Orthognathic Surgery

• Problems chewing, biting, or swallowing
• Speech difficulty
• Jaw pain
• Open bite (back teeth meet, but front teeth do not)
• Protruding jaw
• Receding jaw/over bite
• Breathing problems, such as sleep apnea

• Mandibular (lower jaw) deficiency - The facial appearance of a person with mandibular deficiency is best appreciated in profile. The chin is poorly defined, the lower incisors (front teeth) are often pushed forward, and the lower lip appears full and curled outward under the protruding maxillary incisors.
  
  The facial appearance of a person with a deficient lower jaw and inadequately supported soft tissues worsens with the normal aging process.
  
  The combination of orthodontic treatment and jaw surgery (lower jaw and chin) is the best way to make improvements.

American Association of Oral
and Maxillofacial Surgeons

• Mandibular (lower jaw) excess - When evaluating the problem of mandibular excess (prognathism), emphasis should be given to the overall appearance of the face, with less concern about specific x-ray measurements.
  
  The orthodontist's goal will be to remove all dental compensations (poor positioning of the teeth) while the surgeon's objective is to reposition the jaw to achieve a functional occlusion and to enhance facial aesthetics.
  
  The philosophy for management of the mandibular "prognathic" patient is toward surgically moving the upper jaw forward to achieve normal occlusal relations with enhancement of the skeletal volume. The lower jaw generally requires surgical repositioning to achieve improved proportions and symmetry. Reshaping of the chin is often necessary for ideal facial aesthetics.
  
  These procedures stretch and align the facial skin. This results in loss of unattractive folds, leveling of the lips, and lessening of the deep skin creases that would worsen with aging.
• Maxillary (upper jaw) excess - Controversy continues about the cause and effect of airway obstruction on facial growth. We do know vertical maxillary excess (a "gummy smile") generally occurs in the presence of blocked nasal air flow and a mouth-breathing habit that is ongoing during childhood when the facial bones are developing.
  
  In this situation, the facial skeleton grows long (vertically) and the appearance demonstrates increased length to the upper jaw "gummy smile" with a large separation between the upper and lower lips, a deficient (small) lower jaw, and a long and retrusive (backwardly displaced) chin.
  
  A thoughtful facial aesthetic examination by an experienced surgeon combined with effective preoperative orthodontic treatment, dental model analysis, and meticulous surgical technique will result in improved facial appearance, chewing ability, speech articulation, nasal air flow, and lip closure.

• Preoperative diagnosis and planning for patients with jaw asymmetries and deformities include a photographic analysis and a complete orthognathic workup involving cephalometric and panorex radiographs, dental impressions, and models. This is coordinated between the oral and maxillofacial surgeon and the orthodontist. Usually, pre-surgical orthodontics are necessary to straighten the teeth and align the arches so that a stable occlusion can be obtained postoperatively, while orthodontics following surgery are frequently required to revise minor occlusal discrepancies.
  
  The surgery itself is usually performed as an overnight outpatient procedure in a hospital setting. For most patients, the use of titanium screws and miniplates has replaced wiring of the bone and teeth to hold the jaw stable.