Medical Uses and Conditions Treated
- Corrects gross jaw discrepancies (anteroposterior, vertical, or transverse discrepancies)
- Treats skeletofacial discrepancies associated with sleep apnea, airway defects, and soft tissue discrepancies
- Addresses skeletofacial discrepancies associated with temporomandibular joint pathology
- Fixes disproportionately grown upper or lower jaw causing dentofacial deformities
- Treats conditions like micrognathia, overbite, underbite, and long face syndrome
- Established treatment option for insufficient growth of the maxilla in patients with an orofacial cleft
- Timing of orthognathic procedures is debated to maximize natural growth of the facial skeleton
- Patient-reported aesthetic outcomes are generally satisfactory, despite potential complications
- Scar tissue formation may impair maxillary growth as a long-term outcome
- Comparison between traditional orthognathic surgery and maxillary distraction osteogenesis suggests both procedures are effective, with distraction osteogenesis potentially reducing long-term relapse

Risks and Complications
- Complications include bleeding, swelling, infection, nausea, and vomiting
- Infection rates can reach up to 7%, but antibiotic prophylaxis reduces the risk
- Post-operative facial numbness may occur due to nerve damage
- Diagnostics for nerve damage include brush-stroke directional discrimination, touch detection threshold, warm/cold discrimination, and sharp/blunt discrimination
- Care must be taken to minimize nerve damage to the inferior alveolar nerve, a branch of the mandibular nerve

Surgical Techniques
- Surgery is performed via the mouth, where jaw bone is cut, moved, modified, and realigned
- Jaw osteotomy allows for surgical alignment of dental arches and correction of malocclusion
- 3D facial diagnostic and design systems have emerged for precise planning
- New procedures like IMDO, SARME, GenioPaully, custom BIMAX, and custom PEEK are accessible
- Orthognathic surgery is increasingly used for obstructive sleep apnea and facial proportionality correction

Prevalence and Access
- Approximately 5% of the UK or US population may require orthognathic surgery for dentofacial deformities
- Private health insurance and public hospital funding issues limit access to jaw correction procedures
- Certain heavily socialist funded countries report higher rates of jaw correction procedures
- Common conditions requiring orthognathic surgery include maxillary prognathisms, mandibular prognathisms, open bites, and temporomandibular joint dysfunction
- Increasing self-funding options have made a broader range of jaw correction procedures accessible

Surgery Planning and Techniques
- Orthognathic surgery is performed by maxillofacial or oral surgeons in collaboration with orthodontists or plastic surgeons.
- It often includes braces before and after surgery, as well as retainers after the removal of braces.
- Orthognathic surgery is commonly needed after reconstruction of cleft palate or other craniofacial anomalies.
- Careful coordination between the surgeon and orthodontist is essential to ensure proper teeth alignment after the surgery.
- Radiographs and photographs are taken to aid in the planning process, and advanced software can predict the patient's facial shape after surgery.
- A multidisciplinary team, including oral and maxillofacial surgeons, orthodontists, and speech and language therapists, is involved in the planning process.
- Working with a speech and language therapist beforehand can help minimize potential relapse.
- A psychological assessment may be required to evaluate the patient's need for surgery and its predicted effect on the patient.
- Airway patency is maximised during the planning phase.
- Traditional presurgical orthodontic treatment can take up to one year, but new approaches such as surgery-first and clear aligner orthodontia (like Invisalign) are also available.