Orthognathic Surgery

Patients who suffer from an abnormal growth or development of the jaws have bad bites which affect their ability to chew, swallow and speak. Surgery to correct a malaligned jaw is called orthognathic surgery. Orthognathic surgery means surgery of the jaw bones. This surgery is necessary to properly align the maxilla (upper jaw) and/or the mandible (lower jaw) to the other facial bones and base of the skull. Proper alignment helps to ensure long term success of the orthodontics, protects the teeth and supporting structures, improves function of the jaw and also decreases the potential for overloading forces on the temporomandibular joint and facial muscles.

Orthognathic surgery has become very common as patients have discovered the benefits of jaw alignment as it pertains to their ability to chew and function. In addition, orthodontists realize the advantage of orthognathic surgery from a stability standpoint. Orthodontics is much more stable if any jaw malalignment can be corrected. Correcting the position of the bones allows the orthodontist to place the teeth in an ideal alignment. Ideal alignment insures proper forces on the teeth and helps to eliminate orthodontic relapse. Additionally, alignment of the jaws will many times improve a patient's esthetics. For these reasons, orthognathic surgery is beneficial. Advances in orthognathic surgery have greatly reduced complications. Hospital stays have been reduced to overnight admissions. All surgery is performed inside the mouth without scarring and bone plating techniques have eliminated the need for the jaws to be wired together after the surgical procedure.

Preparing for Surgery

To help direct the jaws to their proper position in relation to the other facial bones, the oral surgeon takes models of the patient's teeth and places them on an instrument called an articulator. The articulator simulates the position of the jaws to the base of the skull and allows the surgeon to perform the surgical procedure on the mounted casts prior to performing it on the patient. After simulating the surgery on the mounted plaster casts, the oral surgeon fabricates plastic templates which guide the teeth to their proper position to the rest of the facial bones . The plastic template is placed over the upper teeth at the time of surgery. It is wired into the orthodontic appliances. The lower jaw is repositioned to fit into the plastic template. Additionally, the template is used post-operatively to verify that the jaws do not move from their desired position. The surgical template is very thin and does not interfere with speech or diet.

After the surgery, 7-10 days of convalescence is necessary. Mild discomfort is reported by most patients, but strong pain medicine is uncommonly required. Patients experience swelling during this 7-10 day convalescence. Patients may, however, return to all activities post-operatively, including school and/or work as soon as they feel capable. As mentioned earlier, this usually happens 7-10 days after the surgical procedure.

Risks

As with other forms of surgery, there are potential complications with jaw reconstruction:

The surgery will be done in an operating room and will require a general anesthetic. There can be complications related to the anesthetic, however, serious complications are rare. The patient must weigh the benefits of this surgery against that remote chance of an anesthetic problem.
Occasionally, it is necessary to give a transfusion to the patient during the surgery. The potential for this is low. Screening techniques for blood transfusions have greatly increased the margin of safety for transfused blood products. Consequently, we no longer feel it is necessary for the patient to reserve their own blood through an autologous blood transfusion prior to most orthognathic surgery. Autologous blood transfusion is still recommended for those patients undergoing complicated cases involving both the upper and lower jaw.
Teeth ad~jacent to the bone cuts can be damaged and may require dental treatment or extraction. This complication is very remote. Surgery is carefully designed to avoid problems such as these.
If the lower jaw is operated on, almost all patients will encounter a relatively long term numbness of the lower lip, chin and gums. This is not a paralysis and the lip is capable of functioning in a normal fashion. Numbness will last several months. The majority of patients regain most if not all of the feeling to their lower lip and chin. Numbness to the tongue has been reported with lower jaw surgery. This is an uncommon complication.
When the upper jaw is operated on the cheeks and upper lip as well as the roof of the mouth will be numb. This numbness lasts for several months but is universally temporary in nature.
If the position of the jaw is not acceptable after the surgery it may be necessary to repeat the operation and reset the jaw bones. Once again, the surgery is carefully designed to avoid this type of complication. With the use of pins and bone plates to secure the bones in a more rigid position, this complication has become less and less frequent.
Growth of the jaw bone after surgery can result in failure of the operation requiring further surgery. This is an uncommon problem. Jaw surgery is timed to occur after jaw growth is completed.
Infection can occur after surgery. You will be placed on an antibiotic to minimize this possibility.
Orthognathic surgery will sometimes alter the appearance of the patient. This change is carefully planned to be a positive one. Computer video imaging has greatly assisted the oral surgeon in predicting the post-operative esthetic result from orthognathic surgery. The video imaging software package available from Orthovisions Technologies has excellent predictability. All patients are encouraged to examine a computer video imaging prediction of their upcoming orthognathic surgery.
When the upper jaw is operated upon it is possible to have problems with the sinuses and/or nasal septum after the surgery. The surgery, once again, is designed to avoid these problems. If they should occur, further treatment may be necessary.
Jaw surgery has sometimes been recommended to aid in the treatment of temporomandibular joint problems. Although it is true that jaw deformities can aggravate temporomandibular joint problems and that patients with bad bites tend to overload their temporomandibular joints, there is no evidence to indicate that orthognathic surgery can correct a jaw joint intra-capsular derangement. Orthognathic surgery is not performed to correct temporomandibular joint (TMJ) problems. Some patients report an alleviation of their TMJ symptoms after orthognathic surgery. This is most likely caused by a decrease in clenching and grinding by the patient after their bite has been corrected. In rare instances joints which were pain free prior to surgery can become painful after surgery. This problem might require additional dental, orthodontic or surgical treatment to resolve. Once again, it has been our experience that patients with TMJ symptoms pre-operatively have less TMJ symptoms postoperatively.

INSURANCE

Orthognathic surgery is covered under many medical insurance contracts. Some insurance contracts limit the coverage to a percentage of the surgical fee. Others have flat payment schedules. We will pre-determine orthognathic surgery with your insurance carrier and submit all necessary information to determine medical necessity. If the insurance carrier denies coverage, an appeal can be made in some cases. As an added service to you, Dr. Lee has an orthognathic surgery coordinator to help you with questions concerning your surgery and financial obligations. We offer this because insurance carriers are becoming harder and harder to deal with placing greater responsibility on the patient to determine coverage, obtain second opinions, and pre-authorize their hospital admission.

More about insurance

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