Reconstructive Jaw Surgery

Orthognathic Surgery

It may be something you don’t know about, but if your teeth don’t align properly, it may be from a discrepancy between your teeth, jaws, and skull. You may know of it as an overbite, an underbite, or your teeth could just not meet together. An estimated 10% of the population will have a corrective jaw surgery procedure to realign the jaws and allow the teeth to meet properly. This can have dramatic aesthetic and functional benefits and has been proven to increase the quality of life. The procedure is completed after growth, so on average between 18-20 years old.

Orthognathic Surgery Presentation

To provide you with a better understanding of orthognathic surgery, we have provided the following multimedia presentation. Many common questions pertaining to orthognathic surgery are discussed.

Orthognathic Surgery Presentation

Common Symptoms

  • Difficulty chewing or biting food
  • Difficulty swallowing
  • Chronic jaw or jaw joint (TMJ) pain and headaches
  • 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 (asymmetry of the face)
  • Receding lower jaw and chin (overbite)
  • Protruding jaw (underbite)
  • Difficulty breathing through the nose and snoring

What we DO NOT do during reconstructive jaw surgery

  • Break your jaw
  • Wire your jaws shut

We DO carefully create an osteotomy to allow us to move the part of the jaw with the teeth into a more ideal position. This is carefully planned and executed.

The Consultation

If you have any of the symptoms listed above, or you have an orthodontist/dentist have indicated you may benefit from jaw surgery, we will perform a virtual consultation with you. This will allow us to examine you, evaluate your bite, and discuss the process with you. We will also determine if we will perform surgery in the upper jaw, lower jaw, or both jaws. This initial consultation will help us determine if you are a candidate for surgery or if other procedures or evaluations are necessary. For most of our patients, we remove the wisdom teeth prior to jaw surgery. Most of our patients have an orthodontist or we help you find one. We are unique in our approach to the use of Invisalign for this procedure and may be able to speed up your orthodontic treatment. Most importantly, we will give you time to ask questions, understand the process, and dispel some of the common fears about having jaw surgery. After your consultation, we will send you a “blue letter” summary of your specific treatment, recovery, and address common questions.

The Process

Surgery First- Surgery is performed prior to the initiation of orthodontic treatment. This will often reduce overall treatment time as the teeth are able to move faster with orthodontic treatment. Not everyone is a candidate for this but it is very common when we are treating patients who had braces when younger and knew they would need jaw surgery later in life. Average treatment: 12-18 months

Traditional Approach- Patients have orthodontic treatment for weeks or months in order to align the teeth in the ideal position over the bone. Ironically, it will make the bite worse prior to surgery in order to allow for movement of the bones to align the teeth. After surgery, there is detailing of the bite by the orthodontist. Average treatment: 18-30 months

Surgery

Surgery is done in the hospital or ambulatory surgical center. For upper and lower jaw surgery (double jaw), patients will spend the night in the facility and be discharged the next morning. Very rarely do patients require 2 nights. The surgery takes about 2.5 hours per jaw (5 hours for double jaw). We may also do additional procedures like genioplasty or rhinoplasty.

The procedure is performed through the mouth (intraoral) and the bones aligned as planned. Small titanium plates and screws are used to secure the new positions. These implants are not planned for removal and fewer than 5% will have them removed over their lifetime. The incisions are closed with absorbable sutures and do not need to be removed. We put ice packs on immediately after surgery to help with swelling and make sure pain is minimal.

One of the many benefits of choosing a CMF doctor for your jaw surgery is we perform the procedure without trainees. Most jaw surgery in Boston is done at academic centers (of which I was faculty for almost 10 years) by resident surgeons or interns. At CMF you will know exactly who will be participating in your care both before, during, and after surgery.

Recovery

Most of the recovery from surgery is done in the first 2 weeks. The most profound part of recovery is swelling. Swelling peaks at the second day after surgery, and by 2 weeks 85-90% is gone. Some residual swelling will be present for several weeks to months but after 2 weeks is generally minor and not noticed by others. There will be a change in the facial balance and appearance, but you will still be recognized as yourself. We may use rubber bands (elastics) to help guide your bite during recovery as your jaw muscles are often confused by the new position of the jaws. You will be able to eat soft foods after a day or two, and right after surgery can have things in a blender. For 4 weeks a soft diet will be prescribed as this helps the jaws heal.

Pain is moderate following the procedure and typically managed with a combination of medications. We use long-acting numbing medication at the conclusion of surgery and an evidence-based protocol for pain management over the 3-5 days following surgery. For most patients by day 5 they are able to control discomfort with Motrin or Tylenol. In general, the swelling is the part that is the most bothersome, and thankfully it resolves quickly.

Insurance

Most health insurances will cover all or most of the procedures related to discrepancies in jaw size. We will work with you to determine coverage.