Orthognathic Surgery: A Guide to Jaw Surgery

Orthognathic Surgery: A Guide to Jaw Surgery
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Orthognathic Surgery: A Guide to Jaw SurgeryClinical Content Reviewed by Dr. Jay Khorsandi, DDS
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Table of Contents

  1. What Is Orthognathic Surgery
  2. Reasons for Undergoing Jaw Surgery
  3. Reasons for Orthognathic Surgery
  4. Types of Orthognathic Surgeries
  5. Post-Surgery Recovery Time
  6. Costs of Orthognathic Surgery
  7. References

Orthognathic surgery corrects jaw misalignments, which can cause a range of problems, including grinding or clenching teeth, sleep apnea, trouble biting and chewing, headaches, and TMJ pain.

People who have overbites, crossbites, underbites, or open bites may benefit from this procedure to realign their smiles and improve facial shape.

What Is Orthognathic Surgery?

Your top teeth are in your upper jaw, and your bottom teeth are in your lower jaw. If you have good dental alignment, your top teeth will rest slightly in front of your bottom teeth, while your back teeth fit together.

However, many people do not have such excellent dental alignment, and one common cause is a crooked jaw. Orthognathic surgery is designed to treat some of the most severe jaw misalignments so your bite is healthy.

There are many reasons for orthognathic surgery, including reducing bruxism (grinding and clenching of teeth), stopping sleep apnea, and reducing temporomandibular joint (TMJ) disorders. Severe overbites, open bites, or underbites might be a sign of jaw misalignment. These can cause trouble speaking, biting and chewing, and even breathing.

In extreme cases, orthognathic surgery is considered medically necessary, but your dental insurance may consider it cosmetic. Work with your dentist to determine whether this is the best course of action for your long-term health.

Why You Might Undergo Jaw Surgery

Your dentist may discuss a diagnosed “bad bite” with you, which means you have misalignment in your teeth and jaw that can cause oral health problems. While misaligned teeth can be adjusted with braces, clear plastic aligners, and/or retainers, some additional problems may be caused by your upper and lower jaws not fitting together properly. This might be due to one jaw being naturally misaligned because of genetics, a birth defect, or a traumatic injury.

If your dentist recommends jaw surgery, they will refer you to a specialist. This specialist is an oral and maxillofacial surgeon. You can then discuss the full procedure, including recovery time and financial cost.

Although children may receive orthodontic treatments to adjust the shape or alignment of the jaw, it is unlikely that a young child will undergo jaw surgery. Typically, orthognathic surgery is recommended in people who are no longer growing. In adolescents who need orthognathic surgery, this is at least 14 to 16 years old for girls, and 17 to 21 years old for boys.

It is estimated that full oral and maxillofacial treatment will take up to three years to complete, but this is because the step before jaw surgery is typically orthodontic treatment to realign your teeth. This can take up to 18 months. Once your teeth are in proper alignment, it will be easier for your surgeon to determine how your jaw should fit together.

Reasons for Orthognathic Surgery

Some of the potential reasons you might choose to have orthognathic surgery include treating or reducing:

  • TMJ pain (chronic pain in the jaw and joint near the ear).
  • Headaches or migraines associated with jaw clenching or teeth grinding.
  • Chronic mouth breathing, leading to dry mouth or throat problems.
  • Facial injuries, leading to a misaligned jaw.
  • Poor jaw formation, leading to facial irregularities.
  • Bruxism or sleep apnea.
  • Trouble biting, chewing, and swallowing.
  • Difficulty breathing, especially trouble breathing with the mouth closed without strain.
  • Birth defects of the face or jaw.
  • Receding lower chin or jaw.
  • Tumors in the jaw or mouth that have caused malformations.
Five percent of the adult population for whom braces or other orthodontic treatments are not adequate turn to orthognathic surgery as a last result.

Types of Orthognathic Surgeries

There are five types of jaw surgery.

Maxillary Osteotomy (upper jaw surgery)
This corrects a receded upper jaw. The surgeon makes an incision in the gums above the teeth in the upper jaw, breaks the jawbone, and moves it into proper alignment. The jaw is then fixed into place with titanium plates and screws as needed. This can correct overbites, crossbites, and open bites in adults.
Mandibular Osteotomy (lower jaw surgery)
This procedure corrects a receded lower jaw. During the procedure, your surgeon will adjust the lower jaw forward or backward, depending on your bite alignment. Typically, your jaw will be adjusted forward since this operation treats underbites best.
Genioplasty
This cosmetic procedure can improve the appearance of the chin in people who have severely receded lower jaws. It is common for genioplasties to be part of lower jaw surgery, so your surgery may perform this additional procedure after the mandibular osteotomy.
Arthroplasty
This is one of two procedures designed to treat TMJ problems. During this procedure, your surgeon will create a “keyhole” in front of the ear and send a scope into this hole so they can remove scar tissue around the jaw. This helps to loosen the jaw muscles and relieve chronic pain.
Arthrocentesis
This is another procedure to treat TMJ ailments. During this procedure, your surgeon will reposition your jaw, realign the cartilage disc, and administer steroid drugs into this joint to reduce inflammation and relieve pain. They will then return the cartilage joint to the correct position and remove any debris in the joint area with a sterile fluid wash.

Post-Surgery Recovery Time

Orthognathic surgery is an operation that makes dramatic changes to your face and mouth, so the recovery time is considerable. While many people who undergo this procedure return home the day after, you are likely to spend at least one night in the hospital, perhaps two. Once you return home, you can expect six to eight weeks of recovery time.

In the first two to three weeks, you are likely to experience swelling, discomfort, and soreness. This is normal, and you may receive a prescription for painkillers to help manage these problems. You should also experience a consistent reduction in swelling and pain over these days. If you do not or any symptoms get worse, contact your dental surgeon immediately.

It is important to follow all post-surgery advice, including getting plenty of sleep and drinking enough water. During these six to eight weeks, you will be on a liquid diet, as your jaw is too delicate to chew. These are common foods you can eat during this time:

  • Soups
  • Smoothies
  • Ice cream
  • Mashed potatoes

Your dental surgeon will let you know when you can change your diet and resume some activities. These recommendations will begin between one and three weeks after your surgery. You may not experience full recovery for up to a year, but most healing will occur within two to four months after the procedure.

Costs of Orthognathic Surgery

Most dental insurance companies in the United States will cover orthognathic surgery if it is deemed medically necessary. This means you have to meet certain criteria, or your jaw surgery will be considered cosmetic. Before insurance, the cost can be $20,000 to $40,000; in some cases, it may cost upward of $50,000.

If you have been recommended for orthognathic surgery, be sure to discuss this diagnosis in detail with your dentist. While it may bring about cosmetic improvement, it may not be medically necessary. If it’s not, orthodontic treatment may give you some cosmetic improvement, and it can improve your oral health. If you do medically need orthognathic surgery, it is important to follow your surgeon’s advice for best results.

References

What Is Jaw (Orthognathic) Surgery? (June 2021). New Mouth. Date fetched: June 21, 2021.

Surgical Treatment to Correct a Bad Bite: Frequently Asked Questions. (November 2018). University of Iowa Hospitals and Clinics. Date fetched: June 21, 2021.

What Does an Oral and Maxillofacial Surgeon Do? Colgate. Date fetched: June 21, 2021.

Jaw Surgery (Orthognathic Treatment). Nottingham University Hospitals, National Health Service (NHS). Date fetched: June 21, 2021.

Corrective Jaw Surgery. (January 2015). Oral and Maxillofacial Surgeons (MYOMS.org). Date fetched: June 21, 2021.

Facial Aesthetics and Orthognathic Surgery. (May 2014). PMFA Journal . Date fetched: June 21, 2021.

Orthognathic Surgery. (October 2020). Cigna. Date fetched: June 21, 2021.

Disclaimer: This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to serve as dental or other professional health advice and is not intended to be used for diagnosis or treatment of any condition or symptom. You should consult a dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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