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.
Orthognathic surgery (/ˌɔːrθəɡˈnæθɪk/), also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and lower face related to structure, growth, airway issues including sleep apnea, TMJ disorders, malocclusion problems primarily arising from skeletal disharmonies, and other orthodontic dental bite problems that cannot be treated easily with braces, as well as the broad range of facial imbalances, disharmonies, asymmetries, and malproportions where correction may be considered to improve facial aesthetics and self-esteem.
| Orthognathic surgery | |
|---|---|
 Osteotomies of the jaws: 1. LeFort I 2. Bilateral Sagittal Split 3. Genioplasty 4. IMDO 5. GenioPaully 6. Custom PEEK 7. SARME 8. Custom BIMAX 9. Super BIMAX | |
| ICD-9-CM | 76.6 |
The origins of orthognathic surgery belong in oral surgery, and the basic operations related to the surgical removal of impacted or displaced teeth – especially where indicated by orthodontics to enhance dental treatments of malocclusion and dental crowding. One of the first published cases of orthognathic surgery was the one from Dr. Simon P. Hullihen in 1849.
Originally coined by Harold Hargis, it was more widely popularised first in Germany and then most famously by Hugo Obwegeser who developed the bilateral sagittal split osteotomy (BSSO). This surgery is also used to treat congenital conditions such as cleft palate. Typically surgery is performed via the mouth, where jaw bone is cut, moved, modified, and realigned to correct malocclusion or dentofacial deformity. The word "osteotomy" means the division of bone by means of a surgical cut.
The "jaw osteotomy", either to the upper jaw or lower jaw (and usually both) allows (typically) an oral and maxillofacial surgeon to surgically align an arch of teeth, or the segment of a dental arch with its associated jawbone, relative to other segments of the dental arches. Working with orthodontists, the coordination of dental arches has primarily been directed to create a working occlusion. As such, orthognathic surgery is seen a secondary procedure supporting a more fundamental orthodontic objective.
It is only recently, and especially with the evolution of oral and maxillofacial surgery in establishing itself as a primary medical specialty – as opposed to its long term status as a dental speciality – that orthognathic surgery has increasingly emerged as a primary treatment for obstructive sleep apnoea, as well as for primary facial proportionality or symmetry correction.
The primary use of surgery to correct jaw disproportion or malocclusion is rare in most countries due to private health insurance and public hospital funding and health access issues. A small number of mostly heavily socialist funded countries report that jaw correction procedures occur in some form or other in about 5% of a general population, but this figure would be at the extreme end of service presenting with dentofacial deformities like maxillary prognathisms, mandibular prognathisms, open bites, difficulty chewing, difficulty swallowing, temporomandibular joint dysfunction pains, excessive wear of the teeth, and receding chins.
Increasingly, as people are more able to self-fund surgery, 3D facial diagnostic and design systems have emerged, as well as new operations that enable for a broad range of jaw correction procedures that have become readily accessible; in particularly in private maxillofacial surgical practice. These procedures include IMDO, SARME, GenioPaully, custom BIMAX, and custom PEEK procedures. These procedures are replacing the traditional role of certain orthognathic surgery operations that have for decades served wholly and primarily orthodontic or dental purposes. Another development in the field is the new index called the index of orthognathic functional treatment need (IOFTN) that detects patients with the greatest need for orthognathic surgery as a part of their comprehensive treatment. IOFTN has been validated internationally and detected over 90% of patients with greatest need for orthognathic surgery.
