How do I know I have a dentofacial deformity?
There are a number of conditions that can make us suspect that there is some kind of disorder at the dentofacial level that may require corrective surgical treatment:
- Difficulty chewing or biting food.
- Difficulty swallowing
- Chronic headaches, jaw or temporomandibular joint pains
- Excessive tooth wear
- Open bite (space between the upper and lower teeth when the mouth is closed)
- Unbalanced facial appearance from the front or side
- Asymmetries in the smile
- Facial injuries or birth defects
- Receding chin
- Protruding jaw
- Inability to make the lips meet without force
- Chronic mouth breathing and dry mouth
- Sleep apnea (breathing problems while sleeping, including snoring)
Why undergo orthognathic surgery?
The objective of orthognathic surgery is to correct a dentofacial alteration by changing the position of the jaw bones and teeth to a more functional (correct bite), more aesthetic (facial harmony), airway improvement (prevention or treatment of sleep apnea) and therefore healthier position for our patients.
Individuals who may benefit include those with an improper bite as a result of misaligned or poorly coordinated teeth and/or jaw bones. In some cases, the upper and lower jaws may grow at different rates. Birth injuries and defects can also affect jaw alignment. While orthodontics can usually correct bite or “occlusion” problems when only the teeth are misaligned, corrective surgery may be necessary to improve the misalignment of the jaw bones.
What types of surgery are performed?
Basically, there are three surgical procedures that are the most common: osteotomy of the maxilla (Le Fort osteotomy), bilateral sagittal mandibular ramus osteotomy (Obwegeser osteotomy) and finally chin surgery (mentoplasty).
These procedures are used among others to:
- Correct an open bite: the bone in the tooth-bearing upper jaw is mobilized. The upper jaw is secured in its new position with plates and screws.
- Correction of a protruding jaw: the position of the mandibular bone is modified so that the portion that carries the teeth of the lower jaw can be moved backwards, allowing proper alignment. On many occasions, the problem is due to a lack of development of the upper jaw, so this bone is mobilized to correct both the dental occlusion and the facial profile.
- Correction of a receding jaw: the bone in the lower portion of the jaw is separated from its base and modified. The tooth bearing portion of the lower jaw and a portion of the chin are repositioned forward. If necessary, the upper portion is also modified to improve esthetics and profile.
- Correction of gummy smile or lack of dental exposure when smiling: the position of both jaws in vertical height can be modified to correct these problems.
- Correction of facial asymmetries: The mobilization of both jaws will allow the harmonization of the facial profile and dental occlusion.
Why is orthognathic surgery combined with orthodontics?
Your dentist, orthodontist and oral and maxillofacial surgeon will work together to determine if you are a candidate for surgery. The maxillofacial surgeon determines which surgical procedure is appropriate and performs the actual surgery. It is important to understand that your treatment, which will likely include orthodontics before and after surgery, may take several years to complete.
Orthodontics is usually necessary to undo the dental offsets that have occurred over the years. It prepares the two dental arches to have a good relationship at the time of surgery.
After the intervention, orthodontics takes care of the completion of the case, giving aesthetics to the smile and long-term stability.
Will I feel pain after the intervention? Will there be scars on my face?
After the surgical procedure there is a normal and expected response of the body, they are not a complication as such but can be annoying.
The most common after a surgery of this type is to have alterations of facial sensitivity that result in feeling part of the face asleep. This type of sensory alterations are usually temporary, although lasting in most cases. In some cases there may be a definitive sensory alteration.
This surgery is not characterized by being very painful. Generally, there is no pain, or it is mild and easily controlled with the prescribed medication.
Regarding approaches and scars, surgery is performed in almost all cases through intraoral approaches, that is, through the gum. In this way, we can access the facial bones to be treated with ease and eliminate the possibility of external scarring.
Very rarely, an extraoral approach may be necessary. In such cases, minimal approaches are always performed in order to camouflage the subsequent scars in an esthetic way. This situation is almost exceptional.