What is Orthognathic Surgery?

Orthognathic Surgery refers to jaw surgery that aims to correct deformities of the upper and/ or lower jaws. It is usually done in combination with orthodontic treatment (braces) and is used to correct dental and jaw abnormalities.

Orthognathic Surgery requires a multidisciplinary team approach that includes an Orthodontist, an Oral and Maxillofacial Surgeon and Allied Health Professionals (e.g. Dieticians, Speech Therapists).

Why is Orthognathic Surgery necessary?

Orthognathic Surgery is necessary to correct discrepancies in the upper and/ or lower jaws.

This is done to improve function (chewing/ speech/ breathing), aesthetics and stability of your bite/ occlusion.

What are common problems that can be managed with Orthognathic Surgery?

Common problems include:

Flat upper jaw
Excessive show of gums (i.e. a gummy smile)
Overall elongation of the face
Facial asymmetry
Long lower jaw
Short lower jaw
Obstructive sleep apnoea
Jaw deformities resulting from trauma

How is Orthognathic Surgery done?

The surgery is performed by an oral and maxillofacial surgeon. It is almost always done inside the mouth to prevent facial scars.

Cuts are made to the jaw bones to move them into the correct position. The jaw bones are then secured with titanium plates and screws in their new position.

ABOUT ORTHOGNATHIC SURGERY

Should the titanium plates and screws be removed?

The titanium plates and screws do not require removal. They typically do not cause any issues and will not be picked up by any metal detectors at security check points.

The few instances where removal is required include the plates and screws becoming loose/ exposed, or if a localised infection develops around the plates and screws.

What are some of the risks of the surgery?

Some possible risks and complications of surgery include:

Bleeding at the operation site that may require blood transfusion or readmission.
Wound breakdown and/ or infection.
Discomfort at the jaw joints.
Injuries to adjacent teeth that can result in the loss of vitality in these teeth. Root canal treatment or even extractions may be required in such cases.
Injuries to the nerves that provide sensation to the lips, chin and tongue resulting in partial or complete numbness. Although the majority of cases recover full sensation within 6 months, it may take as long as a year in some cases. A number of cases have permanent numbness (usually partial).
Relapse (jaw reverts to the original position).

Rare complications include:

Foreign body in the operation site.
Unexpected change of bite after surgery.
Poor healing of jaw bones.
Loss of blood supply and vitality of bone.
Unexpected changes in airway that results in changes to voice quality or increased snoring.
Injury to facial nerve resulting in temporary/ permanent weakness or paralysis of facial muscles.
Injury to structures in the orbits or base of skull which may result in double vision, excessive tearing, dry eyes, or in extremely rare cases, blindness or stroke.
During the course of treatment, dislodgement of the components used for guiding the bite (splint, wires etc.) may occur. Swallowing/ inhaling of the loose parts may occur.

What can I expect if I choose to do surgery?

Orthognathic Surgery is considered a major surgery that is generally safe and is done under general anaesthesia. The surgery typically requires a hospital stay of a few days and hospitalisation leave for 4 to 6 weeks for recovery.

After surgery, a splint may be secured to your upper teeth to guide your bite.

Your teeth will be tied together for a few weeks to ensure your bite is stable and to rest the jaws, and you will be placed on a liquid diet. Common side effects of surgery include facial swelling and reduced mouth opening. These tend to resolve within a few weeks.

	TREATMENT PLANNING Includes taking records and radiographs. Assessed jointly by your Orthodontist and Oral and Maxillofacial Surgeon. Decisions will involve how to best align your teeth and what surgery is most appropriate for you.
	PRE-SURGICAL ORTHODONTICS Many patients undergo pre-surgical orthodontic treatment with the goal of aligning their teeth to facilitate the optimal positioning of the jaw bones. This may take 9-18 months depending on several factors such as the patient’s condition, patient’s age, cooperation and compliance. During this phase, patients are typically seen once every 4-6 weeks.
	ORTHOGNATHIC SURGERY Surgery is planned and executed once the pre-surgical orthodontic phase is completed.
	POST-SURGICAL ORTHODONTICS Orthodontic treatment is continued after surgery to achieve the final alignment of the teeth and help retain them in their new position.