Corrective Jaw Surgery
Corrective Jaw Surgery and Orthognathic Surgery
Corrective jaw surgery or orthognathic surgery refers to the surgery of the upper and/or lower jaw to correct bony asymmetry or deficiency or excess. It is a complex and complicated surgery and requires proper and careful planning on both the surgeon part and also the patient part.
Who needs corrective jaw surgery or orthognathic surgery ?
Corrective jaw surgery or orthognathic surgery is normally indicated for patients with a deficient jaw, jaw with excess growth or patients with asymmetrical jaws. To put it mildly, corrective jaw surgery or orthognathic surgery is indicated in patients who have an underlying skeletal or bony problem.
A deficient jaw is medically termed hypoplastic or retrognathic and for the maxilla or upper jaw, it is called maxillary hypoplasia. Mandibular hypoplasia is the term given to a deficient lower jaw.
An excess jaw is medically termed hyperplastic or prognathic and for the upper jaw, it is medically termed maxillary hyperplasia. Mandibular hyperplasia is the term given for an excess lower jaw.
What needs to be done prior to a corrective jaw surgery or orthognathic surgery?
Before corrective jaw surgery or orthognathic surgery can be performed, the patient will most often than not require orthodontic treatment or braces. This is to enable the teeth to be moved into a position that enables the final position of the jaw after surgery to be relatively stable. Henceforth the patient normally requires about 1-2 years of orthodontic treatment to “decompensate” his teeth for the corrective jaw surgery or orthognathic surgery . Tooth extraction may also need to be carried out.
My orthodontist tells me I am ready for orthognathic surgery or jaw surgery. What should I do before the surgical date?
The orthodontist and the oral surgeon works hand in hand and when you are ready for surgery, the orthodontist will inform the oral surgeon who will then fix an appointment so he can get the proper impressions of your teeth done and prepare study models for your corrective jaw surgery. He will also do a face bow record which translates your jaw position to an articulator and take a bite impression of your teeth. These procedures are to enable him to perform model surgery before he actually does it on you and also to fabricate surgical wafers or surgical templates which will help him put your jaw into position on the operating table.
What are the risks of corrective jaw surgery or orthognathic surgery ?
Nerve injury- The inferior alveolar nerve and the facial nerve are the nerves that may be affected. The lingual nerve or infraorbital nerve may also be involved but rarely as compared to the other two. The most commonly affected nerve is the inferior alveolar nerve which when damaged will cause numbness or paraesthesia to the lower lip and chin on the damaged side. The posterior teeth on the side may also lose sensation. The facial nerve may also be affected and cause facial weakness on the damaged side. Lingual nerve damage will bring about loss of sensation to one half of the tongue again on the damaged side and injury to the infraorbitla nerve will bring loss of sensation to the infraorbital region just below the eye.
Hemorrhage or Bleeding- There are major vessels in the site of surgery and damage to these vessels may bring about bleeding.
Unfavourable split- In unusual anatomies, the jaw may split or fracture in an unwanted position.
Mandibular dysfunction- Due to the pressure and manipulation of the jaws, the jaw joints may be traumatized and cause jaw joint pain also known as TMJ pain. Due to the new jaw position, TMJ disorders may also happen.
Damage to teeth- The adjacent teeth may be damaged due to their proximity to the surgical cuts and if so may need root canal treatment afterwards.
How should I prepare myself for the surgery?
Depending on the surgeon, he may want you to do an autologous blood transfusion or a homologous blood transfusion. In autologous blood transfusion, your own blood is taken one and two weeks before the surgery and stored to be returned back to you during or after the orthognathic surgery is done. You will be given iron tablets to take if you are doing an autologous transfusion. In homologous blood transfusion, blood from a donor will be transfused into you and there is no need for blood donation on your part. Receiving blood from a donor though carries its own set of risks such as transmission of diseases and blood transfusion reactions.
In some cases, both autologous and homologous transfusion may be indicated and needed.
Just prior to the surgery, you may need to be admitted according to the hospital regulations and protocol you are in and you will be asked to fast 8 hours before the surgery.
How is the corrective jaw surgery or orthognathic surgery carried out?
General anaesthesia is required for corrective jaw surgery. An anaesthesiologist will put you to sleep before the surgery commences. Once you are down, the surgeon will give local anaesthetic before he proceeds. He will then make a surgical incision inside your mouth and expose your jaw. During the surgery, your jaw or jaws will be fractured and repositioned into the desired and planned position using the surgical wafers. The jaw or jaws will be fixed into position using mini bone plates and secured with plating screws. He will the close up the incision with resorbable or non resorbable sutures or a combination of both. Drains to prevent blood and fluid accumulation will also be placed. The jaws may also be tied up together using rubber elastics.
Depending on the surgeon, there may be incisions made on the facial region.
The whole procedure takes about 3 to as much as 6 hours. In some cases it might even stretch longer.
What happens after the corrective jaw surgery or orthognathic surgery is completed?
After the corrective jaw surgery or orthognathic surgery is completed, the patient will be woken up from general anaesthesia and wheeled to the recovery for observation. Once his parameters are stable and he or she is responsive, he or she will be brought to either a high dependency ward or a general ward depending on his condition. Rarely does the patient need to go to an intensive care ward like the intensive care unit.
What are the things to look out for after a corrective jaw surgery or orthognathic surgery?
After corrective jaw surgery or orthognathic surgery , the teeth may be tied together and this may be disconcerting to some patients. This is necessary to stabilize the new jaw positions. The patient may only take liquid diet via a syringe and loss of weight postoperatively is not uncommon.
Painkillers, antibiotics, steroids and an antiseptic mouthwash will be prescribed to control pain, infection and swelling.
Some patients will feel a weight of depression set upon them. This is temporary and with motivation and support from friends and family members will be overcome easily.
Do also take note that the effects of the corrective jaw surgery may not be permanent especially in severe jaw abnormalities cases. There may be some slight relapse to total relapse in rare cases where the jaw goes back to its original position before the surgery.
When will I be discharged?
The patient is normally discharged 3 days to a week after the surgery. In some cases discharge is earlier. Rest is much advised without any vigorous activities and an appointment will be fixed the week after to see the oral surgeon for a review.
This article is written and contributed by an oral surgeon and any duplication, reproduction or plagiarism in any form is strictly prohibited without the author’s permission.