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Bimaxillary Osteotomy: Procedure and Outcomes

Bimaxillary osteotomy is an oral and maxillofacial surgical procedure in which both the upper and lower jaws are repositioned simultaneously to correct severe skeletal malocclusions.

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Things worth knowing about "Bimaxillary Osteotomy"

Bimaxillary osteotomy is an oral and maxillofacial surgical procedure in which both the upper and lower jaws are repositioned simultaneously to correct severe skeletal malocclusions.

What is Bimaxillary Osteotomy?

Bimaxillary osteotomy is a complex surgical procedure belonging to the field of orthognathic surgery, in which both the upper jaw (maxilla) and the lower jaw (mandible) are surgically cut and repositioned at the same time. The term "bimaxillary" refers to both jaws being treated simultaneously. The procedure is performed under general anesthesia and is planned in close collaboration between oral and maxillofacial surgeons and orthodontists.

Indications – When is the Procedure Performed?

Bimaxillary osteotomy is indicated when significant jaw discrepancies cannot be corrected by orthodontic treatment alone. Common indications include:

Prognathism: The lower jaw protrudes significantly beyond the upper jaw
Retrognathia: The lower jaw is set too far back
Open bite: The upper and lower front teeth do not meet when biting
Crossbite: Lateral or transverse misalignment of the jaws
Facial asymmetry: Skeletal imbalance of the facial structure
Obstructive sleep apnea: In selected cases to enlarge the airway
Functional impairments: Difficulties with chewing, speaking, or temporomandibular joint pain

Preoperative Planning and Preparation

The surgical procedure is typically preceded by one to two years of orthodontic preparation using braces to align the teeth within their respective jaws. The surgical planning process involves:

X-rays (panoramic radiograph, lateral cephalogram)
3D digital planning and virtual surgical simulation
Photographic records and dental models
Fabrication of individualized occlusal splints

Modern planning frequently uses computer-assisted 3D simulation and 3D-printed surgical guides to predict the postoperative outcome and ensure precise repositioning of the jaws.

Surgical Technique

The procedure is performed under general anesthesia and typically lasts between 3 and 6 hours. All incisions are made inside the mouth, so no visible scars appear on the face.

Upper Jaw (Le Fort I Osteotomy)

The upper jaw is surgically separated using the Le Fort I technique, in which a horizontal cut is made above the tooth roots. The maxilla can then be moved forward, backward, upward, downward, or rotated to the desired position. It is secured with titanium plates and screws.

Lower Jaw (Bilateral Sagittal Split Osteotomy)

The lower jaw is commonly treated with a bilateral sagittal split osteotomy (BSSO), also known as the Obwegeser-Dal Pont technique. The ramus of the mandible is split longitudinally, allowing the tooth-bearing portion to be advanced, set back, or rotated. Fixation is achieved with titanium hardware.

Preoperatively fabricated occlusal splints guide the jaws into the planned bite relationship during and after repositioning.

Postoperative Care and Recovery

Patients typically remain in hospital for 3 to 5 days following surgery. Recovery involves:

Soft or liquid diet for several weeks
Regular follow-up appointments with the surgeon and orthodontist
Swelling management through cooling and anti-inflammatory medication
Physical therapy if temporomandibular joint issues arise
Continued orthodontic treatment for final bite refinement

Complete bony healing takes approximately 6 to 12 months. Temporary numbness in the lips, cheeks, or chin is common and resolves in most patients within months to one year.

Risks and Complications

As with any surgical procedure, bimaxillary osteotomy carries certain risks:

Nerve injury: Temporary or, rarely, permanent numbness due to involvement of the inferior alveolar or infraorbital nerve
Bleeding and postoperative hemorrhage
Infection at the surgical site
Bone resorption or impaired bone healing
Relapse: Partial return of the jaw to its original position
Temporomandibular joint changes
General risks associated with general anesthesia

Outcomes and Long-Term Prognosis

Bimaxillary osteotomy is considered a highly effective procedure with stable long-term results. Studies consistently report high patient satisfaction rates regarding both function (chewing, speaking, breathing) and facial aesthetics. Close collaboration between oral and maxillofacial surgeons, orthodontists, and other relevant specialists is essential to achieving the best possible outcome.

References

Proffit WR, White RP, Sarver DM. Contemporary Treatment of Dentofacial Deformity. Mosby, 2003.
Obwegeser HL. Surgical correction of small or retrodisplaced maxillae. Plastic and Reconstructive Surgery, 1969.
Landes CA et al. Orthognathic surgery in the mandible: a review of the bilateral sagittal split osteotomy. Journal of Oral and Maxillofacial Surgery, 2009.

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