Jaw surgery

Overview

Jaw surgery, also known as orthognathic surgery, is a comprehensive corrective procedure that involves several stages. It aimed at realigning the maxilla (upper jaw) and/or the mandible (lower jaw) in cases where they do not properly align, leading to functional issues such as difficulty in chewing and speaking.

The entire process typically spans two to three years. It begins with orthodontic treatment to align the teeth in preparation for jaw surgery. After the surgery, a recovery period follows, and additional orthodontic adjustments may be required for up to a year. 

Jaw surgery is a significant procedure that can disrupt daily life for several weeks or months. It is essential for individuals to understand its impact and know what to expect throughout the process.

Reasons for undergoing the procedure

Jaw surgery corrects issues where the upper or lower jaw sticks out too much or too little, causing an uneven facial appearance. These jaw problems can be present at birth (congenital) or develop later due to injuries or medical conditions.

Jaw issues can be caused by congenital conditions like an overbite or disorders such as Treacher Collins syndrome. Common problems include:

• Pierre Robin sequence. This condition is characterized by a small lower jaw, which is common in infants and can lead to difficulties in feeding and breathing.
• Cleft lip and palate. This occurs when the structures of the face and mouth do not form properly during development.
• Underbite. This condition arises when the lower teeth protrude past the upper front teeth.
• Crossbite. This occurs when some lower teeth are positioned in front of the upper teeth.
• Open bite. This occurs when several teeth do not make contact when your mouth is closed.

Injuries and medical conditions can cause jaw issues, such as:

• Temporal mandibular joint disorders (TMJ). This occurs when the upper and lower teeth do not align properly, leading to jaw joint problems.
• Facial fractures. The lower jaw can be fractured by an impact, such as being hit or punched by an object, while the upper jaw may be broken from falls, motor vehicle accidents, or direct blows.
• Cysts and tumors. Radiation therapy, often used in cancer treatment, can sometimes damage jaw tissue or lead to complications.
• Growth disturbances. This can occur when the body produces too much growth hormone, causing the upper or lower jaw to grow abnormally large.
• Obstructive sleep apnea (OSA). A jaw surgery called maxillomandibular advancement (MMA) may be recommended to treat this condition. This occurs when airway muscles, tonsils, the tongue, or excess tissue block the airway during sleep, causing breathing to stop and start.

There are three main types of jaw surgery:

• Double jaw surgery: If both the upper and lower jaw are affected, this surgery is recommended.
• Maxillary osteotomy: This surgery is performed when your upper jaw protrudes too much or too little. Maxillary osteotomy also treats conditions such as an open bite and crossbite.
• Mandibular osteotomy: When the lower jaw protrudes too much or too little, this surgery is performed.

Risks

Orthognathic or jaw surgery is a major procedure that carries several risks, such as:

• Complications from anesthesia
• Bleeding
• Infection
• Persistent numbness in the cheeks or lower lip
• Potential damage to the teeth
• Difficulty fully opening the mouth
• Issues with the jaw joint
• Improper healing of the bones
• Need for additional surgeries to address unresolved problems
• Return of the original bite issue
• Scarring

Before the procedure

Jaw surgery is not a quick fix but a long-term commitment that may take years. Since every jaw concerns are different, healthcare providers will offer recommendations based on individual needs, considering personal goals, overall health, and the specific jaw issue. 

Before jaw surgery, the following may be required:

• Dental impressions or scans of the teeth
• Computed tomography (CT) scans
• X-rays
• Photos of the teeth and jaw

One may be advised to prepare by limiting their diet to liquids, such as soups, milk, nutrition drinks, and blended fruits or vegetables, which one can stock up on before the surgery.

It is also recommended to ask detailed questions about the entire process, from pre-surgery orthodontics to recovery and post-surgery care, to ensure they are well-prepared. If one have a specific vision of their desired results, they should communicate this to their healthcare providers to ensure their expectations are aligned.

During the procedure

Before surgery, a healthcare provider will administer general anesthesia, ensuring you remain asleep and pain-free throughout the procedure.

Jaw surgery typically follows these steps:

• The surgeon makes incisions, usually inside the mouth, though small external cuts may occasionally be required.
• The jawbone is carefully cut to allow repositioning.
• The jaw is moved into its new, correct position.
• The surgeon removes, reshapes, or adds bone as needed.
• Surgical screws, wires, or plates are used to secure the jaw in place.
• The incisions are sutured closed.
• The surgical area is dressed to support healing.
• A splint is placed over the teeth to provide stability.

This complex procedure typically lasts between one and four hours, depending on the specifics of the case.

After the procedure

After jaw surgery, one typically stay in the hospital for one to four days for monitoring. They will be given medication to manage pain and prevent infection and will begin a liquid diet that lasts for several weeks.

After the surgery, it is expected that one will experience significant facial swelling. To manage the swelling, they will be given medication and instructed to apply ice packs to their face for the first 24 hours, alternating 20 minutes on and 10 minutes off.

Other things that may be experienced after the surgery include:

• A plastic splint will be placed in the one’s mouth to help their muscles adapt to the new jaw position. The splint should be worn at all times, except during meals or when cleaning teeth. 
• Due to swelling and the splint, speaking may be difficult and could cause frustration. If communication becomes too challenging, assistance will be provided.
• The splint will be removed around eight months post-surgery. If the patient has braces, they will need to continue wearing them for another six to nine months.
• Once the braces are removed, retainers will be necessary to maintain the new teeth alignment. The healthcare provider will give guidance on how often the retainers should be worn, typically full-time for the first year, and then only a few nights a week.

Outcome

Recovery varies, but most people take several weeks off before returning to work or school. Full healing can take up to a year. About eight weeks after surgery, the healthcare provider will remove the mouth splint and stitches.

Light exercise, like short walks, may be allowed after the surgery, but it is important to get clearance from the healthcare provider first.

While on recovery, it is important to monitor one’s health for any signs of complications. Seek medical attention if any of the following is experienced:

• Fever
• Shortness of breath
• Persistent vomiting or diarrhea
• Excessive bleeding
• Worsening pain instead of improvement
• A green smelly discharge from the surgical site, particularly if the area appears dark red or feels warm to the touch
• Stitches holding the incisions together appear to be separating