What is Orthognathic Surgery?

Orthognathic surgery (pronounced “ortho-nathic”—the “g” is silent) is corrective jaw surgery performed by an oral and maxillofacial surgeon to fix various jaw misalignments. It’s designed to correct structural issues with the jaws and teeth that cannot be addressed through orthodontics alone. For example, if the lower jaw is underdeveloped, causing the lower teeth to sit far behind the upper teeth when biting down, orthognathic surgery can reposition the jaw after orthodontic treatment (braces) has aligned the teeth.

Are All Dental Misalignments Corrected Through Orthognathic Surgery?

While most minor misalignments can be corrected with braces or other orthodontic treatments alone, more complex jaw misalignments may require surgical intervention to fully address the issue.

What Types of Misalignments Require Surgery?

Surgical intervention is needed when there is a significant mismatch in the position of the jaws, as orthodontics alone may not be sufficient to correct the bite. Examples of misalignments that typically require surgery include:

  1. Prognathism: When the upper jaw doesn’t develop properly, causing the lower jaw to appear too far forward, resulting in the lower front teeth being ahead of the upper teeth.
  2. Asymmetry: When there is a noticeable asymmetry in the lower jaw, such as the chin not aligning with the facial midline, leading to a lopsided bite.
  3. Severe Bite Problems: When the teeth do not meet properly due to jaw misalignment, causing difficulty with chewing, speaking, or biting.

How Do Orthodontics and Surgery Work Together to Position the Jaws and Teeth Properly?

Orthodontics and surgery work in tandem to create the best possible bite. Here’s how the process typically unfolds:

  1. Planning and Analysis: The orthodontist and surgeon collaborate to determine the ideal bite and jaw position. The surgeon analyzes the shape, size, and symmetry of the upper and lower jaws, and the orthodontist evaluates the positioning of the teeth.
  2. Orthodontic Treatment: Before surgery, orthodontics (braces) are used to level the teeth, eliminate crowding, and adjust angulation. This phase may take several months to over a year.
  3. Surgery: Once the teeth are properly aligned, surgery is performed to reposition the upper jaw, lower jaw, or both. This brings the teeth into proper alignment and improves bite function.

How Does the Surgeon Know Exactly Where to Reposition the Jaws?

Once orthodontic treatment is nearing completion, a detailed plan is developed for the surgery:

  • Plaster Models: Accurate models of the teeth are made to guide the surgeon.
  • CT Scans and X-rays: A precise CT scan and additional X-rays are taken to gather 3D images of the jaws.
  • Sophisticated Software: Using advanced software, the surgeon plans the exact measurements and angles for jaw movement to achieve the desired bite and facial symmetry.

How Are the Jaws Held in Their New Position After Surgery?

In orthognathic surgery, the jaws are repositioned through carefully made cuts in the bone. Bone plates and screws are used to secure the jaws in place. Additionally, for 2-3 weeks post-surgery, patients may wear wires or orthodontic elastics (rubber bands) to hold the jaws together while they heal. This ensures no movement occurs at the surgical sites during the early stages of recovery.

What Other Procedures Are Commonly Done During Orthognathic Surgery?

During the planning phase, your surgeon may recommend additional procedures to improve facial aesthetics or jaw function:

  1. Chin Surgery: If the chin remains disproportionate after repositioning the jaw, chin surgery may be performed to improve symmetry and facial balance.
  2. Soft Tissue Surgery: Procedures like reducing a gummy smile through soft tissue adjustments to the upper lip can be done alongside jaw surgery.
  3. TMJ Surgery: If the temporomandibular joint (TMJ) is affected, the surgeon may address joint damage or wear at the same time as the jaw surgery.

Am I Asleep During the Surgery?

Yes, orthognathic surgery is performed under general anesthesia, so you will be completely asleep during the procedure. Most patients stay in the hospital for 1-2 nights following surgery. Our board-certified surgeons operate at California Pacific Medical Center in San Francisco, using state-of-the-art equipment and facilities.

How Do I Eat If My Jaws Are Wired Together After Surgery?

After surgery, you may have your jaws wired or rubber-banded together for 2-3 weeks, which makes eating, speaking, and brushing teeth challenging. During this period, you will need to follow a liquid or pureed diet, and temporary weight loss is common as eating becomes more difficult.

What Are the Benefits of Orthognathic Surgery? Why Should I Consider It?

Orthognathic surgery offers several benefits:

  • Improved Function: Correcting jaw misalignment can improve chewing and speaking by ensuring that the upper and lower teeth come together properly.
  • Aesthetic Improvement: Jaw surgery can enhance the symmetry and appearance of your face, including your profile and chin.
  • Better Breathing: In some cases, advancing the upper or lower jaw can improve airflow, making breathing easier, especially if you suffer from obstructive sleep apnea or other airway issues.

Do I Have to Be a Certain Age to Have Orthognathic Surgery?

You should be at or past the age when your jawbones have fully stopped growing. For girls, this is typically around age 16, and for boys, it’s around age 18. Adults can also undergo jaw surgery, provided they are in good health, do not smoke, and are committed to completing the required orthodontic treatment before surgery.

How Do I Get Started?

If your orthodontist has recommended orthognathic surgery to correct your jaw misalignment, the next step is to schedule a consultation with an oral and maxillofacial surgeon. It’s best to see the surgeon early in the orthodontic process—ideally before you begin wearing braces—so that a comprehensive treatment plan can be developed.

At Song Oral and Maxillofacial Surgeons, we specialize in orthognathic surgery and can guide you through every step of the process. Contact us today to learn more about how corrective jaw surgery can improve both your function and appearance.