Maxillofacial surgery


What is orthognathic surgery?

Corrective jaw surgery also known as Orthognathic Surgery is performed to correct various irregularities of the facial skeleton and / or of teeth. The word " orthognathic " comes from two Greek words, "ortho" meaning right and "gnathion" which refers to the jaws.

Orthognathic surgery performed by oral and maxillofacial surgeons, not only improves the smile and the appearance of the person but also improves his or her ability to chew, speak and breathe. Other benefits include the relief of facial pain, headache, snoring and sleep disorders such as obstructive apnea. While the aesthetics of the patient can be considerably improved as a result of surgery, it is mainly used to correct functional problems. Orthognathic surgery can change the position of all or part of the upper jaw, lower jaw and chin. In some cases, facial cosmetic surgery can be done simultaneously with orthognathic surgery and patients are encouraged to inquire about the options that are available and speak with a maxillofacial surgeon.

Who needs a orthognathic surgery?

People who benefit from orthognathic surgery includes those whose teeth and jaws create an improper bite .The jaw growth is a gradual process and the maxilla and mandible occasionally can grow at different speed. This can cause functional problems including difficulty when chewing, speaking, breathing or sleeping and overall problems of oral health. A severe misalignment can affect the appearance of a person and cause psychological or emotional problems. Injury to the jaw or head and birth defects can also affect jaw alignment. Orthodontics is responsible for solving the misalignment of teeth bite and orthognathic surgery corrects the misalignment between the mandible and maxilla.

Conditions that may indicate the need for orthognathic surgery:

• Difficulty chewing or biting food
• Difficulty swallowing
• Chronic pain in the jaw joint (TMJ) and headache
• Excessive wear on the teeth
• Open bite (increased space between the upper and lower teeth when the mouth is closed)
• Unbalanced facial appearance of the front or side, disproportion between the facial thirds.
• Facial injuries or birth defects
• Protruding chin or jaw
• Inability to keep the lips closed together without forcing
• Chronic mouth breathing and dry mouth
• Sleep apnea (difficulty breathing during sleep, including snoring)

It is necessary to assess your need for orthognathic surgery. Dr. Diaz Carandell will maintain close cooperation with your orthodontist to determine if orthognathic surgery is recommended as well as choosing the appropriate procedure. Before surgery, your medical history is reviewed and facial measurements, photographs, X-rays, as well as bite and dental impressions are made.

What is orthognathic surgery?

Pre-surgical orthodontics

• Before surgery, the orthodontist aligns the teeth with braces. This phase of treatment usually lasts from 6 to 12 months and requires to visit the orthodontist to make adjustments. Because teeth are moving in a position to fit together after surgery, your bite may seem to worsen during this period. However, when the jaws are repositioned during surgery, the teeth should fit properly. It may be necessary to perform the extraction of one or more teeth including the third molars (wisdom teeth) in this initial phase of the treatment.

Presurgical study

After orthodontics, Dr. Diaz Carandell makes final preparations for surgery: Facial TMJ in 3 dimensions as well as surgical guides and models are obtained from dental impressions.

Preparation for orthognathic surgery

• Most procedures of orthognathic surgery are usually performed under general anesthesia. Before surgery, your medical history is reviewed and a complete physical examination is performed. Also, a special diet is provided according to the dietary needs of each patient.

Surgical procedure

• The duration of orthognathic surgery varies from 45 minutes to three hours depending on the procedure to be performed . Procedures involving the lower jaw usually require the separation of the back of the jaw from the front supporting the teeth. This allows Dr. Diaz Carandell to move the anterior part of the mandible to reposition it forwards or backwards. In the upper maxillar, the part of the teeth is separated from its base and is repositioned up, down, forwards or backwards .
• During surgery , Dr. Diaz Carandell moves your jaws according to your specific needs. Small plates and surgical titanium screws are used to hold the jaw in its new position. All incisions are performed through intraoral orthognathic surgery

Immediately after surgery

• After surgery, patients are taken to a recovery room until the effects of the anesthesia has worn off. Depending on the procedure performed, patients go home the same day of surgery or they stay overnight at the clinic. In any case, it is important to drink enough fluids to maintain an adequate nutrition before returning home. Patients receive instructions with a modified diet and a schedule to move on to a normal diet. Do not smoke or engage in strenuous physical activities.

• Discomfort after orthognathic surgery is easily controlled. You should take medication against the pain and use ice to help in the healing process.
•The post-surgical swelling will usually last a maximum of 48 to 72 hours and then the swelling gradually decreases. Most of the swelling disappears in 7 to 10 days, but the slight visible residual swelling may last for several months.

• After surgery, Dr. Diaz Carandell works closely with your orthodontist to "refine" the bite. Once the braces are removed, you may need to wear a retainer to help keep your bite. The whole treatment, including orthodontics before and after orthognathic surgery may take 1-2 years to complete.

Follow Up

• After orthognathic surgery and orthodontics are completed , Dr. Diaz Carandell and your orthodontist will determine when and how often a re-assessment of your bite is required. In addition, regular checkups with your dentist are very important to maintain an optimal dental health.

Enjoy the benefits of orthognathic surgery

Orthognathic surgery moves your teeth and jaws into more balanced, functional and healthy positions. Although the objective of orthognathic surgery is to improve the bite and its function, many patients also experience improvement in their appearance , breathing and speech. The results of orthognathic surgery can have a very positive effect on many aspects of your life. Chances are your self esteem and confidence may increase significantly.

Orthognathic Surgery Risks

Orthognathic surgery is a major operation and it is important to be informed of certain risks.
• Blood loss is usually mild and bleeding requiring transfusion is extremely rare. Immediately after surgery, especially maxillary, a small nosebleed can occur.
• The temporary numbness or tingling after surgery is typical and decreases as the healing progresses. In very rare cases, altered sensitivity may be permanent.
• During surgery, the position of the jaws and teeth are manipulated with the patient lying down and totally relaxed. When the patient is awake and upright, the muscle tone in the jaw recovers and the bite (malocclusion) can be subtly different. After surgery, Dr. Diaz Carandell will follow closely the progress of each patient to ensure the new bite is identical to the original plan. Quite often, orthodontic rubber bands are used to guide the development of the bite. In rare cases, if the bite is not exactly as expected, additional surgery may be necessary.
• An infection, although there is a potential risk after any surgical procedure, is very rare and is usually treated with antibiotics.
• Unintentional injuries to the teeth, roots, fillings, bridges or surrounding tissue can occur during any surgical procedure on the mouth. If they occur, they may require a proper correction.
• The procedures, such as dental treatment, orthognathic surgery or orthodontics that change the position of the teeth, can worsen or lead to a syndrome of disfunctional TMJ (jaw joint). Although orthognathic surgery is often performed to improve the function of the Temporo Mandibular Joint and its symptoms, in rare cases, it may aggravate a pre-existing condition.
Patients can return to work or school one to three weeks after surgery. Although the initial healing phase is about 6 weeks, complete healing from this procedure takes nine to twelve months . After surgery, Dr. Diaz Carandell decides when your orthodontist can begin to " refine " the bite, which usually takesfrom two to six months.

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