the completion of the operation and before you leave the operating theatre, elastic bands or wires will be placed between the upper and lower teeth to support the jaws in their new position. Generally these elastic bands or wires remain in place for several weeks after the operation.

Your oral surgeon will see you every week for several weeks after your jaw surgery to assess your post-operative progress and you will see the orthodontist about one month after surgery to begin the post-surgical phase of orthodontic treatment.

(D) Post-surgical Orthodontic treatment

After healing has taken place and the new position of your jaw is stable, further orthodontic treatment will be carried out to enable the final position of the teeth to be obtained. Your orthodontist will tell you how long this stage will take.

Side Effects of Jaw Surgery

As this type of surgery is considered quite major it is not without a number of known and predictable temporary side effects.

1. Pain

It is not uncommon for patients to experience more pain after the removal of wisdom teeth than after orthognathic surgery. Appropriate analgesics are given to you in hospital and to take home.

2. Facial swelling

Swelling on the face commences immediately after jaw surgery and reaches a peak at about 48 hours. It does not begin to decrease significantly for about one week after the operation.

3. Bruising

It is quite normal for some patients to have some bruising on the sides of the face, under the eyes and in the upper neck, and usually this occurs about one week after the operation. It may take another week to disappear.

4. Jaw stiffness

Because of the amount of swelling that occurs it is normal for the jaws to be somewhat stiff for about ten days after the operation.

5. Dietary modification

It takes bone some time to regain enough strength after orthognathic surgery to allow a return to normal diet. During the first two weeks after the operation it is essential that all food is pureed. During the following two weeks only soft foods may be eaten. From the fourth week a gradual return to a normal diet may take place over the next two weeks. This is perhaps the most important aspect of post-operative recovery and advice will be given before you leave hospital.

Complications of Jaw Surgery

Following your consultation it would be useful for you to have a summary of the subject, and it is emphasised that this is intended more to inform, rather than to alarm. The complications associated with the various drugs and medicines are too numerous to discuss in this document and perhaps you might discuss this with your anaethetist who will meet you in hospital before the operation.

Haemorrhage may occur during or after the operation. Reactionary haemorrhage occurs in the first 24 hours after surgery, and secondary haemorrhage occurs 5 to 7 days after operation and is usually the result of infection. If bleeding is excessive during an operation a transfusion may be required. If you or your family (i.e. immediate blood relatives) have any concern that there may be a bleeding disorder in the family, advise your surgeon of this concern in order that appropriate blood tests can be arranged promptly with a large and experienced pathology laboratory. If there is an abnormality, you will be referred to a haematologist for further assessment. If you have had unexplained bleeding associated with any operation, please share the details with your surgeon. Haematoma (a blood collection in the tissues) formation occurs in approximately 1-2% of operations on the jaw, and it is for this reason that surgical drains may be used.

Dr John Flood also provides the following related services:

• Cheek and Chin Implants