Orthognathic Surgery

What is Orthognathic Surgery?

Orthognathic surgery, also known as corrective jaw surgery, is a combined orthodontic (braces) and surgical treatment approach for the correction of dental, jaw and facial deformities.

Why is Orthognathic Surgery Necessary?

The upper and lower jaws are bases upon which teeth and soft tissues are aligned. Braces can only correct dental abnormalities like crooked teeth and poor bites (malocclusion). However, disharmonies of jaw size or position can only be corrected surgically to achieve a good overall outcome.

​What Problems are Best Dealt with Orthognathic Surgery?

Common problems that can be dealt with are:

• A protruded or retruded chin
• Excessive show of gums (i.e. Gummy smiles)
• Overall elongation of face
• Facial asymmetry
• Post-traumatic facial injury and defect
• Obstructive Sleep Apnea
• Cleft lip/palate or other major craniofacial anomalies, as part of the comprehensive management plan

What are the Possible Causes of Jaw Abnormalities?

There are many causes of jaw discrepancies. They may be inherited or acquired from developmental or traumatic causes. Jaw discrepancies may affect not only your facial appearance but also your bite, speech and chewing.

​Diagnosis of a jaw deformity is usually by clinical examination, with radiographic imaging to accurately determine the site, nature and extent of the deformity.

​What is the Sequence of Treatment?

Treatment is carried out in 4 phases:

• Phase 1: Treatment Planning
  Treatment planning is carried out jointly by an orthodontist and an oral and maxillofacial surgeon. The orthodontist determines how braces will align your teeth in preparation for surgery. The oral and maxillofacial surgeon studies your jaw deformity and decides on the type of surgery most appropriate for your case. This initial phase of treatment will include consultation, records-taking and discussion of the treatment plan with you.
  
• Phase 2: Pre-surgical Orthodontic Phase
  Many patients undergo an initial period of pre-surgical orthodontic treatment which may take 9 to 18 months. The actual time taken depends on the condition, the patient's age, cooperation and other factors. During this time, patients are seen at intervals of 4 to 6 weekly intervals.
  At the end of this phase, the teeth are aligned so that they will fit into a good bite after surgery.
  
• Phase 3: Surgical Phase
  Surgery is scheduled when the pre-surgical orthodontic phase is completed. Inpatient surgery is needed to correct the malalignment in the jaws and face by making cuts in the jaw bones and repositioning them in their desired alignment. Most patients can be discharged from the hospital after 1-3 days.
  
• Phase 4: Post-surgical Orthodontic Phase
  After surgery, post-surgical orthodontics is continued to achieve final alignment of the teeth and to retain them in their new position.
  

Can Surgery Be Avoided?

In growing patients, timely orthodontic intervention can sometimes correct jaw disharmonies. Special braces can then be used to modify bone growth, eliminating the need for surgery. However, for patients whose facial bones are no longer growing, certain corrections cannot be achieved with braces alone. A combined approach of braces and surgery is the appropriate form of treatment for such cases.

What are the Benefits?

Oral hygiene is easier to maintain without poor bites and crooked teeth. Speech or chewing problems due to jaw disharmonies may be resolved. It may minimize excessive wear of the teeth over years of use in severe malocclusion associated with jaw discrepancies. The relationship of the jaw bones is harmonised, restoring balance to the middle and lower face, thus improving facial appearance. The lasting reward is a healthier and happier you.

Orthognathic surgery is a predictable treatment option to complex dental/facial problems. It ensures the best possible results, both functionally and aesthetically.

​Are There Any Risks?

No surgery is risk-free. Understanding the possible complications can help you make a better decision.

Orthognathic surgery is performed under general anaesthesia. It usually requires hospitalisation of about 1-3 days. Patients who undergo orthognathic surgery are generally healthy and therefore able to recover more easily.

Different conditions are corrected with varying procedures during orthognathic surgery. To set your mind at ease, simply ask your surgeons about the risks.

​How do I look after myself after the surgery?

After the surgery, you will be prescribed medications to control pain and improve your recovery experience. Most patients are able to feed on liquid diet by mouth in the days immediately after the surgery. Your surgeons will walk you through your progress back to normal diet over the next few weeks during your postoperative visits. Proper oral hygiene care is crucial in preventing post-operative infections.

You are advised to avoid:

• Vigorous physical exercises including swimming, typically for the first 3 weeks or until your wounds have healed.
• Participation in contact sports and activities that may result in trauma to the face and jaws for 6 months to prevent accidental fractures of the healing bone.

The surgical team will be in the best position to educate you on post-surgery care advice, including feed and hygiene instructions, which are individualised to your needs.