Orthognathic and Reconstructive Jaw And Facial Surgery
What is Orthognathic Surgery?
When the jaws do not develop properly, correction of bite problems cannot be effectively treated with orthodontics alone. Orthognathic surgery is subsequently necessary when upper and/or lower jaw growth does not allow the teeth to properly fit together for function and for esthetics.
Orthognathic actually means straight jaws; and this is what we accomplish with this form of facial surgery. The teeth are initially straightened and placed normally within each jaw with orthodontics, and orthognathic surgery subsequently repositions the mal-aligned jaws. This not only improves facial appearance, but also ensures that the teeth meet correctly and function properly. In some cases such as obstructive sleep apnea, orthognathic surgery is performed to improve breathing during sleep.
Who Can Benefit from Orthognathic Surgery?
People who can benefit from orthognathic surgery include those with an improper bites or jaws that are positioned incorrectly. Jaw growth is a gradual process and, in some instances, the upper and lower jaws may grow at different rates. The result can be a host of problems that can affect chewing function, speech, long-term oral health, and appearance. Injury to the jaws and birth defects can also affect their alignment. While orthodontics alone can correct bite problems if only the teeth are involved, orthognathic surgery may be required if the jaws also need repositioning.
Orthognathic surgery is needed when jaws do not meet correctly and/or teeth do not seem to fit with in the jaws. Teeth are straightened with orthodontics, and corrective jaw surgery repositions misaligned jaws. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly.
Common Problems Associated with Jaw Deformities:
- Difficulty in chewing, biting or swallowing
- Anterior and posterior open bites (teeth do not touch)
- Excessive over-jets and over-bites
- Recessive or protruding lower jaw and chin
- Crooked facial structures and jaws
- Speech problems
- Chronic jaw or TMJ pain
- Breathing problems and associated gum problems
- Snoring, or obstructive breathing during sleep (obstructive sleep apnea)
Any of these problems can exist at birth (congenital deformities), or may be acquired after birth as a result of hereditary or environmental influences (developmental deformities), or as a result of trauma to the face. Before any treatment begins, a consultation is necessary in order to perform a complete examination and obtain appropriate radiographs. During the pre-treatment consultation, please feel free to ask any questions you may have regarding your treatment. When you are fully informed about all aspects of your care, you and your dental team will make the decision to proceed with treatment together.
Technology and Orthognathic Surgery
Modern treatment planning frequently uses computer techniques and three-dimensional models to show you exactly how your surgery will be approached. Using comprehensive facial radiographs and, in some cases, computer video imaging, we can show you how your bite will be improved and even give you an idea of how you will look after surgery. This helps you understand the surgical process and the extent of the treatment prescribed. It also helps you see the benefits of orthognathic surgery in your specific case.
Advancements in surgical management have now made orthognathic surgery quite routine. Extended intermaxillary fixation (wiring teeth together) is no longer necessary due to the use of rigid internal fixation (titanium mini-plates and screws or even dissolving plates and screws). In addition, the stability of these procedures has been greatly improved with the use of rigid internal fixation, as has the overall comfort of the patient. Finally, the development of Distraction Osteogenesis allows surgeons to treat severe deformities by slowly repositioning jaws over longer distances, simultaneously creating bone.
If you are a candidate for Corrective Jaw Surgery, Drs. Elias, Stephens or Verratti will work closely with your dentist and orthodontist during your treatment. The actual surgery can move your teeth and jaws into a new position that results in a more attractive, functional and healthy dental-facial relationship.
General Procedural Overview
Orthognathic diagnosis frequently begins in the office of the general dental practitioner and/or the orthodontist. Recognition of skeletal bite deformities can easily be done by a thorough clinical examination but the diagnosis frequently requires other information including plain radiographs (x-rays), study models, and 3-D computer axial tomographic (CAT scan) reconstruction. The entire face is evaluated in order to achieve the most balanced and esthetic outcome. Most importantly, the patient’s desires for treatment are understood in order to more accurately provide for the patient’s desired outcome.
Orthodontic alignment is completed in most cases prior to surgical correction. When your orthodontist feels that proper alignment has been achieved, your surgeon will then re-analyze your case in preparation for surgery. After surgery is completed, final orthodontic alignment is completed. The time required for this phase is variable but frequently is under six months.
Most orthognathic procedures are performed in the hospital operating room but frequently require only a single overnight stay. More and more procedures are now being performed on an outpatient basis with patients returning home the same day. These orthognathic procedures can frequently be performed in our in-office fully equipped operating suite and adjacent surgical facilities.
Depending upon the procedures performed, most patients resume normal activities in 7 – 14 days, with the possible exception of a modified diet. As stated above, intermaxillary fixation (wiring teeth together) is generally no longer necessary due to the use of rigid internal fixation (titanium mini-plates and screws or dissolving plates and screws). Diet is advanced from liquids to soft mechanical foods and finally to regular foods over the 6-8 week post-surgical phase. Orthodontics can frequently be resume 1 – 2 weeks after surgery.
Drs. Elias, Stephens and Verratti are highly trained and experienced in orthognathic surgery and has routinely perform these procedures for 34 years. Adjunctive cosmetic procedures can also be performed in order to provide optimal facial esthetics including:
- Genioplasty (bony or implant reconstruction of the chin)
- Zygomatic (cheek bone) and infraorbital rim reduction or augmentation
- Facial augmentation (facial esthetic implants)
- Autogenous bone grafting with graft harvest from the ilium, cranium, and/or facial bones
- Cleft lip and palate revision / alveolar cleft grafting and closure
- Distraction Osteogenesis (special controlled movement of facial bones over time)
- BOTOX injections to reduce facial wrinkles
Surgical care is usually provided through several area hospitals including Huntington Memorial Hospital and Arcadia Methodist Hospital. Some procedures, which require no overnight stay can be performed in our in-office fully equipped operating suite and adjacent surgical facilities. Orthognathic surgery is frequently a covered benefit through medical insurance but pre- authorization is usually recommended. We are not contracted as PPO providers for most medical insurance but some benefits may still be available.
Drs. Elias, Stephens and Verratti‘s surgical training and experience is heavily weighted in orthognathic and reconstructive jaw and facial surgery and we feel very comfortable offering these procedures to our patients. In fact, we are frequently called upon by other surgeons, to consult or assist in the care of their orthognathic patients.
When indicated, orthognathic surgery can drastically improve your quality of life giving you a more attractive, functional, and healthy dento-facial relationship