Orthognathic surgery


Introduction

Orthognathic surgery corrects the maxillary bones deformities that involve facial deformity and a problem of dental occlusion.
 
Correction of deformities in the maxilla, jaw or chin implies a functional treatment of dental occlusion, along with a facial aesthetic approach and facial harmony.

Related to correcting jaws and facial skeleton, facial cosmetic surgery procedures may be carried out in collaboration with the Facial Cosmetic Surgery Unit of Clinica Planas leaded by Dr. Jorge Planas.

Orthognathic surgery is the one that corrects problems of skeleton and teeth.

Orthognathic surgery performs osteotomies in maxillary bones and/or jaw by correcting their position and achieving a perfect dental occlusion as well as harmonious facial proportions for each patient.

In order to perform orthognathic surgery is necessary to have a diagnosis and an accurate planning. Today, we carry out a virtual planning with three-dimensional imaging systems, in which changes in the maxilla may be planned and the final treatment evaluated. 

Indications

People who could potentially benefit from orthognathic surgery include those with an improper bite and those with discrepancies between the jawbones. The growth of the jaw takes place gradually and in some cases the bones grow at different rates. Occasionally this leaves a difference between the bones that causes an incorrect bite and disproportion in the face. This can result in problems with chewing, speech and long-term facial and oral health.

While orthodontics can fix problems if they are limited to the teeth, orthognathic surgery will be required if the jawbones also need to change position. The following symptoms may indicate the need for orthognathic surgery:

Difficulty chewing food
Difficulty swallowing
Problems with speech
Chronic jaw pain
Open bite (space between upper and lower teeth when the mouth is closed).
Facial asymmetry
Facial injury or birth defects
Small or receding chin
Inability to close lips effortlessly
Difficulty breathing with dry mouth
Sleep apnoea (sleep problems such as snoring, difficulty breathing etc.)

Uneven growth of the jaws, injury or birth defects can cause problems and symptoms that require evaluation and treatment by a combined team including an oral and maxillofacial surgeon, an orthodontist and sometimes your own dentist. The oral and maxillofacial surgeon and orthodontist will work closely together in the diagnosis and planning of orthognathic surgery.
The orthodontist is responsible for moving the teeth so that they are positioned correctly once the jaws have been reset by surgery, while your general dentist is responsible for maintaining your oral health before, during and after orthodontic and surgical treatment.



PROCEDURE

Pre-surgical Orthodontics

Pre-surgical orthodontics changes the position of the teeth so that they fit properly after surgery has been carried out to change the jaw position. This pre-surgical orthodontic phase usually lasts between six and 18 months. Your oral and maxillofacial surgeon will review you every four months for the duration of orthodontic phase. During this period the bite between your upper and lower teeth may worsen, however, when your jaw is realigned your teeth will also be appropriately repositioned. Some orthodontics will usually be required at the end to "fine tune" your bite.

Preparation for orthognatic surgery

Orthognathic surgery is performed under general anaesthetic. Before surgery, you will need a physical exam and various analyses to make sure you are in good general health.

Your anesthesiologist will inform you of the most appropriate anaesthetic for your particular case and will answer any questions you may have.

Procedure

The orthognathic surgical process lasts from one to several hours depending on the amount and type of surgery needed.
Immediately after surgery you will be transferred to the recovery room until the effects of the anaesthetic have passed. You will be given intravenous medication to control any post-surgical discomfort or pain. The length of stay may be a day or more.


BENEFITS

Benefits include an improvement of the ability to chew, speak and breathe; and in most cases, the aesthetics as well.


PREOPERATIVE RECOMMENDATIONS

Before starting any treatment an initial consultation will be carried out in order for you to meet each other and to answer any questions you may have. It is important that you understand that your treatment includes pre-surgical orthodontics, orthognathic surgery and a post-operative period.

After the initial consultation a thorough examination will be carried out, during which facial measurements, photographs, x-rays and dental impressions will be taken. Your medical history will also need to be documented to ensure that there are no health problems that could interfere with the surgery or the anaesthetic.

Based on the results of your examination, consultations and other diagnostic procedures, you and the evaluation team will decide together on the best course of treatment for you. Depending on the degree of alteration it may only be necessary to carry out orthodontic treatment, or orthognathic surgery may be advised.



AFTERCARE

After surgery there will be some temporary swelling, especially of the lips and cheeks and there may be some bruising, but this is part of the normal healing process and should disappear over time.

During the first few days after surgery you may experience some nasal congestion or a sore throat due to nasal tubes used for the anaesthetic. Postoperative discomfort is usually not significant and can be controlled with medication. Occasionally intermaxillary fixation may be required, i.e. fixing the jaws together to prevent movement in order to achieve the correct positioning of the jaws and to assist healing, but this is not necessary in most cases. Titanium plates and screws are used to join the bone fragments together in their new position.


A healthy diet is extremely important during the first week following the surgery and supplementing your diet with vitamins, minerals and plenty of liquid is highly recommended. Clínica Planas offers a dietary unit at your disposal to help speed up your recovery process.

Smoking is discouraged because it can slow down the healing process and increases the risk of infection. Avoid sporting activity during the first weeks following surgery.

You should be able to return to work or school as soon as you wish once your doctor discharges you, usually two weeks after surgery. Your oral and maxillofacial surgeon will review you regularly, as will your orthodontist. Initial healing takes about six weeks but it takes nine to 12 months to complete the healing process.

It is essential that you observe the best possible oral hygiene during the entire healing process. Your surgeon and orthodontist can help with this.

Post-surgical orthodontic treatment to refine the bite usually begins four to six weeks after surgery and in most cases braces will be removed between six and 12 months afterwards.


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