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A GUIDE FOR PATIENTS UNDERGOING ORTHOGNATHIC SURGERY

What is Orthognathic Surgery?

Typical jaw movements during orthognathic surgery.This is the surgical repositioning of one or both jaws to achieve a stable and balanced working occlusion (bite). It is carried out in cases where orthodontics alone can not provide a suitable or stable occlusion at end of treatment. Surgery can also improve a patients profile and give them greater self-confidence.

When surgery has been recommended along side orthodontic treatment, you will find a highly motivated team doing their best to make the treatment outcome a successful one. The team includes:

  • Your general dentist - looking after your oral health
  • The Orthodontist - aligning your teeth
  • The Maxillofacial surgeon - carrying out the surgery
  • The Maxillofacial Technologist - carrying out model planning and constructing appliances

A typical treatment plan would be:

  1. To have removed if necessary the four wisdom teeth. This is especially important in the lower jaw, as the wisdom teeth lie where the mandible (lower jaw) is split for either advancement or retrusion (set back).
  2. Fixed appliances would be applied by the Orthodontist; these are checked and adjusted approximately every six weeks until ready for surgery, usually after about twelve to fifteen months.
  3. Up to date x-rays and impressions are taken of your newly aligned teeth shortly before surgery. Jaw movements are planned and acrylic (plastic) wafers are made to ensure correct jaw positioning in surgery.
  4. The surgery is carried out by the Maxillofacial surgeon.
  5. After surgery, orthodontics is carried out to ensure accurate interdigitation (interlocking ) of upper and lower teeth, for up to four months. During the first six weeks after surgery weekly visits are necessary to settle the bite.
  6. 6) The fixed orthodontics are removed and removable retainers are fitted. Then annual appointments are made for a period of five years after surgery.

QUESTIONS AND ANSWERS

Is surgery really necessary?

If you have been given this option then the chances are that it is. You probably have an underlying jaw discrepancy, which although could be masked or camouflaged by orthodontics alone, would in the long run turn out to be unstable and could exaggerate certain aspects of your facial appearance such as a big chin or a small upper jaw.

Is having no treatment at all an option?

Yes it is an option. At best you will remain the same. However if left your condition has a pretty good chance of deteriorating and so may lead to associated problems such as muscle tension down the side of your face, and possible increase in bite abnormalities.

Am I the right age for this treatment?

Surgery is usually carried out in late adolescence around seventeen years of age. It is also acceptable for adults to have the treatment, although tooth movement in the orthodontic stage may take slightly longer.

How long will my operation take?

For a single jaw procedure about two, and for a two jaw procedure about three and a half hours.

How long will I be in hospital?

Approximately four to five days, depending on your progress and how well you are eating. Although eating will be difficult at first, the more you eat the faster the healing process and the sooner you can leave hospital. Unfashionable as it may be for some, it is advisable to really pack in the calories the week before you come in to hospital, as you may lose weight in the first few weeks after surgery.

When will I be able to eat solid food?

For a period of up to fourteen days after the surgery, your jaws will be held in a plastic biting wafer by means of elastics. So liquidated food only. When the wafer is taken out, you may still have elastics on your teeth for some while but you can start on soft food.

Is breathing a problem while my jaws are held together?

For the first couple of days after surgery your nose may feel blocked and there may be some irritation of your throat, but it will pass quickly. Even though your teeth will be held together, you will still be able to part your lips and breathe through your mouth.

Will my speech be affected?

After the operation and while in elastics, YES. However you will overcome this barrier and be coherent quicker than you think.

Will I be swollen after the operation?

Yes. The swelling will come out within the first forty-eight hours post-operatively, will stay constant for about a week and then will slowly recede.

Will I have a scar?

Yes, but only visible inside your mouth. All the jaw surgery is done from inside the mouth, and the only small marks initially visible from the outside of your mouth will be where your drains will have been, but these will fade fast.

Are there any adverse side effects from surgery?

There is a possibility that the nerve running through your lower jaw may be bruised during surgery. If it is then you may experience some numbness around the area of your chin and your lower lip. In many cases this is temporary and feeling will return. In a small number of cases it will not return, but it does not affect the lip movement in any way and the patients that suffer from this cope well and don’t give it a second thought.

How long will I be off work / away from college?

You can gently resume normal activities after about a week, as far as work or college you should be able to return in about four weeks.

Once I have my braces off, is that it?

Once the braces are removed there will be a period of “retention”. This is to allow the teeth to settle and become firm in their new positions. You will be given a set of removable appliances (called retainers) to wear full time for a period of six months, and then if all is well nights only for another six months. You will also be seen on an annual basis for review up to five years after your surgery.

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