Introduction to Corrective Jaw Surgery

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Orthognathic Surgery

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The medical term for corrective jaw surgery is orthognathic  surgery.  The term orthoghnathic it is derived from the latin words “ortho” (straight) and “gnathic” (Jaw) meaning “jaw straightening” surgery. Orthognathic surgery is designed to correct imbalances of the jaws and surrounding bones and soft tissues of the face.  The surgery involves repositioning any bones of the face necessary to move the jaws and teeth into a more balanced, functional, and healthy position. The results of corrective jaw surgery can have a dramatic positive effect on many aspects of one’s life.

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Functional vs. Aesthetic

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There is a close relationship between the functional and the aesthetic aspects of corrective jaw surgery.  “Form follows function” is a famous phrase used throughout all fields of medicine, but is particularly relevant to this type of surgery.  It means that when the bones and soft tissues of the body are repositioned to restore normal function, normal aesthetics are typically achieved as well. Although corrective jaw surgery is often performed to achieve specific goals related to either function or aesthetics, commonly both are improved simultaneously. The knowledge gained from treating the functional issues related to an imbalance of the facial bones has resulted in techniques to improve facial aesthetics when functional impairments are not present.  Modern techniques allow us to reduce, augment, and reshape the facial bones.  The chin can be advanced or reduced, the cheekbones can be enhanced, the jawline can be remodeled as well as the forehead and orbits (bones around the eyes).  This allows for a new dimension in cosmetic surgery.

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Who Is a Candidate for Corrective Jaw Surgery?

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Individuals who may benefit from corrective jaw surgery include those with functional and/or aesthetic issues related to an imbalance of the jaw bones.  The jaw bones may be imbalanced for several reasons: a birth condition, growth discrepancy, previous surgery, habit (tongue thrusting, finger sucking, etc.), or as the result of trauma.  While braces alone can correct the occlusion or “bite” when the teeth are misaligned, corrective jaw surgery is necessary when the jaw bones are imbalanced.  Your dentist, orthodontist, and facial surgeon will work together to determine if you are a candidate for corrective jaw surgery.

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Functional conditions that may indicate the need for corrective jaw surgery include:

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1. Difficulty chewing or biting food

2. Difficulty swallowing

3. Difficulty pronouncing certain words or sounds

4. Difficulty with nasal breathing

5. Chronic mouth breathing and dry mouth

6. Chronic TMJ (jaw joint) pain

7. Obstructive sleep apnea

8. Accidental cheek biting

9. Snoring

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Aesthetic concerns that may indicate the need for corrective jaw surgery include:

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1. A “weak” lower jaw or chin

2. A prominent lower jaw or chin

3. A “gummy smile” (showing too much teeth and gums)

4. An “edentulous look” (not showing enough teeth)

5. An anterior open bite (front teeth not touching when back teeth are fully closed)

6. Small upper jaw with unsupported upper lip and nose

7. Inability to fully close lips together without straining

8. Excess soft tissue and fat under chin

 

What Procedures Will Be Performed?

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The exact procedures to be performed will not be determined until the orthodontic treatment is complete and a final set of records are taken and analyzed.  An experienced orthognathic surgeon can perform procedures that allow the upper and lower jaws to be repositioned in any direction. Procedures to move the upper jaw, lower jaw, and improve nasal breathing are commonly performed simultaneously with additional aesthetic procedures such as a genioplasty, submental liposuction, facial implants, ear “pinning”, or rhinoplasty (see “Cosmetic Procedures Performed With Corrective Jaw Surgery)). The surgeon will reposition the jaw bones in accordance with your specific needs. In some cases, bone may be added, taken away, or reshaped. Surgical plates, screws, and wires may be used to hold your jaws in their new positions.  In most instances the surgery is performed through small incisions made in the mouth.  Utilizing fiber-optic lighting and special instruments, it is possible to reach and operate on almost all areas of the lower face from inside the mouth, avoiding the need for any incisions on the face.  Certain facial bone procedures require very small incisions to be made on the face. When this is necessary, care is taken to minimize and hide these small incisions, typically making them insignificant.  In those instances when the bones of the midface, such as the orbits or forehead are involved, incisions are hidden in the natural skin folds of the eyelids or in the hairline and are usually inconspicuous.  Sometimes, your jaws will be closed together after the surgery with either wires or heavy elastics, for up to four weeks.

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What Will Happen if I Don’t Have Orthognathic Surgery?

 

If your facial bones are imbalanced causing your bite to be off and you choose not to proceed with orthognathic surgery, you may be at an increased risk of developing:

1. TMJ pain and dysfunction

2. Facial pain

3. Periodontal disease

4. Premature tooth loss

 

Patients with uncorrected facial bone imbalances are statistically more likely than a person with a “normal” bite to develop the above problems, however there are many people with uncorrected facial bone imbalances that do not have any of the above problems.  Although one should be aware of the possible consequences of not correcting facial bone imbalances, this should not be the only motivating factor.  An individual should be motivated by the entire package of improved function and aesthetics as well as prevention of future problems.