What is orthognathic surgery?

Orthognathic surgery (pronounced "ortho-nathic"- the "g" is silent) is corrective jaw surgery performed by an oral & maxillofacial surgeon. Corrective jaw surgery includes a variety of different surgeries specifically designed to fix a wide range of misalignments of the jaws and teeth. For example, if you have an under-developed lower jaw that results in your lower teeth being far behind your upper teeth when you bite down, this can be corrected through a combination of orthodontic treatment (braces) followed by a jaw surgery designed to reposition the lower jaw forward.

Are all dental misalignments corrected through orthognathic surgery?

Most minor dental misalignments are corrected through orthodontic treatment alone. However, some misalignments require surgery as well.

What types of misalignments require surgery?

When there is a large mismatch in the position of the jaws relative to one another, surgery is needed because orthodontic tooth movement alone is not enough to correct the bad bite. An example of this is when the upper jaw doesn't develop properly so that the lower jaw appears too far forward and the lower front teeth are in front of the upper front teeth. Another example is when there is asymmetry of the lower jaw, so that the middle of your chin point is not aligned with your facial midline. This frequently results in a bite that is off to one side and the teeth do not align.

How does orthodontic treatment and surgery work together to position the jaws and teeth properly?

The orthodontist and the surgeon work together to determine what the ideal bite and jaw position is for you. The surgeon does an analysis of the size, shape, and symmetry of your upper and lower jaw bones. For example, the lower jaw may be too long or too short, or the problem may be that the upper jaw is too forward, too far back, or too long vertically, resulting in a very gummy smile. Most people do not have perfect symmetry between the right and left sides of their face, but some people develop a jaw that is clearly deviated to one side. The orthodontist analyzes the teeth positions to determine the type of teeth movement needed to achieve a good bite.

In preparation for orthognathic surgery, the orthodontist will level the teeth, eliminate crowding and poor angulation. This may take several months to over one year. Once the teeth movements have been accomplished, surgery repositions your upper jaw, lower jaw, or both, to bring the teeth together into the best bite possible.

How does the surgeon know exactly where to reposition the jaws?

Once orthodontic tooth movement is nearly completed, you will have accurate plaster models made of your teeth and photos are taken of your face, profile, and smile. A very precise CT scan and other x-rays are also done. Your proposed surgery is planned with sophisticated software that allows the surgeon to see exactly how many millimeters and degrees of movement are needed in 3 dimensions in order to bring your teeth into the proper bite and achieve symmetry of the face.

How does the jaw stay in its new, corrected position?

In orthognathic surgery, the jaws are positioned properly through cuts in the bone, and small, specially designed bone plates and screws are placed to keep the jaw(s) in the proper position. Most patients also have the jaws held together using wires or tiny orthodontic rubber bands (elastics) between the upper and lower braces for up to 2-3 weeks. This is only needed during the early healing process so there is no movement where the bone was cut during surgery.

What other procedures are commonly done during orthognathic surgery?

During the planning phase prior to surgery, the surgeon may determine that even after repositioning your jaw(s), your chin will still be too short, too long, too far back, or deviated to one side. Chin surgery is often accomplished at the same time as your corrective jaw surgery to fix symmetry problems and bring more harmony to your face. Other procedures may include soft tissue surgery of the upper lip to reduce a gummy smile, or removal of fat under your chin. Sometimes it Is necessary to do temporomandibular joint (TMJ) surgery at the same time as orthognathic surgery, to reconstruct the joint if one or both of your jaw joints is excessively worn.

Am I asleep for the surgery?

Yes, the surgery is done in a hospital operating room under general anesthesia. Most patients stay in the hospital 1-2 nights after surgery. Our board-certified surgeons operate at California Pacific Medical Center in San Francisco, using new, modern equipment and instrumentation.

How do I eat if my jaws are wired together after surgery?

Most patients do not require more than 2-3 weeks of being wired or rubber banded closed, and frequently less time is needed. During that time, it is difficult to eat, speak or brush your teeth. You must adapt to a liquid or pureed diet and some temporary weight loss is common.

What are the benefits of orthognathic surgery? Why go through with it?

Corrective jaw surgery can improve chewing and speaking, because the goal is to get the upper and lower teeth to bite together in a proper relationship. In addition, there is an esthetic improvement of shape or symmetry of your jaws and face, the appearance of your profile, or the reduction of a very gummy smile. In many cases, moving the upper and/or lower jaws more forward will allow for better breathing because the airway is more open.

Do I have to be a certain age to have orthognathic surgery?

You should be past the age when the jaws have stopped growing in order to undergo surgery. This way the surgical results achieved are not altered by continued bone growth. For girls, this usually means age 16 or later. For boys, age 18 or later, on average. Orthognathic surgery can be done for more mature adults as well, as long as your health is good, you are a nonsmoker, and you are willing to commit to orthodontic treatment prior to surgery.

How do I get started?

If your orthodontist has already mentioned that you will need orthognathic surgery to correct the position of your jaw(s), then you may be referred to our office for an orthognathic surgery consultation. The best time to see our surgery group is at the very beginning of the orthodontic process, or even before you have the braces put on. Learn more about oral surgery in the bay area.