What is Orthognathic Surgery?

Orthognathic surgery is a solution for those who have malformations or anomalies in the mandible, maxilla, or both. It's a safe procedure with a demanding postoperative period.
What is Orthognathic Surgery?

Last update: 13 September, 2021

Orthognathic surgery is a dental procedure performed to correct dentofacial disharmonies or deformities. Although often undetectable to the naked eye, these anomalies alter a person’s facial structure.

According to estimates, around 5% of the world’s population has some type of dental abnormality in the maxilla or mandible. This not only affects aesthetics, but can also compromise chewing, swallowing, breathing, and speech.

What is orthognathic surgery?

A surgeon preparing tools for surgery.
Orthognathic surgery corrects dentofacial deformities.

Orthognathic surgery is a surgical procedure that specialists perform to correct the position of the maxilla and mandible. When this is abnormal, it causes functional problems such as malocclusion, sleep apnea, digestive, and diction difficulties.

This type of surgery allows for the solution of skeletal-facial discrepancies (of the bones of the face) as well as to correct asymmetries. It also makes it possible to repair facial injuries or congenital defects in this area.

A maxillofacial surgeon must perform the procedure. It involves a long preparatory process of 12 to 18 months to align the teeth with braces. During that time, a professional must perform multiple X-ray and 3D imaging tests to identify changes in the maxillofacial structure.

This surgery involves general anesthesia and requires a hospital stay of two to four days. During the procedure, the surgeon makes cuts in the bones and then fixes them in a new position using plates, rubber bands, screws, and the like.

Types of orthognathic surgery

There are three types of orthognathic surgery: Maxillary, mandibular, and simultaneous mandibular and maxillary, also called maxillomandibular or mandibular. Let’s see what each of them consists of.

Orthognathic surgery of the maxilla

Orthognathic jaw surgery involves placing the jaw in the correct position. The objective’s to restore facial harmony and, above all, the functionality of this bone, which is key to chewing, breathing, and speech.

The surgery includes a cut in the maxillary bone, a procedure known as Le Fort I Osteotomy. It allows lengthening, shortening, retracting, advancing, or rotating the maxilla. Once it’s in the correct position, the surgeon fixes it in place with titanium plates. Orthognathic surgery of the maxilla takes about 40 minutes.

Orthognathic jaw surgery

This surgery involves bringing forward or retracting the jaw. However, in the latter case, there’s a risk of narrowing the airway, so it’s rarely performed. Mandibular advancement, on the other hand, has no major risks.

Usually, mandibular orthognathic surgery takes place when a person has a small and retracted mandible about the maxilla. This condition is known as retrognathia or class II and often contributes to sleep apnea.

During surgery, the surgeon cuts each side of the jaw bone. This procedure is called a bilateral sagittal osteotomy. They then advance the bone and fixed in its new position using titanium plates. The operating time is about 30 minutes.

Maxillomandibular orthognathic surgery

Maxillomandibular orthognathic surgery is the most common type of orthognathic surgery. It involves repositioning both the maxilla and mandible. The objective is to achieve a correct occlusion and also to provide greater facial harmony.

Doctors recommend it to treat malformations such as class II, class III, open bite, or facial asymmetry, among others. During the procedure, the actions of maxillary and mandibular orthognathic surgery are combined. The operation lasts between 90 and 120 minutes.

Possible complications

A plaster model of the gums and teeth.
The procedure is considered safe, although it may produce some complications.

Orthognathic surgery is a safe procedure that only rarely produces complications. Although it has a demanding postoperative period, most people manage to overcome everything successfully.

The main complications are the following:

  • Blood loss. About 30% of patients require a blood transfusion during orthognathic surgery.
  • Infection. Infections are very rare. To prevent them, the patient receives intravenous and oral antibiotics during recovery.
  • Nerve damage. There’s a risk of injury to a facial nerve during orthognathic surgery.
  • Mandibular relapse. Occurs when the jaw returns to the position it was in before surgery. This is very rare.
  • Mandibular fracture. This only occurs in 2% of the cases.

What does the recovery process involve?

The postoperative period after this type of surgery is long and demanding. It can take up to nine months, during which the patient must make nutritional adjustments, avoid alcohol consumption, and maintain strict oral hygiene, usually using chlorhexidine mouthwash rinses three times a day.

After surgery, experts usually recommend a period of rest of two to three weeks. There will be swelling in the face, so doctors usually recommend the use of a chin guard, anti-inflammatory drugs, and the application of cold compresses to the area.

It’s best to start physiotherapy immediately to recover normal movement. Usually, in the beginning, tube feeding with a syringe is necessary. Then the patient moves onto ground food, shakes, and broths.

Orthognathic surgery, a way to improve self-esteem

Most commonly, orthodontic treatment is required before and after orthognathic surgery. This allows bone stability to be achieved, as well as a stable occlusion. Therefore, the surgeon and orthodontist must work as a team.

This type of surgery makes it possible to correct functional problems caused by malposition of the maxilla, mandible, or both. It also improves the appearance of the face. This is something that shouldn’t be minimized, as in many cases, it affects a person’s self-esteem.

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