corrective Jaw surgery

It is a completely scar-less surgery done to achieve the perfect jaw line and facial projection.

Corrective jaw surgery a.k.a Orthognathic surgery is used to “put the jaws back into the right position” when there is a discrepancy between the jaws and the dental arches, and when orthodontics alone is insufficient.

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These various types of jaw irregularities most commonly develop due to developmental or growth disturbances but can also occur due to a facial injury during sports or in a road traffic accident and they later manifest as facial deformities. Facial injuries during the growing period of a child can also lead to an irregular bone structure in adulthood which may require surgical correction later in life.

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This procedure requires orthodontist and maxillofacialsurgeon to work together.

Displacement of the jaws often leads to a change in the patient’s appearance due to the fact that the skin will “follow” the contours of the displaced bones.

This type of surgery has been performed for many years and is very well mastered by maxillofacial surgeons, who are skilled in all plastic surgery of the face. In adolescents, it is usually undertaken once the bone has finished growing.

What does Orthognathic Surgery involve?

Initial examination

The orthodontist and maxillofacial surgeon will perform a full clinical examination of the patient concentrating on assessing dental occlusion, the state of the teeth, phonation, swallowing, and respiration; they will also take photographs of the face and teeth from standardized angles.
Paraclinical examinations will then be used to complete the analysis, this may include frontal and lateral radiographs and a dental panoramic radiograph.

Impression casts will be taken to give a precise indication of the relationships between the teeth and to simulate the surgical procedure.

A diagnosis is thus established and the medical team will determine whether treatment is necessary and will adapt such treatment to each individual case.

A diagnosis is thus established and the medical team will determine whether treatment is necessary and will adapt such treatment to each individual case.

The amplitude of the overbite or underbite will determine the length of the treatment and the type of surgery proposed in the treatment plan.

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PreOperative Orthodontic Treatment

Before the operation, orthodontic treatment is essential to prepare the dental arcades of the patient for the surgery. In general, this will take between 6 and 18 months. The aim is to position the teeth to enable optimal surgical treatment.

The patient should therefore keep his orthodontic device for the entire duration of the preoperative preparation period and take great care of it in accordance with the recommendations of his orthodontist.
This preoperative modification will causesome temporary discomfort since the teeth will only “meet” properly once the surgery has been carried out.
It is sometimes necessary, depending on the treatment, to extract certain teeth (wisdom or premolar teeth). The evolution of the modification in theposition of the teeth will be assessed on a regular basis.

Surgery Process

Preparation for the surgical procedure

The date of the surgical procedure will be decided once the orthodontic preparationis deemed to be correct and sufficient by the orthodontist and surgeon.

Before the surgery, the surgeon will perform a schematic analysis of the various proportions and measurements of the facial skeleton. He will also simulate the displacements using impression casts of the teeth to predict the definitive result of the surgery.

The procedure is performed under general anaesthesia (essential for this type of surgery), in a hospital or clinic.

The surgical procedure

The aim of the surgical procedure, which is known as an osteotomy, is to displace the jawbones. The bony architecture of the face is thus altered to enable the teeth to meet correctly. The various bone segments are then fixed to each other using plate and screw type implants, which greatly limit the extent to which the jaws must be immobilised after the surgery. Usually, they are held in place using elastic bands for less than 15 days. These plates are not visible, butcan sometimes be felt. They can be left in place for life, or removed around one year after the procedure.

All of the incisions are made inside the mouth to avoid any visible external scarring. The procedure may take between one and four hours, depending on the number and complexity of movements to perform on the jaws.

The amount of blood lost does not usually necessitate a blood transfusion.

The Postoperative Period

Immediately after the surgery

The patient will be hospitalized for between2 and 6 days.

To facilitate healing and consolidation, patient must adhere to an all-liquid diet for the first few days, then pureed, and finally softened. After at least a fortnight, the patient may return to school or work as usual.

Postoperative orthodontic treatment

The postoperative orthodontic treatment can be started 4 to 6 weeks after the procedure and may take between 3 and 9 months.

This phase is essential to enable the definitive adjustment of the dental arcades after the surgery.

Follow-up

A series of appointments at set intervals will be made with the surgeon to ensure regular medical monitoring. Through- out this period, strict dental hygiene is highly recommended.

All sporting activities or those that might compromise the healing phase are prohibited for 6 weeks to 3 months.
It is important to note that the result of the dental repositioning is visible immediately after the procedure, but the aesthetic and morphological resultwill not be definitive until 2 to 3 months after the procedure

Possible Complications of Orthognathic Surgery

Certain complications may occur during or after the operation. These are however rare oreven exceptional, and above all without any major consequences in the majority of cases:

Pain

This is usually minimal or even absent, and is easily controlled with standard antalgics.

Swelling

This is normal and may persist for several days to weeks.

Bleeding

Usually only minor, it may last for several days.

Nausea and vomiting

These are common complications after general anaesthesia, various medications are given to limit this discomfort.

Sensory disturbances

More common on the lower lip (in procedures involving the mandible) than on the upper lip (following procedures on the maxilla), they may persist for several months, with regular improvements. Patients usually recover full sensitivity.

Infection

This is a risk that is associated with all forms of surgical intervention, it is therefore a possibility and will betreated with antibiotics. In exceptional cases, a further surgical procedure may prove necessary.

Sinusitis

This is possible following a procedure on the upper maxilla.
Displacement of the new position of the jaws that may require longer immobilisation or to repeat surgery.
Limited mouth opening usually temporary and resolved with physiotherapy.