Orthognathic (Jaw) Surgery is the general name of surgeries in which the lower, upper or both jaws are surgically brought to the position they should be in relation to the face. Disorders affecting the facial bones and jaw bones often lead to irregularities in the position of the teeth. Orthodontists and oral, dental and maxillofacial surgeons work together in the treatment of such disorders. While disorders in the position of the teeth can be corrected with braces, disorders in the structure or position of the jaws can usually be corrected surgically.
Jaw and facial surgery is mainly concerned with changes to be made in bone and soft tissue, and thus some definitions emerge.For example, occlusion, or bite, basically means the correct contact of the teeth in the upper and lower jaw, while bite-related disorders are called malocclusion (misbite). Malocclusion can be of a nature that can significantly change facial expression. Although the right and left halves of the upper and lower jaw are subjected to various classifications, the triple classification proposed by Angle according to the position of the first molars in the upper and lower jaw is the most commonly used. According to this, there are 3 main types of malocclusion. In the first type (Type I), there is superimposed contact of the molars in the upper and lower jaw, but the contact surface is inappropriate and the patient does not have developmental disharmony in the upper and lower jaw. In Type II, the lower jaw is further back than the upper jaw, whereas in Type III, the lower jaw is fully advanced and there are certain degrees of developmental retardation in the upper jaw. The malocclusion may stand further forward in the upper and lower lip in accordance with the more developed jaw in the lateral view.
Disorders such as the upper or lower jaw being forward or backward, the lower or upper jaw being positioned on the right or left according to the midline of the face, i.e. asymmetrical, having a long face or gingival smile, and narrow upper jaw can cause both aesthetic and functional problems.
In these surgeries, all incisions are usually made inside the mouth. When necessary, small incisions can be made from outside the mouth and these incisions usually heal without leaving scars. During the operation, following the bone incisions, the lower, upper or both jaws are brought to their ideal position and fixed with the help of titanium plates and screws. In patients with very severe disorders, additional bone may be required. In such cases, bone from the hip is usually used.
Orthodontic problems can be related to teeth and jaws. Jaw incompatibilities are usually due to growth and development;
Class 2, the lower jaw is behind normal,
Class 3, the lower jaw is ahead of normal or the upper jaw is behind, Laterognathia (asymmetry) is when the chin is located to the right or left of the face,
Front open bite, when the jaw closes, only the back-most teeth make contact, can be categorized as
How is the Examination Performed Before Jaw Surgery?
First of all, a detailed orthodontic evaluation is performed in the mouth. Due to many reasons, bite problems, deformational and aesthetic disorders can be seen in the lower jaw.
If the patient’s joint and bite complaints are very severe, they can sometimes make life extremely difficult. However, it is possible to correct them with orthognathic surgery at any adult age.
In general, preparation is made according to the deformity in the lower jaw. The patient’s teeth, gum structure and alignment, bone structure and developmental characteristics, the effect of the skeleton on soft tissues are noted and radiographs are requested.
If an orthognathic surgery is planned due to bite disorder; orthodontic treatment is started following cephalometric examination.
Until the age of 12, this is the most appropriate time as permanent teeth erupt.
After a good tooth alignment is achieved after orthodontic treatment, jaw surgery is planned.
Should I wear a wire?
Since disorders affecting the facial and jaw bones cause disorders in tooth positions, brace treatment is usually required before and after orthognathic surgery.
Is surgery only or surgery first treatment possible?
After the photographs taken in our clinic, clinical examination form, X-rays, 3D computed tomography, intraoral model scans are transferred to the simulation program, simulation is performed. If appropriate conditions are met, first surgery and then wire treatment may be possible.
If the position of your teeth is ideal, it is also possible to restore the jaw bones to their ideal position using only a surgical approach.
However, in order to decide on both treatment protocols, all records must be taken and evaluated by an orthodontist and oral, dental and maxillofacial surgeon specialized in orthognathic surgery.
Recovery after jaw surgery
In patients undergoing maxillofacial surgery; painkillers, antibiotics and treatments to reduce swelling of the face are applied after surgery. In addition, supportive treatment is provided with serums.
It is very rare that the patient needs to stay in intensive care. Nutrition is started on the same day with watery foods.
After the general condition of the patient improves and this process usually happens 2-4 days after the jaw surgery. The upper and lower jaw teeth are fixed to each other with tires and the mouth is closed for 1-3 weeks. This makes bone healing safer.