Jaw surgery or orthognatic surgery is a surgical procedure for jaw repositioning to correct any eventual imbalance between the upper and the lower jaw. This kind of surgery might be needed when jaws don’t meet correctly causing teeth misaligned, difficulty chewing, biting, swallowing etc.
If the imbalance between jaws is small sometimes all you need are braces, this way the jaws misalignment is camouflaged with correct teeth alignment. While braces and orthodontics can correct teeth alignment problems, orthognatic surgery can solve more complex cases where jaw repositioning is needed.
Corrective jaw surgery may be done to the lower jaw, upper jaw or both of them in the same time depending on the problem. It is performed under general anesthesia and all incisions are performed inside the mouth leaving no visible scar. Pain after jaw surgery is easily controlled with painkillers, and the patient can go back to his normal life after one or two weeks.
Before any surgery the alignment of the teeth might be needed
Upper jaw problems
- The maxilla or upper jaw is bigger -Sometimes the maxilla or the upper jaw is not normally developed and tends to grow forward. In these cases the maxilla appears to be longer or bigger, creating an excessive exposure of the gums, the so called gummy smile. This problem can be solved with an orthognatic sugery, where the upper jaw is separated from the rest of the skull and it is positioned superiorly and backwards. It is fixed with plates and screws which osteointegrate in the jaw so another surgery for their removal will not be needed. After the rehabilitation only he the teeth will be visible when the patient smiles.
- The Maxilla or upper jaw is smaller– In this case the inverse surgery might be needed. The maxilla is divided from the skull and brought forward.
- Transverse Maxillary Deficiency-When this condition it’s present another kind of jaw surgery could be performed. In these cases the maxilla is tighter than normal. Generally these patient breathe with their mouth since early age, so the nasal pavement it’s not fully developed. In other cases they have sucked their thumb for too long when were little or because they had other abnormal habits that interfere with the normal development of the orthognatic system. If the patient is still young these discrepancy can be solved with the positioning of a rapid palatal expansor. In more severe situation and when the patient it’s not so young a surgery is needed. The maxillary bone is divided surgically in half exactly where the median palatine suture (the suture that connects the left and right part of the maxilla during growth) used to be. The two parts are divided with an orthognatic appliance and the empty space will fill with bone in a short period of time. After this process the maxilla will be larger and will match the lower jaw in the correct way.
Lower jaw problems
- Mandibular retrognathia- Is a condition where the lower jaw appears weak and a receding chin is present. The procedure needed is called mandibular advancement. During the surgery the lower jaw is separated and it’s brought forward to accompany the position of the upper jaw. The new position of the lower jaw is fixed with plates and screws that osteointegrate and don’t need to be removed after.
- Mandibular prognathia– The condition where the lower jaw appears too large in confront with the upper jaw. In these cases the surgery needed is the inverse process of what we explained for the mandibular retrognathia. The procedure is called mandibular setback. The mandible is separated and it’s positioned backwards, the excessive parts of the bone are removed and the jaw is fixed again with plates and screws.
Is a surgery performed when there is no discrepancy between the jaws and there are no bite problems between lower and upper teeth. There is only a chin problem which needs to be reshaped advanced or setback. Part of the chin bone is separated and repositioned forward, backward, rotated etc and it is fixed in the new position with plates and screws. It is not an important procedure as the other one mentioned and the discomfort after is smaller.
Both Jaws are Problematic
Sometimes the problem it’s not located in one of the jaws but in both of them in the same time. This kind of surgery is called bimaxillary surgery. Each jaw can be moved in any direction needed to fully correct the problems