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ORTHOGNATIC SURGERY
What is it for?
Changes the facial skeleton, improving occlusion (contact between teeth), the relative position of the bones of the face - maxilla ("upper jaw") and/or mandible ("lower jaw") - and facial aesthetics
What does it mean?
Maxillary and/or mandible orthognathic surgery is the culmination of an orthodontic preparation process that takes about 9 to 18 months, which is previously performed by a dentist. The position of the teeth is adjusted so that at the end of surgery, the relative position and occlusion becomes more favoured. It also implies a three-dimensional pre-surgical planning in order to decide the bone movements to perform, and the creation of intraoperative splints.
Bone movements are obtained through controlled fracture of the maxilla and/or mandible and its fixation with plates and screws, allowing correction of problems such as:
- Crossbite - horizontal misalignment of the mandible and maxilla
- Maxillary hypoplasia ("jaw retrusion") - by advancement and vertical descent of the upper jaw, increasing the projection of the bone area below the nose
- Long face with excessive exposure of the upper incisors and gingiva - by reducing the maxillary height
- Mandibular retrognathia or micrognathia ( "small lower jaw") - by extending the dimensions of the jaw
- Prognathism ( "prominent jaw") - through a combination of compensation with maxillary advancement and mandibular setback
- Chin with reduced or exaggerated projection - changing its position and dimensions by genioplasty
Procedure time
2 hours to 4 hours depending on whether a monomaxillary surgery or bimaxillary surgery with/without genioplasty is performed
Other procedures that can be associated
Genioplasty. Rhinoplasty is a procedure that can be carried out after recovery of orthognathic surgery, because the latter itself changes the shape and position of the nose
Type of anaesthesia
General anaesthesia
Scars
The scars are inside the mouth, unnoticeable
Hospitalization
1 to 3 days in hospital
Recovery
Orthognathic surgery allows more radical changes of the face but also requires longer recovery time. Generalized swelling of the face is expected for a few days, gradually reducing in the following weeks. Postoperatively, braces with rubber bands are required for a few weeks to promote favourable occlusion
Most frequent problems and risks
One of the most frequent and significant risk of mandibular orthognathic surgery is lower lip numbness, usually temporary if there is only blunt trauma, but it may be permanent or have protracted recovery in the event of section of the inferior alveolar nerve or mental nerve, which are directly related to the mandible (relatively rare situation). Other complications of mandibular and/or maxillary orthognathic surgery are infection, fracture or displacement of plates or screws (which can be removed after a few months if necessary), injury of dental roots or teeth, slight deviations of dental occlusion (mainly due to weaknesses in the preoperative preparation, and usually correctable postoperatively). In procedures where a mandibular setback is performed, neck laxity (sagging neck) is expected to slightly aggravate and nocturnal respiratory distress (obstructive sleep apnoea syndrome) could become worse in some cases
Longevity
The procedure is definitive, although long-term small millimetric deviations in dental occlusion are possible in more complex cases
