Jaw Surgery is an aid to orthodontic treatment by instantaneously correcting the relationship of the upper and lower jaws.
Although the term “jaw surgery” refers to any surgery of the upper or lower jaws, we are specifically talking about how upper and/or lower jaw surgery aids in the proper orthodontic positioning of the two arches together. It is also called corrective jaw surgery. The surgeon does not “break your jaw” but does very carefully section your jaw and permanently fasten it into a much better position.
On occasion, regular orthodontic treatment alone cannot solve the occlusal alignment problems or malocclusion. Jaw surgery may be necessary in one or both of the jaws, the upper jaw being the maxilla, and the lower jaw being the mandible. This particular surgery is called orthognathic surgery and is performed by an oral surgeon in combination with previous consults with the involved orthodontist.
The LeFort I osteotomy is often used for proper alignment of the jaws. Osteotomy simply means surgical cutting of the bone. In most cases, the osteotomy used is called linear, which is the cutting of bone in a linear fashion. Sometimes the upper and lower jaws and teeth just do not properly match, which leaves the choice of a combined orthodontic/jaw surgery as the only treatment option if the patient wants proper correction. This surgery is used to correct a protruding jaw as well as a receding jaw (upper or lower), to close an open bite in the front, or to reduce the vertical length of the upper jaw (showing too much gums). Very small bone plates are used on the upper jaw and screws on the lower jaw. They are often left in place after healing. Usually your jaws are no longer wired shut, but some surgeons prefer that technique. There are many other forms of jaw surgery including LeFort’s I, II, and III, but we are limiting our discussion to LeFort I.
In the greatest majority of patients, the orthodontist will prepare a plastic bite appliance with the teeth indentations on each side. This is used as a guide by the oral surgeon. He usually performs his osteotomy (s), and then wires the two arches together with the plastic bite appliance holding the teeth and the arch bones in the optimum position. Then he uses surgical steel screws to position the bones into a new and better alignment. The bite appliance is that guide. Once the bones are screwed into the new position and with the proper alignment of the jaws and teeth, the splint is removed and the bone heals. Some surgeons prefer to leave the two jaws wired together for a short period of time.
A dramatic enhancement of the patient’s appearance, especially in the profile, is usually one of the dramatic improvements; that, along with the greatly improved occlusion. There are now software programs that accurately predict the post-op profiles. Another excellent point is that all incisions are within the mouth which leaves no external scars on the face. Complications using the LeFort I procedure are minimal and the procedure yields long-term and reliable benefits. But some of the complications, like any surgery, are nausea, swelling, muscle spasm, bleeding and numbness. This numbness is usually only temporary but on a very rare occasion, it may be permanent. The patient is placed on a liquid diet, followed very soon by soft food, and then hard food.
Upper and lower jaw surgery is in most cases elective and the patient and parents (if a minor) should be well-informed. Often it is the only manner to solve some of the aforementioned problems, but the procedure yields highly predictable results.
Life Member of American Dental Association, Emeritus Fellow of Academy of General Dentistry, American Association of Implant Dentists.