Steps in Orthognathic Surgery

Pre-surgical Orthodontics

Pre-surgical orthodontics will move your teeth into a new position, so they will fit together properly when the jaws are surgically repositioned. During this Pre-surgical orthodontic phase of treatment, which usually lasts 6-18 months, you will be wearing braces and will visit your orthodontist regularly for necessary adjustments to your braces and ongoing evaluation.

Because your teeth are being moved into a position that will be correct after surgery, you may think that your bite is getting worse rather than better during this phase of treatment. However, when the oral and maxillofacial surgeon realigns your jaws into proper alignment during orthognathic surgery, the teeth will be moved into proper position.

After surgery, final orthodontic tooth movement is usually necessary to "fine-tune" your bite. Following removal of your braces, you may be required to wear a retainer.

If you still have your wisdom teeth or your teeth are too crowded, it may be necessary to remove certain teeth prior to beginning orthodontic treatment in order to make space for proper tooth movement.

Pre-Surgical Records

As your pre-surgical orthodontic treatment nears completion, the oral and maxillofacial surgeon will make final preparations for the surgical procedure. Additional records will be taken, similar to the previous ones. Your surgeon may use new x-rays and models of your teeth and jaws to "simulate" surgery in order to finalize the surgical movements of your jaws and anticipate the results of the procedure. From these models a plastic bite wafer can be made to serve as a guide for proper tooth realignment.

When the team determines that your teeth are in the correct pre-surgical position, surgery will be scheduled.

Preparing for Orthognathic Surgery

Orthognathic surgery is performed in a hospital or ambulatory surgical center under general anesthesia. Prior to surgery you will have a physical examination to ensure that you are in good overall health. You may be advised to donate blood in the event you need a transfusion during surgery. Certain dietary supplements and exercise may be prescribed to achieve optimum health, so that healing after surgery will be as rapid and uneventful as possible. Any required lab tests will also be done prior to surgery.

A plastic bite wafer is made during surgical planning to serve as a guide for proper tooth realignment.

In most cases, you will check into the hospital or ambulatory surgical center on the day of your surgery. Your anesthesiologist will discuss the general anesthetic procedure to be used and answer any questions you may have. In addition to the use of general anesthesia, which "puts you to sleep" during surgery, you will be receiving intravenous fluids and medication to prevent dehydration and infection, and to minimize swelling and pain. It is very important that you adhere to any medication schedule or diet prescribed by your surgeon. You may receive pre-operative medications to reduce normal pre-surgical anxiety.

The Surgical Procedure

Orthognathic surgical procedures last anywhere from one to several hours, depending on the amount and type of surgery needed. In lower jaw surgery the rear portion of the jawbone behind the teeth is separated and the tooth-bearing portion is moved forward or backward, as appropriate. In upper jaw surgery the jaw can be repositioned forward or backward, or the jaw can be raised or lowered.

Certain movements may require the jaws to be separated into several parts, with bone added or removed to achieve the proper alignment and stability. Other facial bones that contribute to the imbalance may also be repositioned, augmented, or reduced in size.

In most cases, incisions are made inside the mouth and there will be no visible external scars. If it is necessary to make an external incision, care is taken to conceal it in natural skin creases.

Profiles of patient with a combined retruding upper and protruding lower jaw before and after surgery

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