What is it?
Orthognathic surgery refers to repositioning the upper jaw (maxilla), the lower jaw (mandible) or both jaws to make sure that they fit together in the proper way and that the teeth are aligned (occlusion). The goals of the surgery are to make your child eat/chew better, breathe better, and even speak better. Additionally, if the jaws are not aligned properly, it may influence facial symmetry. Surgery can improve your child’s profile and the harmony of their features, as well as the way the nose and lips look. This becomes especially important for patients with cleft lip and palate. Very commonly, the upper jaw of cleft children does not grow as much as the lower jaw. This is partly from the cleft, and partly from the scar tissue created by the surgeries necessary in early childhood. As a result, these children often have “underbites” where the bottom jaw sticks out past the upper jaw. This discrepancy can be quite severe, and causes all of the above problems.
We also see abnormal jaw growth in patients with hemifacial microsomia, as a part of multiple other syndromes, as a sequela of trauma, or as an isolated congenital anomaly. Minor differences can often be corrected with orthodontics. Larger differences usually require surgery to fix. In most of these instances, surgery is recommended because the patient has symptoms which are treatable and quality of life can be improved. For example, when the teeth do not fit together properly, it can be difficult and painful to chew. This may limit the types of foods your child is able to eat and cause problems with their teeth. Sometimes jaw asymmetry can also cause a problem with speech. If there is not enough room in the mouth for the tongue to form words against the front teeth, it may be difficult to understand what your child says. This can affect school, social life, and potential jobs in the future. Additionally, if your child has a small lower jaw, it can be more likely for the airway to collapse or become obstructed by the tongue, especially during sleep. This is called obstructive sleep apnea. All of these problems can be effectively treated by jaw surgery.
Typically, surgery is not performed until facial growth is complete, usually at 16-18 years of age. This way we know the final size and relationship of the jaws and have a better chance of completing the necessary corrections without needing revisionary surgery. When the discrepancy between the jaws is very severe, we may consider performing an earlier “distraction” surgery. However, the jaws will continue to grow, so your child may still need an additional surgery at adulthood. Prior to surgery, your child will be placed in braces by the orthodontist to prepare the bite and teeth as much as possible. These will remain after surgery to help adjust any minor irregularities that remain.
There are two general patterns of abnormal jaw relationships with multiple other variations in between. The first is class III malocclusion or “underbite”. These patients generally need their upper jaw moved forward so that the upper teeth fit over the lower teeth. If the distance that the jaw needs to be moved is close to or greater than a centimeter, sometimes the lower jaw needs to be moved as well, or something called “distraction” will be needed. The other category is class II malocclusion or “overbite”. These patients generally need their lower jaw moved forward. If the lower jaw is small, it is often beneficial to also move the chin forward to balance out the profile and proportions of the face.
What happens during surgery and recovery?
Before the day of surgery, we take special x-rays as well as impressions of the teeth, and plan the exact movements that we will perform and final positions of the jaws. During surgery, incisions are made all on the inside of the mouth, and the tissues are lifted off of the bone in the areas where we are working. In order to move the bones, we have to cut them with a saw and release them from surrounding tissue. Once the bones are free, we move them into their new position and fix them there with metal plates and screws. Finally, we check the alignment of the bite and close the incisions with absorbable sutures. Rarely, with certain procedures of the lower jaw, your child may need to have the jaws wired shut for several weeks. You should plan for a 1-3 day hospital stay. Your child can go home when they are eating and drinking well and pain is controlled.
You will be sent home with pain medication and antibiotics, and your child will be able to shower. They will have to stick to a soft diet for at least three weeks depending on how they are healing. Expect that there will be bruising and swelling after surgery, and possibly some numbness of the lower lip, chin and cheeks due to nerves in the area of the surgery that can become irritated. Because of the incisions in the mouth, your child will have to be careful brushing teeth, and will have to use a special mouth wash three times a day and after eating. Swelling will be significantly improved after a week, but may take several weeks to months to completely resolve. If there is numbness, this may take months to gradually resolve as well, but is rarely permanent. Exercise or vigorous activity will need to be minimized for 4-6 weeks after surgery to allow for proper healing and to prevent bleeding and worsening of swelling. Your child should not play sports or participate in gym class during this time. Sutures in the mouth will dissolve on their own.
What are the risks?
There are large nerves that exit the jaw bones and control sensation to the face. It is possible for these nerves to become irritated or injured by the surgery, which can cause numbness. Usually this is not permanent, but may take several months to slowly resolve.
It is usually not possible for us to make the bite completely perfect at the time of surgery, so some minor adjustments by your orthodontist will be needed afterwards.
Any time we move the bones of the face there is always the possibility, though small, that they may not heal correctly. This would require additional surgery to fix.
The plates and screws that we place during surgery are meant to be permanent. However, it is possible that they could become infected. Should this happen, they would need to be removed.
Orthognathic surgery refers to repositioning the upper jaw (maxilla), the lower jaw (mandible) or both jaws to make sure that they fit together in the proper way and that the teeth are aligned (occlusion). The goals of the surgery are to make your child eat/chew better, breathe better, and even speak better. Additionally, if the jaws are not aligned properly, it may influence facial symmetry. Surgery can improve your child’s profile and the harmony of their features, as well as the way the nose and lips look. This becomes especially important for patients with cleft lip and palate. Very commonly, the upper jaw of cleft children does not grow as much as the lower jaw. This is partly from the cleft, and partly from the scar tissue created by the surgeries necessary in early childhood. As a result, these children often have “underbites” where the bottom jaw sticks out past the upper jaw. This discrepancy can be quite severe, and causes all of the above problems.
We also see abnormal jaw growth in patients with hemifacial microsomia, as a part of multiple other syndromes, as a sequela of trauma, or as an isolated congenital anomaly. Minor differences can often be corrected with orthodontics. Larger differences usually require surgery to fix. In most of these instances, surgery is recommended because the patient has symptoms which are treatable and quality of life can be improved. For example, when the teeth do not fit together properly, it can be difficult and painful to chew. This may limit the types of foods your child is able to eat and cause problems with their teeth. Sometimes jaw asymmetry can also cause a problem with speech. If there is not enough room in the mouth for the tongue to form words against the front teeth, it may be difficult to understand what your child says. This can affect school, social life, and potential jobs in the future. Additionally, if your child has a small lower jaw, it can be more likely for the airway to collapse or become obstructed by the tongue, especially during sleep. This is called obstructive sleep apnea. All of these problems can be effectively treated by jaw surgery.
Typically, surgery is not performed until facial growth is complete, usually at 16-18 years of age. This way we know the final size and relationship of the jaws and have a better chance of completing the necessary corrections without needing revisionary surgery. When the discrepancy between the jaws is very severe, we may consider performing an earlier “distraction” surgery. However, the jaws will continue to grow, so your child may still need an additional surgery at adulthood. Prior to surgery, your child will be placed in braces by the orthodontist to prepare the bite and teeth as much as possible. These will remain after surgery to help adjust any minor irregularities that remain.
There are two general patterns of abnormal jaw relationships with multiple other variations in between. The first is class III malocclusion or “underbite”. These patients generally need their upper jaw moved forward so that the upper teeth fit over the lower teeth. If the distance that the jaw needs to be moved is close to or greater than a centimeter, sometimes the lower jaw needs to be moved as well, or something called “distraction” will be needed. The other category is class II malocclusion or “overbite”. These patients generally need their lower jaw moved forward. If the lower jaw is small, it is often beneficial to also move the chin forward to balance out the profile and proportions of the face.
What happens during surgery and recovery?
Before the day of surgery, we take special x-rays as well as impressions of the teeth, and plan the exact movements that we will perform and final positions of the jaws. During surgery, incisions are made all on the inside of the mouth, and the tissues are lifted off of the bone in the areas where we are working. In order to move the bones, we have to cut them with a saw and release them from surrounding tissue. Once the bones are free, we move them into their new position and fix them there with metal plates and screws. Finally, we check the alignment of the bite and close the incisions with absorbable sutures. Rarely, with certain procedures of the lower jaw, your child may need to have the jaws wired shut for several weeks. You should plan for a 1-3 day hospital stay. Your child can go home when they are eating and drinking well and pain is controlled.
You will be sent home with pain medication and antibiotics, and your child will be able to shower. They will have to stick to a soft diet for at least three weeks depending on how they are healing. Expect that there will be bruising and swelling after surgery, and possibly some numbness of the lower lip, chin and cheeks due to nerves in the area of the surgery that can become irritated. Because of the incisions in the mouth, your child will have to be careful brushing teeth, and will have to use a special mouth wash three times a day and after eating. Swelling will be significantly improved after a week, but may take several weeks to months to completely resolve. If there is numbness, this may take months to gradually resolve as well, but is rarely permanent. Exercise or vigorous activity will need to be minimized for 4-6 weeks after surgery to allow for proper healing and to prevent bleeding and worsening of swelling. Your child should not play sports or participate in gym class during this time. Sutures in the mouth will dissolve on their own.
What are the risks?
There are large nerves that exit the jaw bones and control sensation to the face. It is possible for these nerves to become irritated or injured by the surgery, which can cause numbness. Usually this is not permanent, but may take several months to slowly resolve.
It is usually not possible for us to make the bite completely perfect at the time of surgery, so some minor adjustments by your orthodontist will be needed afterwards.
Any time we move the bones of the face there is always the possibility, though small, that they may not heal correctly. This would require additional surgery to fix.
The plates and screws that we place during surgery are meant to be permanent. However, it is possible that they could become infected. Should this happen, they would need to be removed.
What is distraction?
Distraction osteogenesis is a surgical technique employed when bones need to move a far distance, usually greater than a centimeter. At the time of surgery, cuts are made in the bone, and special hardware is applied that allows the bones to be slowly moved over time. This allows the body to start forming bone in the gap created, and also helps to stretch the overlying soft tissues. This results in better overall healing without the use of bone grafts, as well as a more durable result with less relapse. The hardware has “arms” on the outside of the body which are turned with a screwdriver twice a day, or “distracted”. Distraction moves the bones 1-2 mm per day. The process can last several days to weeks depending on the distance the bones need to travel. Often you will be able to do the distraction yourself at home. There are two different types of distraction hardware that are used. “Internal” devices are attached to the bones inside of the mouth and have a small arm that extends to the outside for turning. “External” devices, or the “HALO”, are metal rings that are secured to the skull from the outside and keep the bones stable while they are moving. Once distraction is complete, the hardware stays in place for approximately 6 weeks to allow the bone to heal and become solid. With both devices, a second procedure is need to remove the hardware in the operating room. Typically, for distraction of the jaws we use internal devices, and for distraction of bigger parts of the face (such as the nose, cheek bones or eyes) we use the HALO device.
Distraction osteogenesis is a surgical technique employed when bones need to move a far distance, usually greater than a centimeter. At the time of surgery, cuts are made in the bone, and special hardware is applied that allows the bones to be slowly moved over time. This allows the body to start forming bone in the gap created, and also helps to stretch the overlying soft tissues. This results in better overall healing without the use of bone grafts, as well as a more durable result with less relapse. The hardware has “arms” on the outside of the body which are turned with a screwdriver twice a day, or “distracted”. Distraction moves the bones 1-2 mm per day. The process can last several days to weeks depending on the distance the bones need to travel. Often you will be able to do the distraction yourself at home. There are two different types of distraction hardware that are used. “Internal” devices are attached to the bones inside of the mouth and have a small arm that extends to the outside for turning. “External” devices, or the “HALO”, are metal rings that are secured to the skull from the outside and keep the bones stable while they are moving. Once distraction is complete, the hardware stays in place for approximately 6 weeks to allow the bone to heal and become solid. With both devices, a second procedure is need to remove the hardware in the operating room. Typically, for distraction of the jaws we use internal devices, and for distraction of bigger parts of the face (such as the nose, cheek bones or eyes) we use the HALO device.
