Jaw Surgery

About the jaw surgery procedure

How Common Is Orthognathic Surgery?
It is hard to believe but the first orthognathic surgery was done over 150 years ago! Luckily for our patients today the techniques have changed! Orthognathic surgery has become very common, as patients have discovered the benefits of corrective jaw surgery as it pertains to their ability to chew and function. In addition, orthodontists realize the advantage of orthognathic surgery from a stability standpoint. Orthodontics is much more stable if any jaw deformity can be surgically corrected. Correcting the position of the bones allows the orthodontist to place the teeth in an ideal alignment. Ideal alignment insures proper forces on the teeth and helps to eliminate orthodontic relapse. Additionally, alignment of the jaws will many times improve a patient’s esthetics and at the same time may reduce the orthodontic treatment time. For these reasons, orthognathic surgery is beneficial. Advances in orthognathic surgery have greatly reduced complications. In most cases, hospital stays have been reduced to overnight admissions. All procedures are performed inside the mouth without facial scarring. Bone-plating techniques have eliminated the need for the jaws to be wired together after the surgical procedure. Orthognathic surgery has changed from a cruel and painful cutting of the jaws, from outside of the face, to an art form using sophisticated equipment to correct the problem in the most precise way possible.

Preparing For Surgery
Once you have decided to undergo an orthognathic procedure, you must consider the best time for your procedure. Because of the unavoidable recovery time following surgery, it is best to have an orthognathic procedure when social and professional obligations are at a minimum. Also remember to consider holidays. Normally, we are in the operating rooms everyday during major holidays and surgery must be scheduled months in advance. Before and after surgery, you may have to interrupt recreational activities and social habits, such as contact sports and even smoking. In addition, you must inform us if you are currently taking any medications including aspirin. We may ask you to stop taking aspirin-like products, which often interfere with blood clotting and can promote bleeding during and after your surgery.

Combined with exercise and proper diet, an orthognathic procedure may provide the opportunity for you to feel better about the way you look. Before making an appointment to see us, take some time to think about the specific attributes accounting for your dissatisfaction with your jaw form, dental malocclusion, shape of your nose, cheeks and overall facial appearance. Then, discuss your concerns on the day of your visit with us. We will recommend the most appropriate therapy to address your personal needs. Many characteristics can be successfully altered through orthognathic surgery techniques; others cannot. We will help you understand what you can realistically expect if you choose surgery. Examine the benefits and limitations that orthognathic surgery offer and carefully weigh the options before making a decision to precede.

Before any treatment begins, an initial consultation will be needed to get acquainted and answer any preliminary questions you may have. It is important to understand that your treatment, including pre-surgical orthodontics, orthognathic surgery, and post-surgical orthodontics. Healing and treatment may take several months to two years or more to complete. You should be prepared to make a long-term commitment in order to derive the benefits of orthognathic surgery, and in some cases psychological counseling may be an important part of the treatment process.

When Does The Orthognathic Surgery Begin?
As your pre-surgical orthodontic treatment nears completion, we will make final preparations for the orthognathic surgery procedure. Additional records will be taken, similar to the previous ones. We may use new x-rays and models of your teeth and jaws to "simulate" surgery in order to finalize the surgical movements of your jaws and anticipate the results of the procedure. Prior to your surgery, we actually perform the procedure in our laboratory and fabricate a guide called a splint. The surgical splint is a hard plastic wafer that allows us to place your teeth in precise position. When our team (your orthodontist and us) determines that your teeth are in the correct pre-surgical position, surgery will be scheduled.

How Accurately Is The Surgery Planned?
Orthognathic surgery is one of the most delicate and accurate procedures we do at our Center. To help direct the jaws to their proper position in relation to the other facial bones, we will takes models (molds) of the your teeth and places them on an instrument called an articulator. The articulator simulates the position of the jaws to the base of the skull and allows us to perform the surgical procedure on the mounted casts prior to performing it on you! After precisely simulating the surgery on the mounted plaster casts, we make a plastic template, which guide the teeth to their proper position to the rest of the facial bones. The surgical splint is placed over the upper teeth at the time of surgery. It is wired into the orthodontic appliances. The lower jaw is repositioned to fit into this splint. Additionally, it is used post-operatively to verify that the jaws do not move from their desired position.

After the surgery, 7-10 days of convalescence is necessary. Most patients report mild discomfort, but strong pain medicine is uncommonly required. You will experience variable degrees of swelling during the 7-10 days of recovery. You may, however, return to all activities post-operatively, including school and/or work as soon as they feel capable. As mentioned earlier, this usually happens 7-10 days after most surgical procedures.

What Are The Details Regarding The Surgical Procedure?
Orthognathic surgical procedures last anywhere from one to several hours, depending on the amount and type of surgery needed. In lower jaw surgery the rear portion of the jawbone behind the teeth is separated and the tooth-bearing portion is moved forward or backward, as appropriate. In upper jaw surgery the jaw can be repositioned forward or backward, or the jaw can be raised or lowered. Certain movements may require the jaws to be separated into several parts, with bone added or removed to achieve the proper alignment and stability. Other facial bones, such as chins, contribute to the imbalance and may also be repositioned, augmented, or reduced in size.

In almost all cases, incisions are made inside the mouth and there will be no visible external scars. We use special angled instruments (right angle drives) that eliminate any cuts on the skin.

What Should I Expect Following the Surgery?
Following surgery, you will need to give yourself time to heal. Bruising and swelling, while always temporary can occasionally be significant and alarming to even the best-prepared patient. It is not unusual to experience a brief interval of low spirits following surgery. Similarly, it is natural to prematurely interpret the results of a procedure before waiting the necessary time for swelling and bruising to subside. At Center for Corrective Jaw Surgery, we recognize and anticipate these special needs following orthognathic surgery. We are dedicated to kind and compassionate understanding of your needs as they arise throughout your orthognathic surgery experience.

Orthodontic treatment will resume three to six weeks after jaw surgery and frequently last six to 12 months (for a total surgery and orthodontic treatment time of 12 to 24 months). Following removal of the orthodontic braces, the patient can expect a stable cosmetic and functional improvement. Additional cosmetic procedures, such as rhinoplasty and face-lift, can be considered because the internal structures (jaws and teeth) are now positioned for potential maximum aesthetic enhancement of the remainder of the face. Because of the complexity and length of the surgical and orthodontic treatment, patients must be highly motivated and well informed about the importance of their participation in treatment.

Do I need a Follow up Visit after My Braces are off?
We look at orthognathic surgery as an art. We certainly like to admire the great artistic procedures that we do! This not only makes us more proud but also allows us to make sure your teeth and jawbone are staying properly aligned.

Are there Any Risks and Complications?
The following statements are not meant to scare you but to inform you. Risks are rare but we feel that all of our potential patients deserve to be informed.

As with any surgical procedure, certain side effects and complications are possible with orthognathic surgery. You should understand these before you consent to surgery. Orthognathic surgical procedures are safe and predictable. Surgical complications are minor and uncommon. Patients should expect some degree of swelling and bruising during the first two weeks following surgery. When the lower jaw is repositioned, a period of lower-lip numbness or tingling is present and may last for weeks or months. On rare occasions, this altered lip feeling may persist indefinitely. You will have an opportunity to review an animated video presentation describing the risks and benefits of orthognathic surgery. We can answer questions you have about the following possible risks:

Swelling is a normal bodily reaction to any surgical procedure, and the degree of swelling varies with the individual and the procedure. Normally we cover patients after surgery with large doses of steroids to prevent facial swelling. But if you develop swelling, it usually subsides by the third to fourth week.

Discomfort: We expect you to have mild to moderate amount of pain following orthognathic surgery, which can be controlled by medication. You will be given appropriate pain medication to control the discomfort. Most patients state that pain associated with wisdom teeth extractions is more intense than from certain jaw surgeries.

Loss or alteration of nerve sensation, resulting in numbness or a tingling sensation in the face, jaw, teeth or tongue may occur as nerve fibers are regenerating and mending. As healing takes place, you may have sensations of warmth and tingling in the affected areas. Some individuals may experience permanent altered sensations, particularly in lower jaw operations. It is important to note that these nerve alterations does not cause facial disfigurations, since the nerves affected are sensory in nature. It is alteration of sensation.

Nausea and vomiting are rare complications of general anesthesia. One of the great advantages of rigid fixation is that your jaws are not wired together and in rare case of upset stomach it is easier to handle the problem.

Bleeding may be experienced after any type of surgery. Post-operative bleeding is very rare with orthognathic surgery. If upper jaw surgery has been performed, there may be some oozing of blood from the nose.

Infection is very rare since all patients are covered by antibiotics but potential risks of infection exist.

There are other rare complications such as discomfort in the T.M.J. area, limitation of jaw opening, injuries to adjacent teeth, sinus infections and relapse. As mentioned, the above complications are extremely rare, but experience of a surgeon and the orthodontist members of the team will reduce some of these risks and complications.

Dr. Mansoor Madani, Director, Center For Corrective Jaw Surgery, Bala Cynwyd, PA - For over ten million people with jaw deformities, a revolutionary new product promises a change in the face of jaw surgery.

During the past several decades, correction of facial deformities had changed from wiring the jaws to rigid fixation with titanium plates and screws and eliminating the wiring. Now, the plates and screws are made of a polymer that vanishes without a trace within a year after their placement.

For the first time, this resorbable product is available in the United States for facial surgery. This new system is a scientific breakthrough in the treatment of trauma cases as well. Made of a space-age polymer, this system of miniature plates and screws offers many additional benefits: it allows union of bony segments and prevents minor bony movements, which could cause infection and delayed healing of bone. Moreover, it could be used on small children because it will not interfere with bony growth or submergence in the bone.

According to oral and maxillofacial surgeon Dr. Mansoor Madani, the wire and metal free jaw surgery allows patients full use of their mouth within days after surgery, reduces the length of the patient’s hospital visit and recovery and eliminates the need for future retrieval. It completely vanishes from the site of its placement without any toxic by-products.

The resorption process has two phases: hydrolysis and metabolism. Hydrolysis begins when water enters the polymer and chemically reacts with polymer chains causing them to separate. The plate changes shape and mass and the remaining material is digested by macrophages. The polymer eventually breaks down into water and carbon dioxide.

Unlike titanium plating, which remains in the body after healing is complete, this new material completely resorbs within twelve to fifteen months. It is a co-polymer of Poly-L-Lactic Acid and Poly Glycolic Acid. Its strength is comparable to that of the titanium plating currently being used in the fixation of facial fractures and reconstructive surgery.

Dr. Madani is currently working on a few cases with this new plating system. Additionally, there are several patients who have had the original metal plating system and are experiencing problems. All of these patients are available for interviews.