An Oral and Maxillo Facial Surgeon uses corrective jaw surgery (orthognathic surgery) to reposition one or both jaws.

Moving the jaw(s) also involves moving the teeth, therefore, corrective jaw surgery is usually performed in conjunction with orthodontics (braces). This results in a better relationship between the upper and lower teeth, i.e. a better occlusion. Corrective jaw surgery is used to treat abnormal bites that cannot be easily treated with braces. Other benefits include an improved facial profile and lip posture and, in certain circumstances, speech may be improved. The jaw bones are precisely cut and realigned, and then held in place with titanium plates and screws. In addition, procedures like chin augmentation/reduction can be complementary to the main procedure and are performed at the same time.

• Difficulty chewing or biting food
• Difficult swallowing
• Speech problems
• Chronic jaw pain
• Excessive wearing of teeth
• Unbalanced facial appearance
• Facial injury or birth defects
• Receding chin
• Protruding jaw
• Inability to make lips meet without effort
• Chronic mouth breathing with dry mouth
• Open bite (space between upper and lower front teeth when mouth is closed)

The surgeons

Corrective jaw surgery is performed by trained Oral and Maxillo Facial Surgeons in conjunction with orthodontic treatment by trained Orthodontists. Treatment involves braces before and after surgery (with the braces remaining in place for the surgery), and retainers after removal of the braces. There is close and careful coordination between the Oral and Maxillo Facial Surgeon and the Orthodontist to ensure that the teeth will fit together correctly after treatment with an improved facial appearance. In close consultation with an Orthodontist and yourself, the Oral and Maxillo Facial Surgeon can plan your corrective jaw surgery for a successful outcome.

Pre-operative Planning

Planning for the surgery involves input from various professionals comprising the team. Involved professionals include Orthodontists, Oral and Maxillo Facial Surgeons, Dentists and possibly a Speech Therapist. As the surgery usually results in a noticeable change in the patient's face, a psychological assessment is occasionally required to assess the patient’s need for surgery and its predicted effect on the patient.

X-rays, photographs and study models are used to help in the planning. In addition, there are computer software programs to predict the shape of the patient's face after surgery, which is useful for planning and for explaining the surgery to the patient. This software allows the patient to see the predicted results of the surgery.

The Procedure

The surgery may involve one jaw or both jaws during the same procedure. The surgery is performed in hospital under general anaesthesia, and often does not involve cutting the skin, instead the surgeon is able to perform the surgery from inside the mouth. Precise bony cuts are carefully performed in the jaws using special delicate bone cutting burs and saws, and the cut pieces are carefully repositioned in the desired/planned alignment using a surgical splint (like a small mouthguard) which is specifically made for each individual patient. The bony pieces or segments are held and stabilised in the desired position using titanium bone plates and screws - this has eliminated the need for wiring the jaws together for a few weeks after surgery as was the case in the early days when this type of surgery was first being developed. Often, small elastic bands will be applied to the braces to help keep the jaws together loosely and stabilised the bite.

After the Operation

On completion of the surgical procedure, the patient is transferred to the recovery room where their progress is monitored closely by the nurses on duty. The patient remains in the recovery room for about three hours or until they are sufficiently awake to be transferred to the high dependency unit (HDU). The HDU provides the best environment in the first 24 hours after surgery for the close observation that is needed for patients who have undergone corrective jaw surgery. Following this, patients are transferred to their room in the surgical ward.

Some post-operative discomfort is to be expected. In most instances, it is moderate and is treated easily with medications (painkillers) given intravenously. When bone grafts are taken from the hip, more discomfort should be anticipated. Every effort is made to keep patients as comfortable as possible. Ice packs applied to the sides of the face are also useful in reducing discomfort and swelling associated with corrective jaw surgery. Most of the swelling will disappear within the first two weeks, but some subtle swelling may remain for a few months.

After corrective jaw surgery, patients are required to adhere to a soft diet and liquids for 8 weeks. A dietician sees the patient the day after the surgery while they are still in hospital for appropriate dietary advice. Diet is very important after the surgery, to accelerate the healing process. Weight loss ( 3 to 5 kilograms) due to lack of appetite and the nature of the diet is common.

Oral hygiene is extremely important after corrective jaw surgery to minimise the risk of infection as the surgical incision lines are inside the mouth. Patients are encouraged to brush their teeth carefully with a small soft bristled toothbrush and rinse with an antiseptic mouthrinse after every meal.

Most patients are ready for discharge 2 to 4 days after surgery. Medications (antibiotics and painkillers) are sent home with the patient. Patients are seen by the surgeon within one week following discharge from hospital and thereafter are scheduled for regular reviews to check on healing and to make sure there are no problems. The frequency of review visits will decrease over time. It is very important to avoid any chewing of hard foods substances until the surgeon has indicated he is satisfied with the healing.

Normal recovery time can range from 4-6 weeks, but most patients can resume school or work commitments after 2 weeks. It is recommended that patients refrain from any form of strenuous exercise for 4 weeks after the surgery, and refrain from contact sports for at least 3 months.