INTRODUCTION TO ORTHOGNATHIC SURGERY
Orthognathic surgery is jaw surgery performed by the maxillofacial surgeon. This type of surgery is performed in order correct malocclusion and move one or both jaws to a new position, which ensures the correct relationship between jaws and the possibility to create the correct occlusion by means of orthodontic treatment. When the jaw is moved forward or backward, up or down, the facial soft tissues, such as chin, lips, cheeks and nose tip, move as well, and the face height changes. Therefore, given the correct jaw position, facial profile becomes straight and harmony of new features is achieved.
Orthognathic treatment lasts for about 2 years, in cooperation with an orthodontist.
Malocclusion can be caused by:
- It can be genetically inherited;
- It can be caused by environmental factors – too early loss of calf’s teeth, irregular breathing, and so on;
- Upper and lower jaw size/fit discrepancy;
- Improper tooth position (misaligned, crooked teeth);
- Lack of space in the dental arch (crowded teeth);
- Non-standard tooth shape and size.
Whom to contact concerning above mentioned problems?
It is possible to consult an orthodontist for an initial consultation. Upon evaluation of your teeth position, occlusion and jaw size, he or she decides whether orthodontic treatment alone is sufficient or whether additional surgical treatment is required. If the case is complicated, the orthodontist advises the patient to consult a maxillofacial surgeon.
Why is it necessary to correct malocclusion?
- When malocclusion is present, the tissues around the tooth are being damaged while chewing food, the inflammation is caused and the bone resorption process starts;
- Due to resorbed bone teeth can become movable and gaps among teeth may form;
- In case of incorrect teeth position, plaque builds up rapidly and causes inflammation of the tissue around the tooth. Then the decay damages the teeth;
- Temporomandibular joint of the lower jaw can be damaged due to excessive exertion caused by malocclusion;
- Patient expectations – the smile and aesthetics which would make him or her happy.
When is orthodontic treatment applied?
- It is important to notice the improperly growing jaws and malocclusion in children of 9-13 years , since this age this age allows solving problems by applying orthodontic functional devices. The treatment takes about 1.5 years.
- Orthodontic plates or braces are used for orthodontic treatment of patients over the age of 13. The treatment period lasts from 1 to 2 years.
- There no age limits for orthodontic treatment, however, such a treatment in cases of elder patients can be more complicated and time consuming. Over the years, due to the bone tissue resorption orthodontic treatment becomes impossible. The treatment lasts from 1 to 3 years.
In which cases is surgical treatment applied?
Not all orthodontic abnormalities can be treated by orthodontic means and the surgical treatment is required. Ortognathic operations can be performed at the age of 18 years and elder patients. The treatment lasts for the period of 2-3 years in cooperation with an orthodontist.
When should one contact a maxillofacial surgeon?
- Orthognahtic operations can be performed from the age of 18, so until then, if there is a problem of malocclusion, it is necessary to consult an orthodontist. If orthodontic treatment is not enough, it is then necessary to wait until the child turns 18 and prepare for the orthognathic treatment.
- If you are already 18 years old, and your jaw position is incorrect, it is difficult to chew food, you feel discomfort related to your face, it advisable to contact the maxillofacial surgeon.
- If you consult an orthodontist at the age of 18, but it appears that your case is complex and orthodontic treatment alone is not be sufficient, the orthodontist will advise you a visit to the maxillofacial surgeon.
For an initial consultation of a maxillofacial surgeon it is necessary to have:
- Panoramic scan of the mouth (orthopantogram);
- Lateral head cephalogram (teleradiography);
- Dental plaster models that can be produced by your orthodontist.
Stages of initial consultation:
- Your doctor will examine your oral cavity;
- Visual inspection of dental plaster models, evaluation of x-ray scans. If the case is complex, a CT scan will be performed at the clinic;
- Discussion with your doctor regarding your occlusion problems, health problems, medical history;
- Your face will be photographed from the front and in profile;
- You will register for the next visit to discuss in order to discuss the treatment in details, i.e. for the presentation of the treatment plan.
PRESENTATION OF THE TREATMENT PLAN
Once the doctor has prepared the plan of treatment (that is one of the most important stages), it is presented to the patient within 1-2 weeks after the initial consultation. During the presentation of the treatment plan the specifics of treatment, duration, risks and potential complications are discussed. Alternative treatment plans are discussed as well. Once the treatment is started, a radical change in tactics or turning the treatment back may be impossible
PREPARATION FOR THE SURGERY
(Orthodontic treatment – ORTHO-3)
During this treatment phase the patient is undergoing orthodontic treatment that involves orthodontist and maxillofacial surgeon. The aim of orthodontic preparation is to align the teeth and form proper dental arches according to the treatment plan outlined by the surgeon. This result is compulsory in order to start the orthognathic treatment.
Stages of treatment:
- Before the start of orthodontic treatment, or at the beginning of it, all teeth of wisdom are extracted;
- There may be a need to remove two or four healthy teeth due to significant size mismatch between dental arches or teeth crowding;
- For about 12-18 months prior to surgery, the patient wears braces on upper and lower teeth. The aim of orthodontic preparation is to align the teeth into well-aligned arcs that would fit together in accordance with a treatment plan.
- 1-2 weeks before the surgery are the period of preparation for the surgery. At that time, the orthodontic treatment has already been completed and the teeth can no longer be moved with braces. All diagnostic tests and preparatory actions are performed by a surgeon, since it is him who is responsible for the post-operative result and the accuracy of the operation.
- The patient arrives at the hospital for elective orthognathic surgery. He has to be completely healthy and not suffer from any viral respiratory tract infections 2-3 weeks prior to the surgery.
- After the surgery, when the jaws are completely healed, final orthodontic treatment begins and lasts from 6 to 12 months.
SURGERY AND POSTOPERATIVE PERIOD
The patient needs to know that before the surgery:
- Orthognathic surgery is elective, therefore, the patient must be completely healthy and not get viral respiratory tract infections 2-3 weeks before the surgery. If the patient has a cold or running nose, the surgery must be postponed for 2-3 weeks.
- The stomach must be empty before the surgery. If a surgery is planned to be performed in the morning, one may have a meal until 20:00 an evening before and drink liquids until 22:00.
- The morning before the surgery eating and drinking is prohibited. It is a vital rule as if the stomach content rises and gets into respiratory tract the chances of lethal outcome are very high.
Stages of orthognathic surgery:
- The lower jaw is divided into two side sections and a central part where the teeth are located. The central part is placed into proper position and fixed in accordance with the original position of the side sections using titanium plates and screws.
- The upper jaw is opened and separated and, if necessary, divided into 3 or 4 parts, and fixed with titanium plates that remain there for indefinite period of time.
- After fixation of maxilla, small discs are extracted from the bone of the chin and cheekbones and are further used to fill in the gaps in the jaw that occur due to incisions.
- Additionally, plastic surgery may be performed. During this surgery incisions are made in the lower jaw in the chin area. The jaw is then moved forward and fixed in the new position using plates and screws.
- All the wounds are sutured.
The postoperative period
After single jaw surgery the patient is treated in the hospital for 1-2 days, and 2-3 days after the double jaw surgery. The wounds heal in approximately 10 days. The lower jaw heals in 2 months, the upper jaw – in approximately 4 months.