Orthognathic surgery is performed for the correction of jaw bone deformities involving facial asymmetry and a possible dental malocclusion problem. It is also called “surgical orthodontics” because just as an orthodontist repositions the teeth, a maxillofacial surgeon uses orthognathic surgery to reposition the facial bones (upper and lower jaw).
It consists of performing osteotomies (partial cutting of the bone) in the bones of the maxilla and/or mandible, thus correcting their position and achieving perfect occlusion of the teeth and harmonious proportions of the face. The intervention is performed through incisions inside the mouth so they are not visible. Fixation of the maxillary and mandibular bones is achieved by the placement of titanium plates that in most cases will not need to be removed.
The postoperative recovery period ranges from 7 to 10 days in most cases and the benefits include improved ability to chew, speak and breathe. In most cases, the patient’s esthetics are also improved.
Three-dimensional design for orthognathic surgery
Before orthognathic surgery is performed, a precise diagnostic and planning process is necessary. For this purpose, virtual planning with three-dimensional imaging systems is available, with which the planning of the jaw changes is more precise.
Currently we have computer programs to perform an optimal treatment, with stereolithographic models that simulate the facial skeleton of the patient to perform the scheduled surgery in the office of the oral surgeon on these models, thus increasing the safety of the surgery.
Orthognathic surgery is usually combined with orthodontics so that the teeth are in the correct position after surgery. Therefore, coordination between the maxillofacial surgeon and the orthodontist is essential, since the success of the treatment is based on the correct positioning of the teeth, the maxillomandibular bone bases, the analysis of the face and the patient’s expectations.
Orthognathic surgery in 3 phases
Orthognathic surgery treatment has three phases: a pre-surgical orthodontic treatment, the surgery itself and a final phase of occlusal adjustment performed by the orthodontist. The total time of the three phases is usually 1 to 2 years and it is necessary to wait for the natural growth of the body to finish the surgical intervention, between 17-19 years of age.
- Pre-surgical orthodontics will move the teeth to a new position so that they will fit correctly when the jaws are repositioned with surgery. This phase of orthodontics usually lasts 6 to 18 months. You will need to see the maxillofacial surgeon every 4 months during the orthodontic phase.
- Orthognathic surgery is performed under general anesthesia. Prior to surgery, the patient will require a physical examination and a blood test to ensure that he/she is fit enough to undergo surgery. Orthognathic surgery can last from one to several hours, depending on the type of surgery required. Immediately after surgery the patient will be transferred to the recovery room until the general anesthesia has worn off. Intravenous medication will be administered for post-surgical control of pain and discomfort. The duration of this recovery may be one or several days.
- In occlusal adjustment, the orthodontist will begin the post-surgical phase of orthodontic treatment 4 to 6 weeks after the operation to refine the bite. In most cases, the brackets are removed 6 to 12 months after surgery. Thus, the orthodontist is responsible for moving the teeth so that they are positioned correctly after the jaws have been repositioned by orthognathic surgery. In addition, the general dentist will be responsible for maintaining your oral health before, during and after surgical treatment.