What is Orthognathic Surgery?
Corrective jaw, or orthognathic surgery is performed by an oral and maxillofacial surgeon (OMS) to correct a wide range of minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth. Surgery can improve chewing, speaking and breathing. While the patient’s appearance may be dramatically enhanced as a result of their surgery, orthognathic surgery is performed to correct functional problems.
Who is it for?
The following are some of the conditions that may indicate the need for corrective jaw surgery:
- Difficulty chewing, or biting food
- Difficulty swallowing
- Chronic jaw or jaw joint (TMJ) pain and headache
- Excessive wear of the teeth
- Open bite (space between the upper and lower teeth when the mouth is closed)
- Unbalanced facial appearance from the front, or side
- Facial injury
- Birth defects
- Receding lower jaw and chin
- Protruding jaw
- Inability to make the lips meet without straining
- Chronic mouth breathing
- Sleep apnea (breathing problems when sleeping, including snoring)
A pre-anaesthetic consultation and examination, coupled with investigations such as blood tests, may be required before surgery.
If you wish to talk with the anaesthetist before your admission, this can easily be arranged. The anaesthetist may also wish to meet with you beforehand if there are any issues arising from your anaesthetic questionnaire or your pre-operative investigations.
You must not have anything to eat or drink for 6 hours prior to your surgery. If you are a smoker, you are advised to stop two weeks before your operation. On the day of surgery, you should take all your usual medication (unless otherwise instructed) with a small sip of water.
NOTE: If you are diabetic and/or are taking blood-thinning medicines (e.g. Aspirin) you will need to discuss this with your surgeon or anaesthetist. Normally, Aspirin should be stopped 10 days prior to your operation. All herbal remedies, including Garlic, should be discontinued 1 week beforehand.
What to expect during surgery
Orthognathic surgery is a procedure generally still performed today as a hospital based operation. The patient is often admitted on the day of surgery by his doctor and, more often than not, can expect to be discharged on the first post-operative day.
Rightfully, a frequently asked question is whether orthognathic surgery is painful? By contrast, probably the most conspicuous of post-operative findings is the lack of significant pain. However, there is a commitment made by the patient to experience a certain number of immediate post-operative inconveniences and discomforts. All patients are counseled to anticipate the following displeasures to which they must commit in the initial period following surgery:
- Swelling – Simply a result of the trauma of surgery, most swelling from surgery of this kind will peak in visible size over the course of three to five days. Approximately 85% of the swelling resolves within a ten day period after which the remaining percentage often requires several months of maturation.
- Nasal and sinus congestion – As a consequence of the techniques utilized at surgery and associated swelling at the operative site, most patients will experience a five to seven day period of significant nasal and sinus congestion. Resolution of these symptoms is generally parallel with the abatement of visible facial swelling.
- Difficulty eating and chewing food – Although modern surgical techniques have freed the patient of the burdens of being wired shut, the first week following surgery is still fraught with moderate frustrations in the eating department. Swelling and the fear of moving one’s jaw too much tend to self-limit the diet to something of a more blenderized category.
Only a short period of convalescence is necessary before you can return to normal activity. Even patients presenting with the most complex of scenarios, are able to return to work or a school environment within ten days of the surgical date. The only prolonged and prescribed physical restriction may occur in the patient involved in “contact sports,” who may be asked to refrain from such activity for approximately three months.
Limitations and Risks
Following the consultation with your surgeon, you will be given a summary of the procedure. The information provided is intended more to inform you, rather than to alarm you. The complications associated with the various drugs and medicines are too numerous to discuss in this page and perhaps you might discuss this with your anaesthetist who will meet with you, in hospital, before your operation.
- haemorrhage (bleeding) – this may occur during or after the operation. Reactionary haemorrhage occurs in the first 24 hours after surgery, and secondary haemorrhage occurs 5 to 7 days after the operation and is usually the result of infection. If bleeding is excessive during an operation a transfusion may be required. If you or your family (i.e. immediate blood relatives) have any concern that there may be a bleeding disorder in the family, advise your oral maxillofacial surgeon of this concern in order that appropriate blood tests can be arranged promptly with a large and experienced pathology laboratory. If there is an abnormality, you will be referred to a haematologist for further assessment. If you have had unexplained bleeding associated with any operation, please share the details with your oral maxillofacial surgeon.
- Haematoma (a blood collection in the tissues) formation occurs in approximately 1-2% of operations on the jaw, and it is for this reason that surgical drains may be used.
- Wound infection – whilst this is quite uncommon in upper or lower jaw osteotomies, it is recognised. It is essential that you maintain scrupulous oral hygiene both before and after the operation. A prophylactic (scale and clean) is recommended by your dentist before your operation. Wound infection may be minor, small abscess or redness of the skin, or it may be serious or life-threatening. Your consultant anaesthetist will commence intravenous antibiotic therapy after the induction of the general anaesthetic and will be continued during your stay in hospital. After discharge you will also take oral antibiotics.