Orthognathic Surgery

Orthognathic Surgery

Orthognathic surgery, or corrective jaw surgery, corrects a wide range of major and minor dental and skeletal irregularities. One of its primary functions is to correct the misalignment of your jaw and teeth, improving your ability to chew, speak, and breathe.

While orthognathic surgery is performed to correct functional problems, it can dramatically enhance your appearance as well.

Signs You Need Orthognathic Surgery

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  Difficulty chewing, biting, or swallowing food

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  Chronic jaw or jaw joint pain and headaches

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  Excessive wear of your teeth

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  Space between your upper and lower teeth when your mouth is closed (open bite)

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  Unbalanced facial appearance

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  Facial injuries

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  Congenital disabilities

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  Receding chin and lower jaw

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  Protruding jaw

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  Inability to close your lips without straining

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  Chronic mouth breathing

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  Breathing problems when sleeping, such as snoring

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  Inability to close your lips without straining

What is Craniofacial Surgery?

If you have injuries or deformities of the face and head, craniofacial surgery can help improve their look and function. We perform:

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  Reconstructive Surgery

This surgery addresses inadequate bone structure in the upper or lower jaws from injury, trauma, tumor surgery, or long-term denture wear.

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  Congenital Reconstruction

If you have congenital deformities, this form of surgery can help restore your jaw and facial structures to achieve normal function and appearance.

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  Cleft Lip (Cheiloschisis) and Cleft Palate (Palatoschisis)

If you have a cleft lip or palate, we can help repair them through specialized plastic surgery techniques. This form of surgery improves your ability to eat, speak, hear, and breathe while granting you a more normal appearance and function.

Treatment Stages and Time Frames

Your treatment team will work together to define your treatment plan. A treatment team can include an orthodontist, periodontist, general dentist, and oral and maxillofacial surgeon. We can add other medical professionals to the team as necessary, depending on the specifics of your case.

Initial Consult

During the initial consultation, we’ll evaluate your facial features. We'll also take measurements and pictures of your face and teeth. We'll discuss any issues you're having and their potential solutions at the initial consultation.

If you have any recent radiographs or up-to-date model casts, they will all be helpful to bring to your first appointment. If you do not have any of these items, we will take all the radiographs and models needed to ensure we can deliver a successful and customized treatment plan.

Presurgical Orthodontics

During this phase, your orthodontist starts to move and straighten the teeth so we, the surgeons, can place the jaws in the proper position. Any dental work needed should be done at this stage. All cavities should be filled before surgery.

Your gums and supporting bone must be healthy, and your oral hygiene must be excellent. Your wisdom teeth should be extracted at this phase of treatment.

This presurgical phase is often the longest stage of treatment. During this period, you'll see your orthodontist often. At these visits, they will check your progress.

Remember, the work performed at this stage is designed to give you a good bite after surgery. You may even feel like your bite is getting worse. That will change after surgery.

Preparing for Surgery

Once your orthodontist completes the presurgical orthodontic phase, your teeth will likely be in the right positions for surgery. At this time, you will be seen at our office again. We may take new models and discuss your case with the orthodontist.

You'll be given plenty of time to get ready for surgery and plan your recovery. Once we confirm that you are ready for surgery, we will meet again.

One month before the surgery, you need to donate one or two units of blood for your surgery. We almost never have to transfuse blood during or after this type of surgery, but if necessary, we will use this blood.

One week before surgery, you will have a physical exam and blood tests to ensure you're healthy enough for surgery. Depending on various factors, you may also need other tests, such as a chest x-ray or electrocardiogram.

Also one week before surgery, we will perform the presurgical orthognathic workup. Radiographs, articulating models, photographs, and facial measurements will be taken. Surgical procedures will be reviewed, and all risks, benefits, and possible complications will be discussed with you.

An informed consent of the surgical procedures will be reviewed. We will answer any questions you have at this time.

Things to Keep in Mind Before Surgery

There are many things you can do before surgery that will help your recovery:

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  If you smoke, quit. Smoking increases the risk of complications with anesthesia during surgery. It slows healing after surgery. It can also cause or worsen gum disease. The sooner you quit, the better. Have a plan with your primary healthcare provider to quit smoking.

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  Do not drink alcohol at least three weeks prior to surgery.

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  Maintain good oral hygiene.

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  Remember to arrange time off to recover. Ask us how long your home recovery is likely to take and plan in advance your absence from school or work accordingly.

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  Drink plenty of water every day for 30 days prior to surgery.

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  Plan your recovery. You need to learn what to eat, how to eat, and how to stay comfortable after surgery. You won't be able to chew at first. Your muscles are not strong enough, or in some cases, the jaw is held together with elastics or even wires for at least two weeks.

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  Have your prescribed medication ready at home. Be sure we are aware of all medications, herbs, or supplements you take. You may be advised to make changes before surgery. If you are taking any medication that could interfere with your blood clotting mechanism, please check with your PCP or family physician to be sure that you can stop this medication at least three weeks prior to surgery.

Recovery

Recovering in the Hospital

On the first day after surgery, you will begin drinking fluids, and a puree diet will be initiated.

You'll be urged to get up and walk as soon as possible after surgery. This helps you recover from anesthesia. It also helps prevent complications. Sometime later in the day, you'll likely be started on liquids. Using facial muscles helps reduce swelling, so try to talk if you can.

It's common to have some nausea on the first day. Vomiting when you can't open your jaws can be scary, but don't panic. Since you fasted before surgery and you're now taking only liquids, the vomit will be liquid. Just lean over and spit it out.

If you have any concerns about how nausea may affect you, talk to us ahead of time.

Medications

Right after surgery, you may have a PCA pump. With this machine, you will have a special button to push for the self-administration of pain medication. You will be able to manage your post-operative discomfort and pain.

You will be switched to oral medication prior to discharge from the hospital, and you will be given a prescription for medication upon hospital discharge.

You will be on IV antibiotics during and after surgery. You will be given a prescription for antibiotics upon hospital discharge.

Sometimes medication is given while in the hospital and upon discharge to help you sleep at night.

While in the hospital, you will have medication ordered if you feel nauseated.

During and after surgery, you will be given medications to help reduce swelling.

Most patients can resume their regular medications the day after surgery but be sure to confer with your oral surgeon before taking your own medications so that no complications arise.

swelling

You may have significant facial swelling post-surgery. The most severe swelling will last for at least a week after surgery, but most of the swelling (approximately 70% to 80%) will be gone within four weeks, although it usually takes several months until most of the swelling is completely gone.

Ice packs are usually used immediately after surgery and can help reduce swelling for the first 48 hours. After that time, the ice may not help reduce swelling, but many patients find the coolness feels good. Therefore, the ice can be used for an extended period of time.

Sit or lie with your head and shoulders higher than your heart. You will be given medications to help reduce surgical swelling.

going home

Prior to hospital discharge, you must be able to drink fluids well. You will also need to be able to take oral medications and take in puree meals.

You can go home when you're up and around, you have no signs of complications, and any nausea is under control. Before you leave, you'll be told how to reduce pain, swelling, and nausea at home. You'll also be given prescriptions for medications to help control these problems.

recovering at home

At this point, your job is to keep comfortable and help your body heal quickly. Make sure to get plenty of calories and protein. Get up and move around but avoid strenuous activity. Be sure to get lots of rest. Keeping your mouth and teeth clean will help the incisions heal.

If upper jaw surgery was performed, do not blow your nose after surgery for two weeks. You may sniff backward, but do not blow. Blowing your nose too soon after surgery can increase the risk of infection, increase facial swelling, and may increase the chances of bleeding.

You may have a splint (like an orthodontic retainer) on the roof of your mouth after surgery to help stabilize your upper jaw and facilitate the healing process. Your oral surgeon will remove the splint at the appropriate time, usually 4 to 6 weeks after surgery.

You may take a sponge bath and wash your hair the second day after surgery. Do not take a hot shower. Hot water may increase swelling and could make you light-headed and pass out.

Some minor nasal bleeding up to 7 to 10 days post-surgery is not uncommon, as this is part of the healing process of the sinuses as they clean themselves out. However, in the rare occurrence of severe nasal bleeding, you must go immediately to the closest emergency room.

Do not lift more than 10 pounds during the first month after surgery.

post-surgery follow-up Appointments

Our expert oral surgeons closely monitor patients' post-surgery while the patients are in the hospital and following discharge from the hospital.

You will be seen on a weekly basis for the first month following hospital discharge and then appointments as necessary. X-rays may be taken to check on how you're healing. The sutures on your face require removal, and they are usually very easily removed about one-week post-surgery.

The sutures inside your mouth are self-resorbing. If wires or elastic bands were used, they will most likely be removed or adjusted. This process takes just a few minutes and, in most cases, causes little or no discomfort.

You may be given special exercises to help retrain the muscles you use to open and close your jaws. Over time, your surgeon will monitor healing and ensure that bone and teeth align as originally planned.

Returning to work will depend on the nature of your surgery, the type of work you do, and your post-surgery progress. Some patients can return to work after 1 to 2 weeks, but others will require more time.

It takes approximately 3 to 4 months for the jaws to complete the initial bone healing phase and for most new bone to develop in the bony surgical areas.

It usually takes an additional 6 to 9 months for the new bone to mature and for the healing process to reach completion.

Temporary numbness in the face and jaw is very common with this type of surgery. It could take anywhere from a few days to a year or more until the feeling makes its maximum return.

Permanent numbness can occur, but this is uncommon.

completing your treatment

Surgery isn't the end of your treatment. You still need orthodontic work to perfect your bite. You'll see your orthodontist as soon as two weeks after surgery and very often during this last treatment stage, which often lasts 6 to 12 months.

Once your braces are taken off, your orthodontist will give you a retainer which will help to keep the teeth from moving out of their new positions.

your long-term care

After your braces are off, you may still need other dental work. Remember to use your retainer as directed. Get regular dental care to prevent or control gum disease and tooth decay. Home care is a key part of your ongoing treatment.

diet & nutrition

You will need to get enough nutrition, which may be harder when you can't chew. You also need fluids to help prevent dehydration and nausea. Avoid milk products, refined sugar, other sweets, and carbonated beverages postoperatively for at least 2 to 4 weeks. This will decrease mucous production, help prevent decalcification of the teeth, and minimize bacteria media.

Avoid caffeine products (i.e., coffee, tea, cokes, chocolate, etc.) because this could cause muscle and nerve problems as well as increase pain levels.

Dietary supplements can be taken after surgery but speak with your surgeon beforehand.

You will be on a puree diet following discharge and can usually progress to a soft diet within about 1 to 2 weeks. You will need to stay on a soft diet for approximately 3 to 4 months or as directed by your oral surgeon. It takes 3 to 4 months for the jaw bones to adequately heal to withstand normal biting forces.

Do not use straws postoperatively for the first ten days since the suction can stress the incisions in your mouth.

You can use a special feeding syringe (provided by the hospital), cup, glass, spoon, or fork to get your fluids and food into your mouth.

Drink eight glasses (8 ounces per glass) of water every day for 30 days after surgery

keeping your mouth and teeth clean

Try to keep your teeth as clean as possible. If you can't open your jaws, brush the front surfaces of your teeth with a baby toothbrush.

A special mouthwash may be ordered for you in the hospital that will also help keep the teeth and gums clean.

You can use an oral irrigator about ten days after surgery and on a low setting only. However, check with your oral surgeon before using one. An oral irrigator can be very helpful in keeping the mouth clean but can cause problems if used too early after surgery.

Aim to get back to brushing and flossing normally as soon as you can. Gentle brushing with a child-size toothbrush and toothpaste can begin the first day following surgery. Teeth should be brushed at least three times per day, particularly after each meal.

when to call your surgeon

If you have any of the following problems, call your surgeon:

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  Severe bleeding

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  Pain that can't be controlled

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  Nausea or vomiting that can't be controlled

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  Swelling that continues to worsen after 3 to 4 days

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  A fever of 101°F (38.3°C) or higher

Go to the emergency room if your doctor's office is closed.

your role after surgery

After orthognathic surgery, your role is to follow any and all of your oral surgeon's aftercare instructions in order to avoid complications and ensure a quick and speedy recovery.

Here are some post-op tips that your doctor may ask you to follow:

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  Take your pain medications as directed.

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  Do not drive a vehicle or perform any task that requires coordination or judgment for at least 48 hours following your anesthetic.

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  Apply ice packs and keep your head elevated to minimize facial swelling.

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  Brush your teeth gently with a small, soft bristle toothbrush, and make sure not to injure your gums while brushing.

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  Don't smoke.

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  While jaw motion may be restricted during the first one to two weeks after surgery, so to get proper nutrients, a liquid or soft food diet is recommended.

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  Avoid exercising, any heavy lifting, or activities that raise your blood pressure or pulse for at least a month after surgery.