Definition and Overview

Technically known as orthognathic surgery, jaw surgery can refer to a number of corrective and aesthetic treatment procedures performed to correct issues in the structure of the face and jaw caused by conditions involving dental, orthodontic, and skeletal problems. In modern medicine, jaw surgery can also be performed to improve functions hampered by cleft palates, sleep apnoea, TMJ conditions, and malocclusion, as well as other related conditions.

As a surgical practice, orthognathic surgery can involve various techniques and approaches, such as cutting and realigning bones and putting in plates and/or screws to hold the new position in place. Most of the surgical procedures in this category are designed to correct the position and function of the jaws.

Modern jaw surgery is usually performed inside the mouth to minimize the risk of unsightly facial scarring as well as the recovery period. Jaw surgeons often make incisions directly into the jawbone to correct the position and alignment of mandibular structures. Additional medical grade materials, such as fillers, implants, screws, and plates, can be used to secure the jawbone into the new position, which could function and look better after the procedure.

Some procedures involve the use of bone harvested from the patient's own ribs, legs, or hips, or processed bone implants harvested from animals. Many surgeons, however, recommend the use of artificial materials to minimize the risk of infection, tissue rejection, and other such complications after the surgery.

In cases where the dental structures are affected by jaw problems, doctors typically refer the patient to an orthodontist first, who will often prescribe and install braces to correct teeth alignment and position before the orthognathic surgeon can proceed with aligning the jaw.

Types of jaw surgeries

  • Upper jaw surgery or maxillary osteotomy. This is often recommended for patients with crossbite, who has not enough or too much teeth showing, an open bite, or a significantly receded upper jaw.
  • Lower jaw surgery or mandibular osteotomy. This procedure is recommended for patients suffering from a significantly receded lower jaw.
  • Chin surgery. Also known as a genioplasty, this procedure is recommended for patients with a severely receded lower jaw, which could impede the normal functions of the jaw, including eating and talking.

Who should undergo and expected results

Jaw surgery is highly recommended for patients whose jaw conditions are affecting their day-to-day life. When the jaw is properly aligned through surgery, the patient will experience a number of benefits. Chewing food and biting will be much easier, with the manner of the chewing greatly improved. Patients can also enjoy minimized wear on the teeth, preserving dental structures and protecting them from tear and eventually from breaking down. There are also aesthetic benefits, including a more balanced facial appearance, and improved facial smile as the patient will be showing an adequate amount of gums (or prevent the lips from hooding the teeth). Jaw surgery can also repair the functional and aesthetic damage caused by illness, congenital defects, and injury.

Patients who are suffering from TMJ disorders also report relief from the symptoms of their conditions, allowing for a more enjoyable and functional life. Sufferers from sleep apnoea also report reduced symptoms.

How the procedure works

The procedure should be performed in a hospital, and will require the patient to stay for one to two days before being discharged.

For upper jaw surgery, the surgeon will cut the bone under the eye sockets and just above the teeth to move the entire upper jaw, including the upper teeth and the roof of the mouth. The surgeon will then move the upper jaw and the teeth forward until they are slotted in the right position, where they fit perfectly with the lower teeth and jaw. After realigning the teeth and the upper and lower jaw, the surgeon will put in plates and screws to hold the new position of the upper jawbone. Over time, the material of these plates and screws will integrate into the patient's bone.

In a lower jaw surgical procedure, the surgeon will cut behind the molars, with the incision running lengthwise down the bone. This is done to make the front part of the jaw move as a single unit, making repositioning easier. The jaw will be adjusted to the right position, and held together by biocompatible screws until the jaw heals and recovers.

In a genioplasty, the surgeon will cut into the chin bone and realign it into a proper, functional position. The chin can also be restructured by using implants or bone transplants.

Surgical procedures on the jaw typically involve the use of general anaesthetic, as well as a nasal tube (for intubation) instead of an oral tube, which is commonly used for other types of surgery. A nasal tube allows the surgical team to wire the teeth together during the procedure. Most of the time, the skin is not cut during jaw surgeries.

Complete recovery will take around three to six weeks, with the patient returning regularly for check-ups to ensure that no complications or infections have occurred. Visits to the orthodontist are also ideal after the patient has healed from the jaw surgery to finish the alignment of the teeth.

Possible risks and complications

Like any surgical procedure, jaw surgery also has known side effects, complications, and risks. There is always the risk of excessive bleeding, since the incision is usually made inside the mouth, where proper dressing cannot be made. Swelling and discomfort are also common complaints of patients who have undergone the surgery.

Infections are quite rare, but when they do occur, they are relatively easy to treat and will go away almost immediately. However, more serious infections should be treated immediately to eliminate the need for additional surgery.

Facial nerves, as well as the nerves inside the bone, can suffer from bruising, which can lead to numbness in certain facial areas. Typically, the numbness occurs on the upper lip and around the nose.

References:

  • Herrmann HJ. Wilderness dentistry and management of facial injuries. In: Auerbach PS, ed. Wilderness Medicine. 5th ed. Philadelphia, Pa.: Elsevier Mosby; 2007:chap 26.
  • Kellman RM. Maxillofacial trauma. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa.: Elsevier Mosby; 2010:chap 23.
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