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Jaw Surgery - The Art Of Restoring Your Inner Beauty!
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Have you ever looked in the mirror and found a part of your face not perfectly right? Are your jaws too small or too big? Have you ever been told you have a weak chin? Do you think that your face and your looks affect your job and your life?
It is generally a known fact that a persons appearance will affect every aspect of their life. We look at a face and think we can tell if a person is honest, kind, intelligent or even make a good dinner companion.
Although mental or physical illness can be apparent on one's face, people often over generalize what they see. Harmless irregularities in facial features of perfectly normal people can resemble those associated with mental or physical illness but have nothing to do with a person's health. It is interesting to know that we all have some degrees of facial imbalance and you can hardly find a perfectly symmetric face.
In this section of our site we discuss surgical techniques used to correct many facial imbalances and will answer the most commonly asked questions about jaw surgery.
Is Jaw Deformity A Rare Condition?
Not at all! There are over 10 million people in the United States alone who suffer from jaw deformities. Jaw growth is a slow and gradual process. Something may go wrong with this process and the upper and lower jaws may grow at different rates. We are all born with certain facial irregularity, and there are no perfect faces. However, in most cases these irregularities are either so minute or insignificant that ordinary people will not even recognize them. On the other hand, there are some facial irregularities that can be cause for concern. A jaw that sticks out or recedes, teeth that do not fit together properly, or a "gummy" smile can often be corrected with a certain reconstructive jaw surgery procedure called orthognathic surgery.
Jaw Surgery
What causes jaw and bite problems?
As mentioned above, jaw irregularities can occur as a result of a growth difference between your upper and lower jaws. This could cause your lower jaw for example to be larger or smaller than your upper jaw. Underlying genetic factors and accidental fall on your chin when you are very young could also be another factor. The sooner the problems are addressed the more successful and more stable results can be achieved.
Why should I consider jaw surgery?
If you have an imbalanced jaw or chin or have difficulty chewing, swallowing and even breathing you should consider an evaluation. Your bite problem can also affect your speech as well as your looks. Surgery to correct a misaligned jaw is necessary to properly align your upper jaw and/or your lower jaw to the rest of your facial bones. Proper alignment helps to ensure long term success of the orthodontics, protects the teeth and supporting structures, improves function of the jaw and also decrease the potential for overloading forces on the temporomandibular joint (TMJ) and facial muscles. Major benefits of orthognathic surgery are: improvements of facial appearance, enhanced ability to chew, breathe and speak normally.
Horizontal imbalance of the jaws may cause cosmetic concerns as well. In such cases, your chin and lower jaw could look receded or weak or just the opposite your jaw could be protruded and very large with a chin point that is too strong. Your teeth may not fit together properly too. This is called a malocclusion, which can cause an "underbite" or "overbite" condition. The tongue and lips may be forced to move awkwardly during speech and swallowing in an attempt to compensate for the improper jaw position. There may be a speech defect or excessive mouth breathing. Unfortunately, many times we hear from our patients that their jaw joint clicks and as they get older this condition gets worse and they develop TMJ problems.
What is Orthognathic Surgery?
Orthognathic surgery or "Surgical Orthodontics" is a joint effort between your orthodontist and our team of oral & maxillofacial surgeons. Your orthodontist straightens your teeth using braces. This is a long and tedious process, which may take over a year to complete. During this period of your treatment, we are in continuous consultations with your orthodontist to make sure the position of your teeth and your jaws are acceptable in preparation for surgery. Once the teeth are lined up properly, we take you to the operating room and correct the jaw problems with surgery. We can fix one jaw or both your upper and lower jaw and at the same time and we can correct the position of your chin as well. In some cases, we may be able to do certain parts of your surgery in our center. With orthognathic surgery, we can correct a wide range of minor and major facial and jaw irregularities, and benefits include an improved ability to chew, speak and breathe. In many cases an enhanced appearance can also result.
Since 1980 we (as well as the rest of Oral & Maxillofacial Surgeons) have made tremendous contributions to change and modify orthognathic surgery procedures. With the new technology now available, we no longer have to wire your jaws together or make incisions on the outside of the face. All incisions are done from the inside. No scars are created on the face. We use resorbable plates and pins to secure the repositioned jaws in some cases.
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 patients 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.
Where Is The Surgery Performed?
Orthognathic surgery is usually performed in a hospital under general anesthesia. We perform easier procedures in our center avoiding the hospitalization and extra expense. Prior to surgery you will have a physical examination to ensure that you are in good overall health. If you are having a more complex orthognathic surgery you may be advised to donate blood (usually 2 weeks prior to surgery) in the event you need a transfusion during surgery. Certain dietary supplements and exercise may be prescribed to achieve optimum health, so that healing after surgery will be as rapid and uneventful as possible. Multivitamin with Iron is normally a routine recommendation. Any required lab tests will also be done prior to surgery.
In most cases, you will check into the hospital or ambulatory surgical center on the day of your surgery. An anesthesiologist will discuss the general anesthetic procedure to be used and answer any questions you may have. In addition to the use of general anesthesia, which "puts you to sleep" during surgery, you will be receiving intravenous fluids and medication to prevent dehydration and infection, and to minimize swelling and pain. It is very important that you adhere to any medication schedule or diet prescribed.
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.
Before my jaw surgery, the puzzle of my life was missing one piece and you found it. Now I am a complete person at 15 years old." Marie
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Why We Snore
We all snore occasionally, but in most cases it is a problem that self-corrects and does not bother anyone. In some, it is compounded by a deadly condition of impeded breathing. Basically, you stop breathinganywhere from a few seconds up to 20, 30, or even 100 times or more per minute This stoppage of breathing plus snoring along with a few other symptoms are known as obstructive sleep apnea.
I snore and stop breathing, could I die from it?
In fact, you can have very serious complications if you suffer from sleep apnea. With sleep apnea, you are more prone to have:
* Heart attack (myocardial infarction) or MI
* Stroke
* Hypertension
* Emotional issues & mood problems (getting agitated & upset easily, having shorter
attention span, depression, having anxiety)
* Sexual problems
* Car accidents
* Lose time from your work and unable to perform well at work
* Increased chance of stopped breathing altogether (higher morbidity & mortality), so a patient with sever obstructive sleep apnea and other risk factors such as obesity, high cholesterol level, hypertension, etc has much higher chance of dying young and/or while they sleep! It has been estimated that over 3800 people die every single year from complications of sleep apnea in the United States only.
How about my life, my job?
Quality of life issues range from sleeping in separate bedrooms, body fatigue, irritability, nervousness, arguments and even divorce has been brought up by many couples.
* Personal financial impacts range from an increased cost of medical care, prescription & over the counter drug expenses.
* Institutional impacts at work could range from:
* Job related Illness and injuries to self as well as coworkers
*Increased Healthcare expenses to self as well as employee
*Causing injuries to others (buss & truck drivers)
*Inability to focus & concentrate at work
*Inability to perform complex tasks
*Afternoon job performance issues
*Reduced problem solving ability
*Tired & sleepy at work
*Reduce productivity
Why is it that more men snore than women?
We have examined over 20,000 patients for snoring and sleep apnea and have operated on several thousand patients. We estimate that ration of Men versus women are 9:1. We believe that a major reason is the mens body size, and their anatomy. We cant disregard genetics, hormones and other factors either.
