Jaw Surgery

Where do I start?
First call for an appointment and a consultation to discuss your needs. We will then refer you to a surgically oriented orthodontist if you don't already have one. Pre-surgical orthodontics will move your teeth into a new position, so they will fit together properly when we reposition your jaws. If you still have your wisdom teeth they may have to be removed several months in advance of lower jaw surgery. If you have severe crowding of the teeth, it may be necessary to remove certain teeth prior to beginning of orthodontic treatment, in order to make space for proper tooth movement. During this pre-surgical orthodontic phase of treatment, which usually lasts 6-18 months, you will be wearing braces and will visit your orthodontist regularly for necessary adjustments to your braces and ongoing evaluation. We would like to also see you every 2-3 months prior to surgery to assure proper teeth placement and advise your orthodontist properly of our opinion and progress.

Because your teeth are being moved into a position that will be corrected after surgery, you may think that your bite is getting worse rather than better during this phase of treatment. However, when we realign your jaws into proper position during orthognathic surgery, the teeth will be moved into proper position.

Most patients will need to wear braces anywhere from six months to two years to properly straighten the teeth. The goal of treatment is to shorten or lengthen the horizontal, vertical or transverse dimensions of the jaw so that the facial soft tissue, teeth and the other facial structures are in proper functional and aesthetic balance. Other surgical and medical evaluations may also be required to assess associated cosmetic (skin, nose and neck) and functional (speech, airway, sleep) problems. After surgery, final orthodontic tooth movement is usually necessary to "fine-tune" your bite. Following the removal of your braces, you may be required to wear a retainer. Patients will begin treatment with orthodontic management.

The process of computer imaging is simple and quick. Via a video camera or a digital camera, the computer captures a person's image. We then scan your cephalometric x-rays taken from the side of your face. Both facial photos and radiographic images are then overlapped. Analysis of the face and radiographs then could be done. With the help of a computer program, the bony portion of the jaw could be moved into the desired position and patients can see how the surgery is done and how they will look after surgery. While the resulting photograph is obviously an approximation of what orthognathic surgery can accomplish, it can be useful in discerning the possible results of treatment.

The computerized photograph can help motivate the patient who is contemplating undergoing orthognathic surgery care. Plus, this "after" photo can provide a real incentive for the patient to cooperate with required orthognathic surgery treatment. For example, the photos encourage patients as they change eating habits (not always required).

What other options are available except Orthognathic surgery?
Orthodontic treatment alone could be an alternative for some patients.  You must understand that orthodontics only can correct your teeth positions and not your jaw position.  Your orthodontist will explain the orthodontic options to you so that you can make an informed decision about your treatment. Even though certain orthodontic cases are best treated by surgical means, non-surgical treatment can sometimes be accomplished by combining the extraction of teeth with the orthodontic treatment. 

My orthodontist is recommending to pull four of my teeth (Premolar teeth) can this solve the problem?
Unfortunately no and it can create a major problem later in your life.  If your orthodontist has recommended extracting few of your teeth to create room because your teeth are crowded you may want to have a second opinion.  In a study of 6,200 patients with sleep apnea we have found that many of the individuals who had taken their teeth out for orthodontic reasons when they were younger have developed obstructive sleep apnea when got older.  When a dentist pulls your teeth and pushes your front teeth backward it can make the internal size of your mouth where your tongue is located too small.  If you already also have a receded chin and jaw when you sleep the tongue falls in the back of your throat and blocks the airway. We also noted that patient’s nose gets longer too because when the teeth are pushed back the upper jaw does not move as much hence causing a longer nasal tip and a protruded upper jaw.  Unfortunately most orthodontists are not trained in sleep apnea and this point is completely ignored.  Hundreds of patients are being told every year to have their orthodontics repeated to move the teeth in the opposite direction (Upper teeth forward) and consider jaw surgery to correct the position of the jaws as well.      

Why then doesn’t everyone choose to be treated non-surgically?
As mentioned above, non-surgical treatments seem like an easy way out and advantageous initially, it is important to be aware that facial appearance can sometimes change unfavorably with orthodontic and extraction treatment alone. For example, the chin can appear more retruded or the nose can appear more prominent. Be sure to take this into consideration prior to making your decision and make sure you ask your orthodontist about these concerns and if they apply in your particular case. Because the orthodontic phase of treatment for surgical and non-surgical treatment plans differ quite significantly, the orthodontist must know at the beginning of treatment which treatment option a patient chooses.

If you are concerned about your children’s future orthodontic treatment, the best manner in which orthodontic treatment for children and young teenagers can be simplified, is to have them assessed early in life while the jaw bones are still growing. In this way, potential jaw growth can be utilized in their orthodontic treatment and corrective jaw surgery may be simplified, or even avoided completely, later in life.

Can You Also Do Cosmetic Surgery For Me?
When unequal jaw growth is the source of the problem, corrective jaw surgery may be necessary. Corrective jaw surgery involves moving all or part of the upper and/or lower jaw into a more favorable position. For example, the entire jaw can be moved backward if it's too large. The goal of treatment is to improve function and restore facial balance.

As a result of orthognathic surgery, facial esthetics is almost always improved. Some patients may consider having additional cosmetic procedures to enhance their new appearance, such as surgery on the eyes, nose, chin or neck. You may wish to discuss these options with us including if and when these procedures should be performed. In many instances the cheek, chin and nasal procedures are done at the same time as an upper jaw and lower jaw surgery. Cosmetic procedures are normally not covered by insurance companies in the United States.

Does Orthognathic Surgery correct TMJ?
Not all the time. Jaw surgery has sometimes been recommended to aid in the treatment of temporomandibular joint (TMJ) problems. Although it is true that jaw deformities can aggravate TMJ  problems and those patients with bad bites tend to overload their TMJ; there is no evidence to indicate that orthognathic surgery can correct a jaw joint intra-capsular derangement. Orthognathic surgery is not performed to correct TMJ problems. Some patients report an alleviation of their TMJ symptoms after orthognathic surgery. This is most likely caused by a decrease in clenching and grinding by the patient after their bite has been corrected. In rare instances, the joints, which were pain free prior to surgery, can become painful after surgery. This problem might require additional dental, orthodontic or surgical treatment to resolve. Our observation has been that in some cases patients with TMJ symptoms pre-operatively have less TMJ symptoms postoperatively.

Do I Need Chin Surgery?
The chin is an important component of the overall facial profile. A large or small chin may create a proportional imbalance with other facial structures such as the neck, lips, nose and forehead. A chin that is too large in the horizontal, vertical or transverse dimension can be reduced, and the chin that is too small in the same dimensions can be augmented. These procedures can be done alone or in conjunction with other orthognathic procedures. Local anesthesia with intravenous sedation or general anesthesia is required.

A patient's chin may be reduced in size through a mouth incision made behind the lower lip. Then the chin bone will be aligned (Chin Surgery -Genioplasty) with power instruments. All incisions are done in the mouth and no external scars will be formed. Following surgery, patients must wear a chin dressing and eat soft foods for two to three weeks. Patients will experience a brief period of lower-lip swelling, discoloration, and a numbness or tingling sensation.

It is more common for patients to seek chin augmentation. This is accomplished by advancing the chin bone or placing an only of artificial implant material. The degree of chin deformity and the patient’s treatment goals dictate the type and complexity of this procedure. Following surgery, patients must wear a firm chin dressing and eat soft foods for two to three weeks. Patients will experience a brief period of lower-lip swelling, discoloration, and a numbness or tingling sensation. (Visit our photo gallery for more pictures)

"My receding lower jaw and protruding upper teeth and jaw made eating, swallowing and even speaking difficult for me.  At night I had difficulty breathing because of my narrow air passage.  Now I can breathe better, I can eat, swallow and speak without any problems. I look good and feel great, thank you Dr. Madani" - Barbara

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