What is orthognathic surgery?
Orthognathic surgery is surgery that corrects dentofacial deformities. They are those patients that we can see many times in the street with an excess of jaw, we see a very powerful jaw, that protrudes a lot, or we see a lot of jaw but in reality what they have is very little upper jaw, or very little marked cheekbones. Or on the contrary, there is a group of patients that we see that they do not have a chin, that we see the lower lip. We see the neck and, practically, it is a straight line where the cervicofacial angle cannot be discerned; it is not that they do not have a double chin, it is that they do not have a neck.
There is another group of patients who are asymmetrical, patients who you look at their face and you notice that the jaw is very deviated to one side, or that the upper jaw is canted, or that you see that one eye is on top of the other. And perhaps, finally, we can include in this surgery those patients who, without having a great dentofacial deformity, what they have is that they are not happy with the shape of their face. Nowadays we can achieve, with a very protocolized and minimally invasive surgery, that the facial appearance improves a lot.
In many of these patients who have a dentofacial deformity, their teeth do not match, they have the jaw in front, the upper jaw behind and they have a problem to eat, to chew, they have problems to keep many of their pieces, which they see overloaded because they only use a few of them. On many occasions, orthognathic surgery is always accompanied by orthodontic treatment, which may consist of immediately placing brackets and operating on the patient, or we may place brackets on the patient for 3 or 4 months and then operate on him/her, or a previous orthodontic treatment of 1 year or 1 year and a half and then operate, depending on the initial state of the patient. The relationship between us, the specialists in Oral and Maxillofacial Surgery, and the orthodontists is key, because it is thanks to them that we achieve an excellent result in orthognathic surgery.
Is it a very aggressive surgery?
Classically, orthognathic surgery has been considered a very aggressive surgery. Patients come to the consultation with a lot of fear, they have looked on the internet, “doctor, what is this? I only watch videos on youtube and they are tremendous, in the opinion forums they say it is a savage surgery…”. Today this is very successful. Here at the institute, thanks to a series of fundamental elements, small but united, what we do is to achieve that what used to be a difficult surgery, it is true, nowadays becomes a surgery in which the patient is operated on in the morning and the following morning he can go home.
What we do, first of all, is to take great care in the previous preparation of the patient. The patient has to come to the operating room very well prepared, not physically, which is fundamental, but psychically. He has to know what he is coming for, and this is important because the patient has to start moving quickly, he has to start moving, he has to start having a positive and dynamic attitude after the surgery in order to avoid, as far as possible, getting carried away by the fatigue inherent to any intervention. Secondly, we take great care of the anesthetic part. From the moment the patient enters the room we try, as far as possible, to lower the temperature as much as possible, we set it at a few degrees the night before the operation, so that the patient will be cold. He will not feel cold because he will be asleep, but during the surgery he will be cold, he will have a very low blood pressure and, with this, what we achieve is that he will have a very small expense, he will consume very little blood, he will have very little basal consumption and, therefore, the surgical gesture for the patient will be very small. Furthermore, the fact that the surgical field is clean and I do not have to waste time cleaning and aspirating the blood makes it easier for me to carry out each of the steps of the surgery in a very direct and very programmed way.
This is the third key part of planning orthognathic surgery, to make it a short surgery, a surgery that is about. A bimaxillary orthognathic surgery lasts 1 hour and a half. That is why what we do is to plan everything very well at home before arriving at the surgery. I spend 1 hour and a half to operate but it is possible that I spend 6 or 7 hours at home to plan the case well and that in the operating room I do not have to improvise absolutely nothing, that I have to do one step after the other, step A, B, C, which are the steps that I have previously and calmly planned at home.
Nowadays we have very powerful tools to plan the surgery. We take a CAT scan of the patient in the office, we take a series of photographic records, we take his teeth in 3D and all this information is transferred to the computer. I have the patient in my house in 3D with a simulation software and a surgical planning software with which I plan all the facial movements with millimetric precision and I can have everything analyzed and make a series of surgical guides that are carried by the computer and allow me to take each of these small fragments that I have moved through small incisions to their correct position.
What complementary procedures can we perform during orthognathic surgery?
Since we manage to greatly optimize the orthognathic surgery time, we can perform the surgery in practically one hour or one and a half hours. This allows us, in the same surgical act, as we finish the orthognathic surgery, to take advantage of that same surgery, that same anesthesia, the moment and the recovery, to perform more complementary procedures.
Thus, practically 80% of the patients that we operate orthognathic surgery are usually associated with a rhinoplasty and perhaps 90% of the patients are associated with a mentoplasty. In addition, many of them can have eyelid surgery, blepharoplasty, and sometimes we even perform a facelift in the same surgical procedure. And in as little as 5 – 6 hours, 4 hours, depending on what complementary procedure we do and use, we can solve a lot of problems at the same time.
What is the post-operative period of orthognathic surgery like?
This is the eternal question patients ask when they come to the office. The patient will eat from the first day, as soon as he gets to the room after the post-operative awakening, he will start eating and he will never eat with a straw. The first few days he will eat with a syringe and that will last for a week. After a week he will be able to eat normally, we will remove the rubber bands, he will open his mouth, he will do exercises of forced oral opening, he will eat a diet the first few days more crushed and then, as the days go by and he gains strength, a more consistent diet, but he will never become malnourished during the first month. The mouth will not be closed for a month, the mouth is blocked to guide the new musculature that we have placed in a new position and we need some guide bands that, when opening and closing the mouth, take the jaw with respect to the upper jaw to that new position that we want the mouth to have. But, before eating, he will remove the rubber bands and will do forced opening exercises, he will eat and will have a good oral hygiene.
A very important part is to clarify that this surgery does not hurt, it is not a particularly painful surgery. There are other surgeries on many other parts of the body that are more painful than orthognathic surgery. It is a fairly bearable surgery. It is an uncomfortable surgery, especially during the first two days of the intervention, the day of the surgery at night and the following day. Then the edema begins to diminish and the recovery and the time it takes for the patient to feel much better, but there will be no pain.