Orthognathic surgery

Orthognathic surgery is a major surgical procedure done along with orthodontic treatment (braces) to correct skeletal and dental irregularities, including misalignment of jaws and teeth. The skeletal irregularities may occur on upper jaw(maxilla) or lower jaw(mandible) or both.

Orthognathic surgery gives new position to jaws and teeth that improves your facial appearance.

Orthognathic surgery is performed by a team of oral maxillofacial surgeon and orthodontist. Braces are integral part of orthognathic surgery. Braces are worn before and after the surgical procedure.

Indications

  • Difficulty in Chewing, Biting or Swallowing.
  • Temparo mandibular joint pain
  • Mandibular prognathism (forward placed or protruding  lower jaw than normal)
  • Mandibular retrognathism (lower jaw is retruded than its normal position)
  • Open bite (abnormal spacing between the upper and lower teeth)
  • Maxillary prognathism (forwarded placed or protruding  upper jaw than normal)
  • Maxillary retrognathism (upper jaw is retruded than its normal position)
  • Bimaxillary protrusion (both upper and lower jaws are protruded)
  • Bimaxillary recursion (both upper and lower jaws are retruded)
  • Inability to close the close the lips without straining.
  • Involuntary mouth breathing
  • Small jaw (hypoplasia)
  • cleft palate and cleft lip
  • Trauma to face
  • Tumors and other pathological disease Orthognathic surgical procedure

Surgeries for maxilla

Maxillary osteotomies are surgical procedures to advance forward or retract backward or the whole or part of maxilla. Maxillary can also be positioned upwards or downwards by osteotomies. The following are few of the maxillary osteotomies.

Le fort l osteotomy

Most commonly done maxillary osteotomy. In Le Fort I, the alveolar Ridge (th bone Structure supporting teeth) is fractured from its base above the roots of teeth.

The fractured alveolar bone can be positioned forward, or upward by removing segment of bone above the osteotomy site,or downward by placing graft above the fractured site.

Success rate of IVF depends on many factors like age of patient (young patients have more success rate) , cause of infertility (Diagnosing the cause of fertility is very important for the success of IVF), reproductive history (previously pregnant patient have high success rate) . The birth rate after IVF is 41 to 43% for patients below 35 age group. With increase in age the success rate declines.

Le Fort II osteotomy

In le Fort II is rarely done procedure, the incision is made higher than le fort I. Incision is made at the level bridge of nose. Maxilla along with nose moved together. Le Fort II are done to correct severe maxillary retrognathism (retrusion) .

Le Fort III osteotomy

It is a major surgery, in which the whole face  is separated from cranium and positioned forward. It is done in patients with growth failure of middle face involving upper jaw, cheek bone and nose.

Eg. Crouzan’s syndrome.

Wassmund operation

The upper jaw alveolar bone front segment from right canine to left canine including the  palate is fractured or separated from the rest of the jaw. The loose segment can be positioned forward by inserting the graft the fractured site or retracted (backward) by removing both the first premolars along with segment of bones.

Surgeries for mandible (lower jaw)

Horizontal section of vertical ramus:  This surgery is performed by dividing the ramus horizontally and loosen body of mandible segment is set back. Mandible prognathism is treated by this procedure.

Sagittal splitting

Sagittal splitting is commonly done mandibular osteotomy, in which lower jaw on both side is separated horizontally at Ramus and vertical cut made in bone below molar teeth. The lower jaw can be moved forward or backward depending on the patient requirements.

Vertical sigmoid notch

This is done on patients with mandibular prognathism. A vertical incision is made on ascending region of lower jaw and mandible is divided from Sigmund notch (concavity in the superior surface in a sending region of lower jaw) till the angle of mandible. Segment of bone is removed or overlapped to retract the jaw.

Kole’s operation

Segmental surgery, done by making vertical cut from canine to canine teeth and horizontal cut under the teeth and the bone is  separated, the separated bone can be raised with graft or lowered with removing segment of bone or advanced forward or retracted.

Genioplasty

Chin surgery or genioplasty is a surgical procedure to reshape the bony contour of chin.

Reduction genioplasty

 A segment of bone is removed in the front of chin to reduce excessive prominence or bone may be removed from bottom aspect to lower the facial height in patients with long face.

Chin augmentation

Bone grafts may be added to make the chin prominent. Augmented bone is held in its place by chin implants.

Sliding genioplasty – surgical procedure done by sliding or moving forward the lower border of chin to increase the prominence.

Role of orthodontic treatment

Usually patient undergo orthodontic treatment (braces) before the surgery to correct the dental irregularities. Orthodontic appliance (braces) are not removed during surgery, it serves as an guideline for surgeon to establish correct bite. After surgery Patient will continue with orthodontic appliance for proper finishing. Patients normally wear braces for 6 to 8months after surgery but it may vary.

Orthognathic surgery – procedure

It is normally done as inpatient procedure.

Before surgery the doctor will perform a ‘complete physical examination, blood test and other investigations to make sure the patient is medically fit for surgery. Usually orthognathic surgery is done under general anesthesia. Jaws are separated and positioned to ideal dental-facial relationship and fixed with titanium plate and screws. Maxilla and mandible will be immobilized with wires for healing in the corrected jaw position.

Recovery

Jaws will be immobilized for a period of 2 to 6 weeks. For surgeries involving lower jaw immobilization period is less compared to upper jaw. Patient will be on liquid diet during the period of immobilization. After immobilization soft diets is advised for 4 to 5 weeks. Patients can resume their routine life with in 2 to 6 weeks. Complete recovery may take 2 to 4 months.

Results

Orthognathic surgeries have excellent success rate.  They are safe and stable procedure with predictable outcome. Patient appearance is dramatically enhanced with improved function.

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