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Maxillofacial (orthognathic surgery)

If there is enough abnormal growth of the upper and lower jaws to prevent orthodontic treatment to line up the teeth adequately, surgery may be required to move the jaws into a better relationship. This cannot be done before growth is completed because the lower jaw grows for a longer period of time than the upper one. Before such surgery is done, the teeth are all straightened up using Orthodontic techniques and finally the jaws are moved according to a very carefully planned operation. The improvement from these operations is usually very dramatic and extremely worthwhile.

The aims of the surgery are to:

  • Get a better relationship or balance between the top and bottom jaw – this alters the profile of the face
  • Create low maintenance dentition – which means your teeth will be easier to look after as an individual grows older

Other benefits may include, improvement in the individuals ability to chew and speak and for some breathing may become easier.

This procedure is done in close liaison with the Orthodontist, and requires lots of planning work. It takes time.

What happens step-by-step…

  1. Pre-operative orthodontic treatment to position the teeth in the upper and lower jaws so they will match well when the jaw bones are cut and repositioned.
  2. Planning work using photos, plaster dental models and x-rays of facial bones and teeth.
  3. Maxillofacial Surgery:
    1. If the jaw only needs to be moved a small distance they will break the jaw and reposition in the correct place. This is called ‘maxillary advancement’. Sometimes this will require a further bone graft to be put in.
    2. If the jaw need to be moved 5ml or greater they can use a technique called, ‘distraction osteogenesis’. In this technique pins are placed on each side of the cuts in the bone and attached to an external frame called a distraction device. Screws on the device are turned daily and pull the healing bones slowly apart until enough lengthening has been achieved. This generally takes up to 6 months. There are many visits to the Maxillofacial Surgeon to supervise the speed of lengthening.
  4. Final orthodontics – which usually lasts about one year, completes the process and the final bite relationship between upper and lower teeth is established.

Maxillary Advancement

Requires a hospital stay of about 3-5 days for this procedure. Patients would generally have 2 weeks off school or work and up to 6 weeks off sport.

A soft diet is required post surgically. Adequate nutrition is important for healing. Eating small amounts 5-6 times per day is a good idea. You can ask for dietary advice. Many people lose weight after this procedure.

Oral hygiene is very important. Brushing is difficult during the first week after surgery. At least 4 times daily, and especially after meals, rinse your mouth out with warm salt water, especially after meals.  Your surgeon may prescribe a mouthwash to help.

Distraction Osteogenesis

For the placement of the metal plates, a hospital stay of about 3-5 days is required. Patients generally will have 2 weeks off school or work and up to 6 weeks off sport.

A soft diet is required post surgically and oral hygiene is very important.

The bolts that you screw lie inside your mouth, so no one can see them. The most uncomfortable part of this procedure can be the bolts which may irritate the inside of the patient’s cheek.

This process generally takes about 6 months and requires a further surgery to remove the metal plates.

General points about orthognathic surgery

  • Not everyone needs this procedure.
  • Growth must be complete. This is checked by x-rays
  • Surgery is often combined with orthodontic treatment. Be prepared for the overall treatment to take a long time.
  • The decision to have surgery is always the individuals. Decisions can be made when you are satisfied with the information you have received and believe you have been well informed.
  • Remember to discuss the benefits, risks and limitations of treatment, and of not having the treatment. Make sure your expecations are realistic.
  • Meticulous cleanliness and care of the mouth is essential for rapid healing and prevention of infection.
  • Adequate nutrition is essential for healing too. Many people lose weight during these types of surgeries and recovery periods.
  • Your appearance may change, so you should be prepared for signs of surprise from family and friends. It will not take them long to adjust.

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