Orthognathic Surgery: Purpose, Procedure, and Benefits and Side Effects

Orthognathic surgery, also referred to as corrective jaw surgery or just jaw surgery, is a series of procedures used to treat conditions of the jaw and lower face related to structure, growth, airway problems such as sleep apnea, TMJ disorders, malocclusion problems primarily caused by skeletal disharmonies, other orthodontic dental bite problems that cannot be easily treated with braces, as well as the wide range of facial imbalances, disharmonies, asymmetries, and malproportions. If your jaws are not in alignment it may make it challenging for you to speak and eat.

Orthognathic surgery is done in collaboration with a maxillofacial surgeon, an orthodontist, an oral surgeon, or a plastic surgeon. It frequently entails retainers after the final brace removal, as well as braces before and after surgery. Orthognathic surgery is frequently required when a cleft palate or other significant craniofacial anomaly are repaired.

The process entails braces to get your teeth ready for jaw surgery, the operation, recovery time, and then further braces for up to a year following the surgery. The entire procedure of having a jaw operation may take two to three years.

Orthognathic surgeries are divided into several categories depending on the degree of the misalignment and the position of the jaw. Various techniques are performed to treat different kind of jaw issues. If your jaws protrude too much outwards or inwards, it may be necessary to have jaw surgery to balance out your facial features. Jaw surgery can be done through three methods to treat these conditions

Surgery to repair a badly receding top jaw is often known as maxillary osteotomy or upper jaw surgery. If your upper jaw may protrude too far or too little, in whichever case maximum osteotomy surgery is performed. Crossbite and open bites can both be treated with a maxillary osteotomy. The upper jaw is cut and moved in order to place it properly during the treatment by making an incision in the gums directly above your upper teeth.

If your lower jaw sticks out outwards or inwards, this procedure is performed. One of the most popular jaw surgeries, also known as lower jaw surgery, is used to repair a significantly receding lower jaw. This surgery is frequently used to address an underbite. To correct the patient's bite alignment, the lower jawbone is moved either forward or backward during the surgery.

The procedure to reposition or reconstruct badly misaligned lower jaws is frequently referred to as ‘chin surgery’ or Genioplasty. The chin is the area that needs to be reconstructed most frequently for several reasons. It can be done by oral and maxillofacial surgeons with specialized education and expertise.

Damage to the articular disc, which cushions the jaw joint, results in temporomandibular joint disorder (TMD), a condition that is accompanied by excruciating pain in the jaw muscles. TMD is frequently handled with open surgery.

• Arthroplasty: The most popular method for treating temporomandibular joint disorder or dysfunction (TMD) is arthroplasty, sometimes referred to as keyhole surgery or open-joint arthroplasty. Damage to the articular disc, which cushions the jaw joint, results in temporomandibular joint disorder (TMD), a condition that is accompanied by excruciating pain in the jaw muscles. TMD is frequently handled with open surgery.
  The treatment involves making a tiny incision and inserting an arthroscope with a tiny camera head into the joint. The joint's surrounding scar tissue is removed during this surgery to reduce pain.
• Arthrocentesis: This minimally invasive surgery, also known as joint aspiration, involves injecting fluid with tiny needles into the TMJ. As a result, the joint can be lubricated and any material associated with inflammation can be removed.

  During this operation, the surgeon may additionally straighten or reposition the jaw and inject steroid medicines into the joint.

Your teeth and jaws will be placed in more balanced, useful, and healthy positions after orthognathic surgery. Problems brought on by misaligned upper and lower jaws can be resolved through jaw surgery. The main benefits of orthognathic surgery are an improved bite and function, although many patients also report;

• Enhanced appearance
• Adjusting your bite, which refers to how your teeth fit together when your mouth is closed
• Addressing issues with facial symmetry
• Easing pain from a temporomandibular joint disorder
• Repairing facial injuries
• Preventing additional wear on your teeth
• Making biting, chewing, and swallowing easier
• Improved Respiration
• Proper speech
• Addressing breathing issues like mouth breathing and obstructive airway disease.

Your life may be dramatically improved as a result of orthognathic surgery, and your self-confidence and self-esteem are likely to be greatly increased.

Orthognathic surgery, sometimes referred to as jaw surgery, straightens up misaligned jaws and teeth to improve their functionality. Your facial look might also be improved by making these adjustments. Usually, genetic factors play a role in jaw abnormalities. Additionally, some childhood practices like thumb sucking and mouth breathing may have an effect on a person's dental and jaw structure.

The majority of people have biting problems, which may need to be fixed surgically:

• Overbite: It occurs when the upper jaw overhangs the lower jaw significantly
• Underbite: It occurs when the lower jaw pushes forward beyond the alignment of the upper jaw
• Open bite: The top teeth do not touch the lower teeth when the mouth is closed

When a patient has both a dental malocclusion and substantial skeletal anomalies, orthognathic surgery may be necessary. The jaws may need to be surgically realigned or dentoalveolar segments may need to be repositioned during these treatments, which are typically carried out by an oral and maxillofacial surgeon in a hospital setting.

Though to be one of the best surgeries for jaw related issues, orthognathic surgery carries a number of risks that are very minimal and uncommon if performed by an expert surgeon or a team of surgeons, comprising; maxillofacial surgeon, an orthodontist, an oral surgeon, or a plastic surgeon. The risks associated with jaw surgery are;

• Harmed teeth
• Delayed or failed healing
• Problem with jaw joint
• Unable to fully open your mouth
• After surgery, your lower lip and cheeks are stays numb for long
• If your initial surgery fails to address all of your issues, you might require another surgery
• Recurrence of bite issues that led to your jaw surgery
• You may get scars

Despite the risks, an orthognathic surgery can be a good choice for people with jaw issues. The chances of countering the risks can also be ignored or reduced if the surgery is done by an expert surgeon at Pristyn care.

Speak with a reputable healthcare professional at Pristyn care before the procedure to receive detailed instructions on how to get ready for the surgery. Your medical professional might be able to provide you with information about the pre- and post-surgery preparation and treatment that may include;

• Nothing to consume after midnight, the night before surgery or for at least six hours before it
• Six weeks in advance of the procedure, quit smoking. Smoking prohibited for six months following surgery
• Seven days before the procedure, stop taking aspirin and ibuprofen (Motrin, Advil), as well as ibuprofen analogues (Aleve, Naproxen). Avoid taking NSAIDS and other analogous medications unless told to do otherwise by the doctor
• Two weeks before surgery, stop using any herbal remedies, including vitamin E, fish oil, and vitamin supplements (apart from a tiny daily multivitamin). For best healing results, take a multivitamin every day. However, do not take it the morning of the procedure
• The patient must be accompanied by an accountable adult as he/ she won't be able to drive for 24 hours
• If the patient is sent home following surgery, someone must keep monitoring them for at least 8 hours
• Contact your dentist if you have a severe cold, sore throat, or sinus infection with significant drainage before the procedure. He might wish to see you before the surgery or postpone the appointment until after you've recovered
• On the day of operation, no jewelry or makeup should be worn. To make placing the monitor easier, at least one fingernail should be unpolished. Avoid wearing contact lenses to the hospital on the day of surgeryBefore surgery, brush, floss, and rinse your teeth.

• The patient is brought to the operating room on the day of surgery well in advance of the scheduled procedure time
• Prior to the surgery all clothes and surgical instruments are cleaned to eliminate any bacteria and germs
• The patient is changed into a fresh surgical gown
• An anti-blood clotting medication, may be given as a pre-operative dosage
• A thorough physical checkup is performed before the procedure. Vitals such as the heart rate, blood pressure, body temperature, and breathing rate are monitored
• Depending on the issue and method, orthognathic surgery varies substantially. The procedure can start when you've been prepared and given the proper anesthetic

Orthognathic surgery varies greatly depending on the problem and technique. There won't be any facial scars on the chin, jaw, or mouth region because surgery is frequently performed inside the mouth. However, there are some circumstances where it can be essential to make small incisions outside of your mouth.

Maxillary osteotomy (upper jaw)
To enable the entire top jaw, including the roof of the mouth and the upper teeth, to move together as a single unit, your surgeon cuts the bone above your teeth. The jaw and upper teeth are advanced until they are perfectly aligned with the lower teeth. If any extra work like orthodontics is required it will be done at this stage to assist correct any residual fit disparity.

Mandibular osteotomy (Lower jaw surgery)
The front portion of the lower jaw is separated, movable forward or backward, and fixed with plates and screws.The surgeon makes incisions behind the molars and along the length of the jawbone to enable the front of the jaw to move as a single unit. The jaw can then be moved to its new location by moving it forward or backward. As the jawbone heals, plates and screws hold it together.

Genioplasty (Chin surgery)
Usually, the jaw and the chin can be altered during the procedure. The surgeon cuts the chin bone near the front of the jaw, moves it forward, and then fixes it with plates and screws.At the end of the treatment, your doctor may suture up any incisions made during surgery.

After your operation, you might need to stay in the hospital for one to four days so your doctors can check on how you're doing. Here are some things you might go through while in the hospital and as you recover:

• After orthognathic surgery, your medical team will transfer you to a recovery room or the post-anaesthetic care unit (PACU) so you can wake up from the anesthetic. With local anesthesia, this normally takes 10 to 15 minutes, however when under general anesthesia, it takes 45 minutes. You can have some discomfort or pain when the medication wears off
• Additionally, you can be given medications to ease your post-surgery discomfort, oral antibiotics to help prevent infection, and wound care instructions
• If your vital signs have returned to normal and you can walk upright, you will be discharged from the hospital
• A friend, relative or hospital service might be needed to drive you home. However for some procedures, staying in the hospital for another one or more days may be essential
• If you have braces, you must wear them for six to nine months following surgery
• After your braces are removed, you'll need detachable retainers to keep your teeth in their new position. Your doctor will give you instructions on how often you wear your retainers, but most people follow those instructions religiously for a whole year. After that, you might need to wear your retainers a few evenings a week.

Orthognathic surgery not just aids in improving face look, but it also helps fix problems like; overbite, underbite, crossbite, TMJ disorders and chewing difficulties.

The price of orthognathic surgery varies from hospital to hospital or from treating doctor to doctor. However, depending on the complication and infrastructure, the typical cost of orthognathic surgery in India starts from Rs. 50,000 and can go up to Rs. 3,00,000.

Orthognathic surgery in Bangalore can cost somewhere between Rs. 65,000 to Rs. 1,70,800, in Delhi from Rs. 68,250 to Rs. 1,79,340, Mumbai Rs. 71,500 to Rs. 1,87,880, whereas in Chennai it can go somewhere from Rs. 61,750 to Rs. 1,62,260, while in Hyderabad it can cost Rs. 65,000 to Rs. 1,70,800, and in city like Pune it can range from Rs.65,000 to Rs. 1,70,800.

You must follow a liquid and soft-food diet following orthognathic surgery, avoiding chewy, hard, or crunchy foods for at least the first several days. The process might take several weeks if it's complicated. So, while you're healing after maxillofacial surgery, you may still indulge in a broad selection of savory and nourishing meals and beverages;

• Greek yogurt or protein powder in fruit smoothies
• Beverages with nutritional supplements
• Chicken, beef, or veggie broth with less sodium
• Oatmeal or cream of wheat that has been thinned
• Stew that includes sautéed vegetables and beans
• Baked fish served with risotto or rice
• Meatloaf
• Pudding or custard
• On soft bread, a chicken or tuna salad
• Carrots, cauliflower, squash, or potatoes purée
• Vegetable soup

Orthognathic surgery is extremely safe when done with the best anesthesia and surgical team. Every medical procedure carries some risk, and orthognathic surgery is no different.

Although orthognathic surgeries can include intrusive procedures, the dangers and side effects are often overlooked given the long-term advantages and benefits. Visit a qualified and trained medical professional at Pristyn care for your jaw issue for better results with less risks and consequences. Make sure you are completely informed about the operation beforehand.

Oftentimes, orthognathic surgery is painless. You won't actually feel any pain during the procedure as you'll be under anesthesia, however after jaw surgery, it is usual to feel some pressure or pain in or around the jaw joint locations. This might resemble an earache in several ways and is brought on by pressure in the jaw joint region which is caused by your jaw's new location. This pain will typically go away within two to three weeks.

All dentofacial osteotomies require a 2–6 week initial healing period, followed by another 2–4 months for secondary healing (full bony union and bone remodeling). Sometimes the jaw is immobilized (its movement is limited by wires or elastics) for one to four weeks. But it will still take two to three months for the jaw to fully recover.

The following steps make up a jaw surgery recovery timeline:

• During the first two to three weeks after surgery, patients may have some pain and soreness. But this is very natural
• The swelling should go down after three weeks or in very rare case it might take a month time to completely go away
• Get additional rest, drink plenty of water, and pay attention to your surgeon's post-operative recommendationsTake your prescribed painkillers and antibiotics as directed by your maxillofacial surgeon

Additionally, depending on how much pain they are experiencing, patients should not work heavy machinery or drive or operate motor vehicles while taking painkillers, which are normally administered for six to eight days following surgery. Patients must follow specific postoperative guidelines for preventing infections, such as daily cleaning and antibiotic use. To ensure healthy, strong teeth, cleaning the mouth should always be done, regardless of surgery. After surgery, patients can resume their jobs in 2 to 6 weeks, but they must adhere to particular recovery guidelines for at least 8 weeks.

Last but not least, during the two to three month healing phase, bone will normally grow over any screws that were placed into the jaw.

Orthognathic surgery has been proved to be safe, although it could result in consequences like these;

• Blood loss
• Infection
• Nerve damage
• Jaw fracture
• Relapse of the jaw to its pre-surgical position
• Problems with bite
• Jaw joint pain
• Need for further surgery
• Need for root canal therapy on selected teeth
• Loss of a portion of the jaw.

• Swelling and bruising: Following surgery some swelling and bruising can be present for about two weeks. Your head should be elevated, and cold compresses should be administered to the jaw, nose, and eyes to get relief from this problem. For a few weeks, residual bruising can be apparent. Contact your healthcare provider right away if you have severe swelling or vision issues.
• Activity: Sit up, straighten up or slightly reclined. For 72 hours, refrain from any physical exertion, straining, or bending over. Do activities which are easy to do but avoid engaging in strenuous physical activities which may raise blood pressure, such as jogging, swimming, weight lifting, and bending. No blowing the nose. Stay away from activities that are jarring or hammering.
• Pain: It's common to feel some soreness after surgery. Take any prescribed painkillers exactly as instructed. When taking narcotic painkillers, never drive. It is frequently advantageous to take the drug after eating in order to lessen nausea.
• Eating: You should eat when you are ready. Your food must be soft and mushy. Start out by consuming cool liquids. Prepare some dietary supplements to compensate for the nutrients that your restricted diet can’t provide for.
• Wound care: Do not get the surgical site wet for 24 hours following surgery. Later, you can let some water run over the region without getting it soaked. Avoid getting shower spray on the surgery site. After the initial few days, facial sutures (if any) should be left exposed to air. In 5-7 days, the sutures should be removed.
• Oral hygiene: Start brushing your teeth and rinsing carefully the day following surgery. Don't vigorously swish the mouthwash at first. If the incision is kept meticulously clean throughout the healing process, it will heal more quickly. Lightly massaging the incisions with your fingertip once a week has passed. Oral stitches will be taken out after two weeks.
• Tobacco consumption: Stop using all tobacco products six weeks before and six months after surgery. Failure to do so could have a detrimental impact on the operation's success.
• Sleeping: Raise the head of your bed by 30 degrees for sleeping. Try not to apply pressure to the area which has received surgery since the bones' new positions need time to mend before they become stable.
• Facial exercises: The muscles used for facial expression, particularly after upper jaw surgery, will not function properly, and the upper lip will swell significantly. After surgery, practice smiling three times every day.

Orthognathic surgery is a major operation and is often performed to fix conditions like an injury, or abnormality of jaws. Conditions like TMJ, jaw structural issues can not only affect your facial appearance but can also cause severe pain or discomfort and bite issues. Before undergoing orthognathic surgery, you should consult your medical professional who can explain the procedure, its complications and risks in detail.