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Orthognathic Surgery – Jaw Correction Explained

Orthognathic surgery corrects jaw misalignments through surgical procedures. It improves chewing, speech, and facial appearance with long-lasting results.

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Orthognathic surgery corrects jaw misalignments through surgical procedures. It improves chewing, speech, and facial appearance with long-lasting results.

What is Orthognathic Surgery?

Orthognathic surgery, also known as corrective jaw surgery, is a specialty within oral and maxillofacial surgery that focuses on the surgical correction of jaw misalignments (dysgnathia). A jaw misalignment refers to a skeletal discrepancy of one or both jaws that goes beyond what can be corrected by orthodontic treatment (braces) alone. The procedure is performed collaboratively by oral and maxillofacial surgeons and orthodontists.

Causes and Indications

Jaw misalignments can arise from a variety of causes:

Genetic factors: Inherited conditions affecting jaw or craniofacial growth
Growth disturbances: Asymmetric or excessive bone growth during development
Trauma: Injuries to the jaw leading to structural changes
Cleft lip and palate: Congenital malformations affecting jaw structure

Surgery is indicated when patients experience functional problems such as difficulty chewing, swallowing disorders, snoring, obstructive sleep apnea, or temporomandibular joint (TMJ) issues that cannot be resolved by orthodontic treatment alone.

Common Types of Jaw Misalignment

Prognathism (underbite): The lower jaw protrudes too far forward
Retrognathia (overbite): The lower jaw is set too far back
Open bite: A gap remains between upper and lower front teeth when biting
Crossbite: Lateral misalignment of the dental arches
Facial asymmetry: Unequal growth of the left and right sides of the jaw

Diagnosis and Treatment Planning

Thorough diagnostic evaluation precedes any surgical procedure:

Clinical examination by both orthodontist and oral surgeon
Cephalometric X-rays and digital imaging for skeletal analysis
3D planning using cone-beam computed tomography (CBCT) and computer-aided surgical simulation
Dental model fabrication and surgical splint preparation

Pre-surgical orthodontic treatment is typically required for one to two years to align the teeth in preparation for surgery.

Surgical Procedures

Upper Jaw Surgery (Le Fort I Osteotomy)

The Le Fort I osteotomy involves separating the entire upper jaw (maxilla) from the rest of the facial skeleton and repositioning it in three dimensions -- forward, backward, upward, or downward -- as required by the treatment plan.

Lower Jaw Surgery (Sagittal Split Osteotomy)

The bilateral sagittal split osteotomy (BSSO), developed by Obwegeser and Dal Pont, is the standard procedure for correcting lower jaw misalignments. The mandible is divided on both sides and repositioned, then fixed in place with titanium screws or plates.

Chin Correction (Genioplasty)

A genioplasty may be performed in addition to jaw surgery to reposition the chin tip by cutting and moving the bone segment, optimizing the overall aesthetic result.

Bimaxillary Surgery

In cases of severe or combined jaw discrepancies, both the upper and lower jaws are operated on simultaneously in a bimaxillary procedure, achieving the best possible functional and aesthetic outcome.

Procedure and Recovery

Orthognathic surgery is performed under general anesthesia and typically requires a hospital stay of three to five days. A soft or liquid diet is necessary for several weeks following surgery. Facial swelling and temporary numbness are expected and gradually resolve over weeks to months. Post-surgical orthodontic treatment usually continues for an additional six to twelve months to finalize tooth alignment.

Risks and Complications

Temporary or permanent numbness due to nerve involvement
Swelling and bruising
Infection or impaired wound healing
Rarely: post-operative bleeding or hardware loosening
In rare cases: temporomandibular joint discomfort

Outcomes and Prognosis

Orthognathic surgery yields excellent functional and aesthetic results in the majority of cases. Patients frequently report significant improvements in chewing ability, speech clarity, and overall quality of life. With proper planning and surgical execution, outcomes are stable in the long term.

References

Proffit WR, White RP, Sarver DM: Contemporary Treatment of Dentofacial Deformity. Mosby/Elsevier, 2003.
Obwegeser HL: Orthognathic Surgery and a Tale of How Three Procedures Came to Be. Plast Reconstr Surg. 2007;120(5):1423-1432.
Miloro M et al.: Peterson's Principles of Oral and Maxillofacial Surgery. 3rd ed. PMPH USA, 2012.

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