Orthognathic surgeries are surgeries performed on jaw bones ie maxilla or mandible to alter their shape size or position. These are done in conjunction with orthodontic or braces treatment to align the teeth along with the jaws.
Orthognathic or jaw surgery is required when maxilla and / or mandible is not in good proportion to each other or to cranial base. The cause of jaw disproportion may be heredity, trauma or certain environmental disturbances. When jaws are in disproportion, the teeth alignment is also affected. Therefore along with jaw surgery, braces treatment is also required to align the teeth.
1. Diagnosis and treatment planning
The orthodontist will diagnose which jaw is at fault and the degree of jaw disproportion in all 3 dimensions after studying patients diagnostic records such as plaster models, dental and facial photographs, x rays and 3D scans and findings from a detailed clinical examination.
Ideal treatment plan is chalked out. Oral surgeon in consulted and his opinion and approval taken for the treatment plan
Generally orthodontic treatment is started to prepare the patient for surgery. This pre surgical orthodontics is done for few months until all presurgical orthodontic objectives are achieved. Final surgical planning and preparation is done. Patient then undergoes surgery under local /general anesthesia. Hospitalization is required for 0-5 days depending on the need. After the patient recovers, orthodontic treatment is continued ( post surgical orthodontics) till the final alignment and functional settling on teeth is done.
In few cases, surgery is done in the beginning ( “surgery first “ protocol) and then orthodontic treatment is done to correct the teeth alignment. Both the technics have advantages and disadvantages. Careful case selection is must for successful result.
TYPES OF ORTHOGNATHIC SURGERIES
Le Forte 1 osteotomy with maxillary repositioning in anteriorly or posteriorly, superiorly or inferiorly with occlusal plane tilt / rotation
Surgical palatal split with expansion
Bilateral sagittal Split osteotomy ( BSSO) with set back / advancement
Vertical Ramus Osteotomy
Genioplasty - advancement or reduction
More complicated surgeries like Lefort 2 osteotomy or cranial base surgeries may be required when the degree of disproportion is huge and involves specialized surgical team.
The orthodontist and the surgeon will decide the surgical requirement of the patient depending on his esthetic and functional needs.
Safety – Today orthognathic surgeries are very safe and are routinely done all over the world with very less room for complications or failures
Success – There is a very high success rate with most orthognathic surgeries with respect to quality of results and stability
Morbidity – Immediately after surgery, the patient needs to stay home for a week or so after initial hospitalization and is put on regime of soft / liquid diet. Facial swelling and pain may be there for about 10 – 14 days. Patient resumes with normal diet after about 15 days and can attend work or college. There may be few restriction on physical activities for a month or so. There may be facial numbness for a few days which usually recovers with in 3 – 6 months.