Definition & Overview
A dentofacial osteotomy, also known as an orthognathic surgery, is a corrective jaw surgery performed to correct dentofacial deformities. During the procedure, the surgeon cuts, moves, and realigns the bones of the jaw to achieve an improved facial and natural-looking appearance. It can be performed on either the upper or lower jaw, and used to resolve a wide range of maxillofacial problems.
Who Should Undergo and Expected Results
Dentofacial osteotomy is recommended for patients who suffer from dentofacial deformities, such as:
- Maxillary prognathisms
- Mandibular prognathisms
- Mandibular retrusion
Dentofacial deformities can make certain actions challenging for patients, and can also cause symptoms, such as:
- Open bites
- Pain related to temporomandibular joint disorder
- Excessive wear and tear of teeth
- Difficulty swallowing
- Difficulty chewing
- Receding chin
- Jaw pain
Dentofacial osteotomies have been in use since the 1940s. Due to the continuous development and improvement of the techniques used in this procedure, it has significantly evolved and is proven to be highly effective in correcting extreme jaw deformities. The procedure, which is sometimes combined with dental extractions, is also expected to relieve pain related to jaw disorders, including the very common temporomandibular joint disorder or TMJ.
In the past, an osteotomy was considered as a major surgery performed under general anaesthesia and full sedation, which requires patients to stay in the hospital for up to 2-3 days after the surgery. Nowadays, it is performed under local anaesthesia supported by intravenous sedation, essentially making it an outpatient procedure.
Aside from correcting jaw deformities and relieving painful jaw symptoms, patients who undergo the procedure can also expect minimal pain during surgery, no hospitalisation, and a short recovery period.
How is the Procedure Performed?
Dentofacial osteotomies are performed by a maxillofacial surgeon, usually on an outpatient basis. The specific manner in which it is performed differs depending on the specific problem at hand.
A maxilla osteotomy is used to resolve upper jaw deformities, such as an open bite. During the procedure, the surgeon makes an incision below the patient’s eye sockets to move and align the entire upper jaw correctly into its ideal position. The jaw is then stabilised using titanium screws.
A mandible osteotomy, on the other hand, is used to correct deformities affecting the lower jaw. During the procedure, the surgeon makes an incision behind and in between the first and second molars. The front jaw is then detached and the mandible is placed into the desired position. The jaw is secured with stabilisation screws, which will be removed once the patient is fully healed.
A bilateral sagittal split osteotomy is another type of dentofacial osteotomy and is, in fact, an indispensable tool for correcting dentofacial abnormalities. This procedure takes about two hours, with the patient under general anaesthesia. During the procedure, the surgeon makes a horizontal incision on the inner part of the ramus mandible going to the anterior portion of the ascending ramus, then continues it towards the descending ramus all the way to the lateral border of the mandible. The surgeon follows this up with a vertical cut along the body of the mandible towards the inferior border of the mandible. A chisel is then used to carefully split the mandible in half, after which it can then be moved forwards, backwards, or sideways. As with other types of osteotomies, the jaw is then stabilised with screws and wired shut for around 4 to 5 weeks.
Recovery following a dentofacial osteotomy may take around 2 to 6 weeks, but the patient’s bone will continue to heal gradually over a period of 2 to 4 months. The jaw may be immobilised for up to 1 month after the procedure, and may continue to heal for 2 to 3 months. Pain medications and antibiotics are typically prescribed to ensure patient comfort and prevent the risk of infection.
Possible Risks and Complications
Risks and potential complications linked with an osteotomy include:
- Nerve damage
- Bacterial infection - Studies show that the risk of infection is significantly higher among patients who undergo an osteotomy and a third molar extraction at the same time.
In general, however, the rate of complications related to the procedure has decreased significantly since more advanced surgical techniques were introduced.
Mills PB. “The orthodontist’s role in surgical correction of dentofacial deformities.” American Journal of Orthodontics. http://www.sciencedirect.com/science/article/pii/0002941669902772
Nanda R., Sugawara J. “Mandibular adaptations following total maxillary osteotomy in adolescent monkeys.” American Journal of Orthodontics and Dentofacial Orthopedics. http://www.ajodo.org/article/S0002-9416(83)90247-6/abstract