Orthognathic Surgery

Orthognathic (jaw) surgery is needed when the jaws and teeth don't meet correctly. Teeth are straightened with braces (orthodontics) and corrective jaw surgery (orthognathic surgery) repositions the misaligned jaws. This is done primarily to ensure that the teeth meet correctly and function properly, but it may also enhance facial appearance.

Please call us if you have questions about jaw surgery at our Indianapolis offices.

Who needs orthognathic surgery?

People who can benefit from orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly.   In most cases, the upper and lower jaws have grown at different rates, and are not properly aligned.  Sometimes jaw fractures and birth defects can affect jaw alignment.

Most individuals with bite or tooth alignment problems are referred by an orthodontist (braces specialist) who has determined that the problem is more than can be addressed with braces alone.  People needing orthognathic surgery often have one or more of the following problems:

• Difficulty in chewing, biting or swallowing 
• Speech problems 
• Chronic jaw or TMJ pain 
• Open bite  (front incisors don’t overlap)
• Protruding jaw 
• Breathing problems  (such as sleep apnea)

Preoperative consultation

Most individuals are referred to our practice by their orthodontist because they believe the results of treatment will be better if braces are offered in conjunction with orthognathic jaw surgery.  During your initial consultation, your surgeon will evaluate your unique situation:

During the pre-treatment consultation we will summarize the goals of surgery, the recommended procedure(s), the potential risks, and your alternatives to orthognathic surgery.   Your surgeon will send a summary of his or her evaluation and treatment recommendations to your referring doctor.  Our office will request a predetermination of benefits to your insurance carriers.   Your insurance company may cover orthognathic surgery depending on your particular situation.

During the preparation process, feel free to ask any questions that you have regarding your treatment. When you are fully informed about the aspects of your care, you and your dental team will make the decision to proceed with treatment together

Sequence of treatment

Although every patient’s situation is different, the typical treatment sequence involves three stages:

1. Pre-surgical orthodontics:  Your orthodontist will straighten your teeth, often without regard to how the upper and lower teeth fit together.  Braces are usually worn for 6 to 18 months.  Your orthodontist will then inform you and your surgeon that they have completed this stage and you are ready to proceed with surgery.  You will meet with your surgeon to be re-evaluated and discuss your procedure.
2. Orthognathic surgery:  Your maxilla and/or mandible will be surgically re-aligned.
3. Post-surgical orthodontics:  This usually commences 6 to 8 weeks postoperatively.  Your orthodontist will adjust your teeth for 6-9 months to optimize your occlusion.

As you can see, the time commitment is significant, and can range between 12 to 26 months or even more, depending upon the complexity of your problem.  Orthodontic appliances (braces) are kept on your teeth throughout the entire course of your care. During this time it is important that you keep up on your dental hygiene both at home and through frequent professional cleanings.

Orthognathic surgery and post-operative care

Your orthognathic jaw surgery will be performed in an outpatient surgery center or hospital.  This will be determined by the extent of your surgery and insurance factors.  An anesthesiologist will put you to sleep, and the surgeon with whom you’ve met will perform your surgery.  He will be assisted by another oral and maxillofacial surgeon in our practice or a resident.

When you awake, you will have elastics (rubber bands) between your upper and lower braces, assisting with keeping your teeth and jaws together in their new position.  You won’t be able to open your mouth much for the first five days, so a liquid only diet is recommended during this initial period.  You will be able to speak and breathe fine, but it will feel awkward at first.  Post-operative pain is typically well-controlled with either liquid pain medication or a pain pump, where you can administer specific controlled amounts of intravenous medications to yourself. 

You will go home with liquid pain medication, liquid antibiotics, and sometimes a decongestant.  Your elastics will hold your teeth together for about five days, and then your surgeon will loosen them.  At this point you can start chewing soft, mushy foods which can be easily squished between the prongs of a fork.  It takes six weeks for the jaw bones to heal enough to withstand normal chewing, so it is important to refrain from eating normal foods for at least six weeks.

Throughout your care, our surgeons will work closely with your dentist and orthodontist during your treatment. The actual surgery can move your teeth and jaws into a new position that results in a more attractive, functional and healthy dental-facial relationship.