Orthognathic Surgery (Jaw Surgery)
As human beings, we interrelate most frequently through our facial appearance and facial expression. The face and mouth are logically and practically the first part of the body our eyes contact. As individuals, we have different concerns about our dental and facial presentation. Some patients may be concerned about very minor imbalances or appearance difficulties, such as crooked teeth, while others may be perfectly satisfied and unconcerned about significant facial discrepanies.
Malalignment of teeth or jaws may have significant impact on future jaw/facial function and development. When a problem is suspected, it is apropriate for your dentist to refer you to an orthodontist and/or an oral and maxillofacial surgeon, Dr. Bourget , for their analysis and opinion.
Generally, an orthodontist is able to successfully treat dental crowding and intercept growth problems at an early age. In many cases however, it is necessary to consider surgery to change the underlying skeletal or bony structure to provide the ideal facial appearance and function. Dr. Bourget is trained to diagnose and treat abnormalities of the facial bones and soft tissues.
You should consider the following items when making a plan for your overall treatment:
- Are you having any problems with chewing or digesting foods?
- Do your teeth interfere while chewing, causing soreness to the soft tissue areas (example, roof of the mouth/cheeks, etc.)?
- Are there any negative effects on your teeth, (example: excess wear, loosening)?
- Do you have concerns about the presentation of your appearance (e.g. are you satisfied with the tooth, lip, bone, nose position, etc.)?
Orthodontic/surgical treatment may be the solution to many or all of the problems which concern you in this area.
But before making any commitment to this type of treatment, you should investigate all aspects of it. You should be clear about the benefits you are hoping to achieve from the proposed treatments, as well as the risks involved. You should be clear about the benefits you are hoping to achieve from the proposed treatments, as well as the risks involved. You should be aware that the treatment time may vary from 1 to 3 years and finally you should be fully aware that as an integral part of the team that will work towards achieving your goals, you must be committed and allow for the time an financial demands of the various treatments.
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.
About your Face:
Facial bones and teeth in general may present distortions or imbalances in the following ways:
A. Mandibular Deficiency
The most common problem is that of a short or retrognathic lower jaw. This type of bite is frequently called a Class II malocclusion. The surgical procedure indicated to correct this problem is advancement of the lower jaw.
B. Mandibular Excess/Maxillary Deficiency
One of the most obvious presentations of a facial bone problem is that of a protrusive or long lower jaw. This is called a prognathic or Class III malocclusion. This type of a problem may also be primarily caused or exaggerated in appearance by a small or underdeveloped upper jaw. The surgical correction for this problem is to set the lower jaw back and/or moving the upper jaw forward.
C. Maxillary Excess / Open Bite
Upper jaw problems most frequently involve excess posterior or back growth of the upper jaw. This may lead to an open bite malocclusion or inability to close the front teeth completely. This makes chewing difficult and may make it difficult to close the lips. To treat this condition, Dr. Bourget will level or move the upper jaw to the correct position.
D. Asymmetries / Crooked Jaws
In addition to the above problems, asymetries or crooked jaws may develop. In such, cases, one side may grow excessively at an early age or one side may not grow as a result of trauma or growth disturbance. If these problems occur at a young age, the overall facial bone structure will develop unevenly. Dr. Bourget or your orthodontist will determine whether jaw development has ceased. Most patients with asymmetries have concerns about the facial appearance and will frequently have chewing difficulties. Various surgical options involving the lower jaw / or upper jaw are available to correct the asymmetry.
Evaluating the bite and Jaws
Your dentist and orthodontist will require certain x-rays, photographs and records to evaluate tooth and gum health and potential tooth movement. In addition, periodically, Dr. Bourget will require x-rays, photographs, records and models to plan your surgery. Mock surgery or model surgery is carried out by tracing facial x-rays and transferring movements onto the models of your jaws.
You will be evaluated as your treatment progresses for the final decision on surgical movements. Plastic splints will frequently be constructed from the models to produce a ‘‘holding device’’ for your bite. This will be used during and occasionnaly after surgery. Various x-ray studies will be needed to diagnose and plan your case. In some cases, computer-assisted drawings and x-ray reconstructions may be utilized to predict your treatment outcome.
Necessary consultations will generally be arranged with any other medical or dental specialist required in your case. Your orthodontist and Dr. Bourget will make them aware of the exact type of surgical treatment. The timing of any necessary tooth extractions (e.g. wisdom teeth) will also be decided.
In average cases, preparatory orthodontic treatment occurs over a period of 6 to 24 months prior to surgery.
Timing of surgery is a mutual decision between your orthodontist and Dr. Bourget .
Once all essential pre-operative decisions have been made, our office will work with you to arrange booking at the hospital.
The hospital will contact you with details about check in time. Depending on your procedure and your progress, you will normally be discharged from the hospital 1 to 4 days after surgery. Before you leave, you will be assessed and given prescriptions for your necessary medications. Arrangements will be made for several post-operative appointments with Dr. Bourget . During those appointments, post-operative records will be taken and your wires and elastics will be removed.
Wires or elastics may be removed immediately after surgery to a few days to a few weeks later, depending on your type of procedure.
Final timing for your return to regular activities or work will be determined. Resumption of any special physical or sporting activities should be discussed with Dr. Bourget .
The Surgical Process
When you enter hospital prior to surgery, registration and recording of your general history is carried out. Arrangement for the type of room, insurance details and approximate length of stay are made.
Appropriate lab tests are carried out to confirm the state of your health and your suitability for the procedure and for general anaesthesia.
Your medical history and present physical state will be assessed thoroughly. Your particular medical situation may be unique and it is very important to discuss this with your doctors.
You will also be asked to sign a consent form. You must make sure that you understand all the information contained in the form.
A general anaesthetic will be used. Although complications such as drug reactions can occur during anaesthesia, the anaesthesiologist and hospital staff are prepared to handle such problems.
Emergencies occur only rarely. The overwhelming majority of orthognathic jaw surgery treatments are successful.
There are many techniques and types of surgery which may be indicated depending on your particular jaw problem. Cuts in the jaw or osteotomies may be carried out on either jaw, or in some cases on both jaws simultaneously.
In addition, cuts may be made within the jaw to move individual parts of the jaw in other dimensions.
Occasionally, grafting with your own bone may be required. Artificial bone or bone substitutes may also be used for correction of certain problems or to promote new bone to heal.
After the surgery, patients awake in the recovery room. There they will be monitored and observed until they are fit to return to their rooms.
Jaws may be held together with elastics and/or wires. There may also be plastic splints. In many cases, bones may be held internally with small pins, screws or plates. The period of jaw wiring may vary depending on your particular type of surgery. This again should be discussed with your doctor. In many instances, elastics will be used at the time of surgery and it will be necessary for the patients to learn how to apply and remove them. This should be reviewed with Dr. Bourget and with your orthodontist.
Virtually all patients will have some swelling after the soft tissue and bone incisions are made. A pressure dressing or ice pack may be used for a period of time to control this. They are generally removed before you are discharged from hospital.
Medications to control infection, nausea, and swelling are frequently used immediately after the surgery. Pain control medications will also be ordered as required.