Jaw Surgery

Are All Orthodontists Well Versed In Orthognathic Surgery?
Yes, all board certified (or eligible) oral and maxillofacial surgeons are qualified to perform orthognathic surgery. However they may not be interested or exposed to doing orthognathic surgery on a routine basis. Orthognathic surgery is one of the most delicate procedures performed by an oral and maxillofacial surgeon. Once again as an intelligent consumer we encourage parents as well as patients to ask questions and if in doubt second opinion must be considered for both the orthodontist as well as the surgeon.

Unfortunately many times some orthodontists try hard to avoid surgery because of false impression that orthognathic surgery is painful for their young patients or may be too complicated. The fact is that if an individual has a skeletal problem doing orthodontic treatment alone may harm the teeth by a process called root resorption. Additionally not only the result may be unstable and causes a relapse but cosmetically patient’s facial appearance may also be jeopardized. Very often we see patients with excellent occlusion but unattractive facial appearance, mostly receded chin or gummy smile.

Based on the results of your examination, consultations and other diagnostic procedures, we will recommend the course of treatment that is best for you. Depending on the extent of your problem, orthodontic treatment alone may be sufficient, or orthognathic surgery may be indicated. Surgery can range from minor movement of a single part of your dental arch to the repositioning of both jaws. During the pre-treatment consultation process, feel free to ask any questions that you have regarding your treatment. When you are fully informed about the aspects of your case, you can make the decision to proceed with treatment.

As an intelligent consumer we encourage parents as well as patients to ask questions and if in doubt second opinion must be considered for both the orthodontist as well as the surgeon.

Who Will Be In Charge Of My Orthognathic Surgery?
In diagnosing your need for orthognathic surgery, we work closely with a qualified orthodontist to evaluate, diagnose and treatment plan your particular situation. The orthodontist is responsible for moving the teeth so they will fit together properly after the jaws have been repositioned, and we are responsible for repositioning the jaw(s) so the teeth and jaws are in proper alignment. In addition, you and your general dentist are responsible for maintaining your oral health before, during, and after your orthodontic and surgical treatment.

The role and importance of the orthodontist is crucial in achieving a successful result. Orthodontist will start placing the orthodontic devices in your mouth and they continue to fine-tune your bite after the surgery. In our opinion, if this was an orchestra they will be the principal conductors!  

How Do I Know If I'm Choosing the Right Surgeon?
Choosing an Oral and Maxillofacial surgeon is a personal decision that you should make after careful assessment of the surgeons background and interest. As a board certified Oral and Maxillofacial surgeon we have proven record of continued interest and success in this most fascinating part of facial surgery. We have performed hundreds of cases since 1982. We have modified certain types of procedure. We have contiguously used the most advanced technology to perform the surgery, including rigid fixation, resorbable plating and computer imaging. We have been fortunate to treat patients from all around the globe. Finally we invite you to visit our facility for a complimentary consultation. We can assure you that you will encounter a center dedicated to providing state of the art technology for unparalleled care for our patients.

The combined skills of your orthodontist and our expertise to evaluate your situation and establish a treatment plan will provide a pleasing facial appearance and restore normal occlusion. Once this evaluation is complete, treatment begins.

Why Do Patients Come To The Center For Corrective Jaw Surgery?
Help with the diagnosis and treatment of difficult surgical problems, being extremely interested in well being of our patients, having a vast experience in orthognathic surgery are probably the most common reasons. Some want a second opinion, while others come to us for surgery. Our center also offers examinations for treatment of snoring and sleep apnea (the famous "snorenet web site"), which has helped thousands of people to have peaceful nights after a laser surgery or radiofrequency treatment. Another reason people come to the Center for Corrective Jaw Surgery is because they like the Center's team emphasizes on quality patient care. With a little research from our previous patients about the type of care they had here, patients response is that they don’t mind flying from other continents to come here for treatment.

Why Do People come to Philadelphia For Orthognathic Surgery?
Dr. Madani sees patients from all over the world. They come to him because they like the results of his work. Traveling is quite easy nowadays, and airline costs are low, especially compared to the costs of facial cosmetic surgery. If you feel that Dr. Madani has demonstrated the skill you are looking for in a surgeon, we invite you to come to Philadelphia. We can help you make the arrangements.

Can I travel from other countries or States for treatment?
Yes, you can! The Philadelphia (Bala Cynwyd) area (also known as "the Golden Gate To The Main Line") is located in one of the most prestigious suburbs of Philadelphia, has a variety of accommodations to meet your needs and preferences. Postoperative accommodations are decided between you and our dedicated staff and are determined by factors such as your age, general health and the extent of your surgical procedure. The majority of surgical procedures are safely performed on an outpatient basis, which means you can go home or to your hotel the same day.

You will be given detailed postsurgical-care instructions and our toll free telephone number (800) 206-2000 for contact should you develop any concerns. For more complex cases that requires hospitalizations you are required to plan to stay in the area for 3-4 weeks but return in 2 months and 6 months after surgery. If you have more advanced postoperative needs, several options for accommodations exist. For a more closely supervised recovery, you may need a temporary, full-service hospitalization. The Miracle of Jaw Surgery happens here! That’s why people will travel to Philadelphia to have surgery done!

What to do if you are considering a trip to Philadelphia?
Contact the office, 1-800-206-2000. Our office manager will discuss with you arrangements to fit your particular situation. Typically, we will request that you send us pictures of yourself (Polaroid are usually fine) a panoramic and a cephalometric x-ray will be needed. Dr. Madani will review the pictures, to see whether he thinks you might be a good candidate for surgery. If you appear to be a good candidate, we can schedule a surgery date, and a consultation with Dr. Madani for the day before surgery. During your consultation the day before surgery, you would have plenty of time to thoroughly discuss the surgery with Dr. Madani, making sure that you and he are both comfortable with the plan.

Another option is to schedule two trips to Philadelphia-Bala Cynwyd, one for the consultation and one for the surgery.

Is it possible to get the procedure codes for my procedures? (In U.S. Only)
Yes of course!  An interesting and commonly asked question!  First you must understand that a specialist must verify these codes and insurance companies almost never can grantee payments.  But to help you in answering the question we provide these procedure and diagnosis codes.  (Diagnosis codes are ICD-9 codes and procedure codes are CPT codes)

For mandibular prognathism (If your lower jaw is in front of your upper jaw- you have a protruded jaw and chin) ICD-9 is 524.0, 524.1, 524.2, 524.4, 524.5, and 526.89.

Excess mandibular bone causes protrusion of the lower jaw beyond the normal alignment with the upper jaw. This can prevent effective biting and chewing of food and hastens periodontal disease. Temporomandibular joint function and speech may be impaired. Excessive chin hyperplasia or malposition may require a reduction or sliding genioplasty (Chin surgery).  This is completely cosmetic and not covered by insurances.  The following CPT codes could be used for lower jaw surgery: 21120-23, 21193-96, 21198, and 21209 (Visit our photo gallery for more pictures)

Mandibular retrognathism is when you lower jaw is too small- you have a receded jaw and chin.  The following ICD-9 could be used for the diagnosis code: 524.0, 524.1, 524.2, 524.4, 524.5, and 526.89

Retrognathia or micrognathism is a deficiency of the mandibular bone. This does not allow the upper and lower teeth to come together when chewing food and may affect speech. Sleep apnea (ICD-9: 786.09) may also be produced by a retruded or deficient lower jaw. A deficiency of bone supporting the chin may require surgery (genioplasty) to build up the tissue and provide a normal framework for the chin. CPT: 21120-23, 21193-96, 21198, and 21208 once again could be used for lower jaw surgery. (Visit our photo gallery for more pictures)

Maxillary excess is when you show too much gum when you smile or have a really elongated face.  The diagnosis code (ICD-9) 524.0, 524.1, 524.2, 524.4, 524.5, 526.89 are used.

Maxillary excess may cause either protrusion of the upper jaw or elongation of the face, with downward displacement of the mandible. In vertical maxillary excess (ICD-9: 754.0), the disfigurement causes a "long-face syndrome) with accompanying distortion of facial features. CPT: 21141, 21206.  In many instances a combined upper jaw and lower jaw procedure in addition to chin surgery may be needed to correct these conditions then the CPT codes 21120-23, 21193-96, 21198, and 21208 could also be used in addition.

Maxillary deficiency is when your upper jaw is too small and when you speak you don’t show any teeth at all.  People may think that you have no teeth!  ICD-9: 524.0, 524.1, 524.2, 524.5 is generally used.

In this condition, also called hypoplasia, the growth of the maxilla does not match that of the lower jaw. There is a collapse of the normal mid-face supporting structures (ICD-9: 754.0). In addition to causing difficulties with eating and speech, this deficiency may be associated with anomalies of the supporting structures of the nose and cheeks. Partial obstruction of the nasal passages (ICD-9: 519.8, 754.0) may be present. Reconstruction of the nasal and malar tissues (your cheeks) may be intimately related to treatment for maxillary deficiency. CPT: 21141, 21142, 21143, 21145, 21146, 21147, and 21206

Of course we treat variety of other conditions, which requires coordination of work between a team of surgeons in many fields and your dentist and orthodontist.

"I was born with half of my lower jaw missing and my chin was growing sideways..  Until I had my surgery, I could not bite a sandwich.  Dr. Madani treated me when I was 6.  He took a part of my rib and shaped it like a jaw.  He placed it in such a position that my rib actually transformed into a perfect jaw. My chin is exactly in the middle of my face.  I never had any other procedures.  It has been 10 years since my surgery no one even can imagine that I had reconstructive jaw surgery.  Dr. Madani I really appreciate what you have done for me." - Joey