Orthognathic Surgery in Delhi, India

Orthognathic surgery is performed to treat functional issues caused by jaw problems. The following reasons may make a person a good candidate for this surgery, including:

• Unbalanced facial structures/bones
• Facial injuries
• Birth defects
• Trouble with chewing or biting
• Chronic TMJ pain
• Protruding jaw/retarded jaw
• Breathing problems or sleep apnoea

The doctor will talk in detail about orthognathic surgery, including the potential risks and benefits. In some cases, the orthodontist places braces or aligners onto the teeth a few months before the surgery to align the teeth. The oral and maxillofacial surgeon will prescribe tests like X-rays, 3D CT scans, and more. The surgeon also uses virtual surgical planning (VSP) in some cases to guide them during the procedure for the best results.

• Medical tests and evaluations

• Take pictures of the face from different angles to examine the bone structure, shape, fat distribution, and more.

• Taking certain medications or applying certain products to prepare the skin before the surgery

• Avoid taking anti-inflammatory drugs and herbal supplements

• Stop smoking

• Stay hydrated

• Some teeth, like impacted wisdom teeth, might have to be removed a few months before the jaw surgery.

Orthognathic surgery is generally performed with inpatient hospitalisation, meaning that patients need to stay in the hospital for two to four days after the procedure. The surgery is done under general anaesthesia. The surgical procedure is done inside the mouth, meaning that there will be no visible scars.

However, the surgeon may make small incisions outside the mouth in some cases. The surgeon then performs the surgery to align the jaw position and uses tiny plates, wires, screws, and more to secure its place. The surgery usually takes two to three hours, depending on the complexity of the procedure. Orthognathic surgery can be performed on the lower jaw, chin, or upper jaw.

Depending on the condition, the surgeon may use the following surgical techniques:

Maxillary Osteotomy

Also known as upper jaw surgery, the procedure is performed from the inside of the mouth. The surgeon makes a through the gum behind the back teeth of the upper jaw to access the jawbone. The bone is then cut with a small saw and aligned to its normal position. The surgeon then uses metal plates and screws to secure the position and stitches the wound with dissolvable stitches.

Mandibular Osteotomy

The surgery is performed to treat the low jaw. The surgeon cuts through the gum behind the back teeth during the procedure to access the jawbone. The surgeon then cuts it with a small saw and moves it to its new position. The surgeon then secures it with small plates and screens. In some cases, the surgeon also makes a small ‘stab’ incision outside the mouth to insert the screws. Lastly, the doctor stitches the wound with dissolvable stitches.

Genioplasty

This is a type of cosmetic surgery that reposition or reshape the chin to improve facial appearance. There are two types of genioplasty surgery, including:

• Sliding genioplasty: In this procedure, the surgeon cuts along the border of the lower gums and makes an incision in the layer of the soft tissues to gain access to the chin bone. The surgeon then cuts the bone away from the rest of the jaw and slides it to its new position. The bone is then reattached to the jaw with metal plates and screws.

• Chin Implant: In this procedure, the surgeon makes a small incision on the inside of the mouth or under the chin. The surgeon then inserts an implant through the incision and positions it around the chin bone.

Jaw TMJ Arthroplasty

The surgery treats temporomandibular joint disorder (TMJ). During the procedure, the surgeon makes an incision from the inside sideburn area to the front of the ear to expose the TMJ capsule. The capsule is opened to reveal the disk. The surgeon then repairs or remove the damaged disk, remove scar tissue, or smoothen the bone. Once done, the surgeon then stitches the incision.

Arthrocentesis

The surgery is also performed to treat TMJ. During the procedure, the surgeon puts two hypodermic needles into the joint and flushes it with a sterile saline solution. The fluid washes any chemical byproduct of inflammation and helps reduce the pressure that causes the joints to be stiff. This procedure can also be performed using a specialised arthroscope.

It is generally safe to go for orthognathic surgery. However, it also has some risks and complications, as with any surgery. These may include:

• Infection

• Jaw fracture

• Blood loss

• Pain and swelling

• Problem with bite or alignment

• Jaw joint pain

• Jaw position relapse

• Nerve damage

• Root canals

Patients that go through orthognathic surgery can take about six to eight weeks to heal properly. After the surgery, one may feel swelling and discomfort for the first few days. The swelling generally goes away after three weeks.

The doctor will monitor the progress with follow-up appointments during the next two months. The doctor will brief in detail about proper oral hygiene and how to minimise the risk of complications. These might include:

• Follow wound care instructions

• Eat easy-to-chew foods

• Maintain proper oral hygiene

• Don’t use straws for the first three weeks after the surgery

• Avoid strenuous physical activities

• Avoid excessive pressure or motion on and around the incisions

• Avoid using makeup till allowed by the surgeon 

• Avoid direct sun exposure for a few weeks 

Reviewed by Dr. Anurag Singh, Principal Consultant - Oral & Maxillofacial Surgeon and Implantologist, Dental Care, Maxillofacial Surgery and Implantology on 27-Feb-2023.

What is Orthognathic Surgery?
Orthognathic surgery, also called corrective jaw surgery, involves repositioning the upper jaw (maxilla), lower jaw (mandible), or both to correct facial and jaw irregularities and improve overall bite function and aesthetics.

Why is Orthognathic Surgery performed?
Orthognathic surgery is performed to correct various conditions, including malocclusion (improper bite), facial asymmetry, temporomandibular joint (TMJ) disorders, sleep apnea, difficulty chewing or speaking, and certain congenital or developmental jaw abnormalities.

How is Orthognathic Surgery planned?
Orthognathic surgery is carefully planned by a team of specialists, which may include an oral and maxillofacial surgeon, an orthodontist, and sometimes a prosthodontist. The planning involves the use of advanced imaging techniques, such as X-rays, CT scans, and computer simulations.

What is the recovery time after Orthognathic Surgery?
Recovery time after orthognathic surgery depends on the complexity of the procedure and the individual's healing rate. Generally, it can take several weeks to months for the swelling to subside and for normal jaw function to return.

Can Orthognathic Surgery be performed on teenagers?
Orthognathic surgery can be performed on teenagers if they have completed their growth spurt and jaw development. The timing of the surgery is determined by the orthodontist and oral surgeon to achieve the best results.

Is Orthodontic treatment required before Orthognathic surgery?
Yes, orthodontic treatment is typically required before orthognathic surgery. Braces and other orthodontic appliances can align the teeth and ensure a stable bite before the surgical procedure.

Does Orthognathic surgery involve the use of plates and screws?
Yes, orthognathic surgery often involves the use of plates, screws, or other fixation devices to secure the repositioned jaw segments in their new position during the healing process. These devices are usually made of titanium and are biocompatible.

What are the risks and complications associated with Orthognathic surgery?
Some risks and potential complications include infection, bleeding, nerve damage, jaw joint problems, changes in sensation, malocclusion, and relapse of the jaw position. These risks are relatively low but should be discussed with the oral surgeon.

Can Orthognathic surgery improve facial aesthetics?
Yes, orthognathic surgery can significantly improve facial aesthetics by correcting jaw alignment and harmonizing facial proportions. The procedure can enhance the balance and symmetry of the face, resulting in a more even appearance.

Can Orthognathic surgery improve breathing and Sleep apnea?
Orthognathic surgery can help improve breathing and treat sleep apnea by repositioning the jaws and expanding the airway space. This can alleviate breathing difficulties and reduce the severity of sleep apnea symptoms.

How long does the planning process for Orthognathic surgery take?
The planning process for orthognathic surgery can take several months. It involves comprehensive assessments, including orthodontic evaluations, 3D imaging, dental models, and collaborative discussions among the surgical and orthodontic teams.

Are there non-surgical alternatives to Orthognathic surgery?
Non-surgical alternatives, such as orthodontic treatment alone or the use of camouflage techniques with dental restorations, may be considered for mild jaw discrepancies. However, significant skeletal irregularities usually require orthognathic surgery for optimal results.

Can Orthognathic surgery correct open bite or underbite?
Yes, orthognathic surgery can correct open bite (the lack of vertical overlap of the front teeth) and underbite (protrusion of the lower jaw). The surgery repositions the jaws to achieve proper alignment and improve bite function.

Can Orthognathic surgery be performed in combination with other procedures?
Orthognathic surgery can be performed in combination with other procedures, such as genioplasty (chin surgery), rhinoplasty (nose surgery), or dental restorations, to achieve comprehensive facial and dental esthetics.

Can Orthognathic surgery be covered by insurance?
In some cases, orthognathic surgery may be covered by insurance, especially if it is performed to correct functional issues or improve oral health. Each insurance policy varies, so check with the insurance provider for coverage details.

Can Orthognathic surgery affect speech?
Orthognathic surgery may temporarily affect speech during the initial recovery period due to swelling and changes in jaw positioning. Speech therapy can be recommended to help patients adapt and regain normal speech patterns.

Can Orthognathic surgery be performed with minimally invasive techniques?
Orthognathic surgery typically involves open procedures to access and reposition the jawbones accurately. However, some advancements, such as computer-guided surgery and endoscopic techniques, may minimize incisions and enhance precision.

Can Orthognathic surgery correct Temporomandibular Joint (TMJ) disorders?
Orthognathic surgery can help improve TMJ disorders caused by skeletal irregularities. By repositioning the jaws, the surgery can alleviate TMJ symptoms, such as jaw pain, clicking, and restricted jaw movement.

Can Orthognathic surgery improve bite function and chewing ability?
Yes, orthognathic surgery can improve bite function and chewing ability by realigning the jaws, allowing for better dental occlusion and more efficient mastication.

Can Orthognathic surgery be performed on older adults?
Orthognathic surgery can be performed on older adults as long as they are in good overall health and do not have contraindications for surgery. Age alone is not a determining factor for candidacy, and the decision is based on individual assessments.

Can Orthognathic surgery correct facial asymmetry?
Yes, orthognathic surgery can correct facial asymmetry caused by jaw discrepancies. By repositioning the jaws, the surgery can help achieve a more symmetrical facial appearance.

Can Orthognathic surgery treat congenital jaw abnormalities?
Orthognathic surgery can be used to treat certain congenital jaw abnormalities, such as cleft palate or craniofacial anomalies. The treatment approach is tailored to the condition and individual needs.

Can Orthognathic surgery be performed with 3D virtual planning?
Yes, 3D virtual planning is commonly used in orthognathic surgery to simulate the surgical outcome, evaluate facial aesthetics, and guide the surgical procedure with enhanced precision.

Can Orthognathic surgery improve self-confidence and psychological well-being?
Orthognathic surgery can have a significant, positive impact on self-confidence and psychological well-being. By improving facial aesthetics and bite function, it can enhance overall satisfaction with one's appearance and quality of life.

Can Orthognathic surgery be performed by a team of specialists?
Yes, orthognathic surgery is performed by a multidisciplinary team, which includes an oral and maxillofacial surgeon, orthodontist, prosthodontist, and sometimes other specialists such as plastic surgeons or speech therapists. The collaborative effort ensures comprehensive treatment planning and optimal outcomes.

Review

Reviewed by Dr. Akash Sachdeva, Consultant - Dental Care, Maxillofacial Surgery and Implantology.