Surgical Process

The surgical process involves sectioning the jawbones and then once repositioned they are then held in place with titanium plates (see picture below) and screws.   They allow the bone to heal which takes around 6 weeks.  After this point the plates are not really needed, but are not removed unless they become infected.  9 out of 10 patients have no problems and keep their plates in place for life.  

An example titanium plate used in jaw and facial surgery

The surgical incisions (cuts) are made inside the mouth so there are no scars on the skin. There are four types of surgical procedure depending on which jaws are going to be repositioned.  None of them require your jaw to be wired together.  You will be able to open and close your mouth after surgery however it will be very limited due to swelling and elastic bands helping to hold the jaws in the correct place.  

The types of jaw operation are:

Maxillary Osteotomy (Upper Jaw Operation)

A patient's X-ray after upper jaw only surgery - with four plates and the braces on

This operation is also called a Le Fort 1 osteotomy.  For access to the upper jaw (maxilla) incisions are made to the lining of the mouth high underneath the top lip.  The sectioned jaw will include all of the top teeth and the roof of the mouth. This operation is used if your upper jaw is too far back or not at the correct height.

Mandibular Osteotomy (Lower Jaw Operation)

The incisions in the gum will be at the back of your mouth around where your lower wisdom teeth would be.  Your wisdom teeth will need to be taken out by your dentist or surgeon more than 6 months before having a lower jaw operation as this is where the surgical incisions will be made. Otherwise and the bone will be weaker and prone to infection if this is done at the time of orthognathic surgery.

Bi-Maxillary Osteotomy (Both Jaws Operation)

 

A patient's X-ray after upper and lower jaw surgery - with six plates and the braces on

 This involves both jaws and your stay in hospital will be longer than the single jaw procedure.  The incisions are the same as described above for the single jaw operations.

Chin Surgery (Genioplasty)

Your surgeon will decide if this is necessary to improve the contour of the lower jaw if is too steep or too shallow.  It is done during the lower jaw operation by dividing the lower front part of the chin and moving it forward and then securing it with plates.  

 

What To Expect After Surgery

There are several things which are guaranteed to happen and some although exceptionally rare are still risks.  All are important for you to know about.  These should be added to the risks of the braces.  

  Swelling of your face is normal and the amount varies from person to person.  The swelling is worst the day after surgery and will remain the same or increase for the next two days before gradually going down over the next 2 weeks.  To help keep swelling to a minimum you will be prescribed anti-swelling medication.  Keeping upright helps to resolve the swelling.  Avoid lying flat when sleeping by having extra pillows.  You will have some slight swelling for as long as 6 months after surgery whilst the scar tissue from the surgery shrinks.

You will see lots of bruising on your cheeks and due to gravity you will find that the bruising drains down the front of your neck to your chest.  It is normal and don't be alarmed.  Some patients find that the herbal remedy Arnica can reduce bruises quicker.

 Due to the nature of the surgery discomfort of the face normal.   Initially it will be uncomfortable and will take 2-3 weeks for the pain to subside but every day the pain will reduce.  The anaesthetist and surgeon will help make it manageable for you by prescribing strong painkillers when you are asleep and during your stay in hospital.  When you go home you will be given a further 2 week supply of painkillers.  Soft diet and rest will help.

The upper and lower lip will be numb after the operation.  In the short term it is beneficial as you won't feel so much pain.  It will feel the same as having an injection at the dentist.  The lower lip will take several months to recover, you may find that there may be numb patches on the chin and the lower lip that never completely get full sensation back.  If sensation does not return by 2 years following the operation, it is unlikely to ever return.  The lips will move and look normal and most patients find it does not affect them to any great deal.  The feeling in the upper lip returns very quickly.

 Active bleeding is very rare.  There will be a small amount of blood leaking from the nose and mouth to start with. When it mixes with your saliva it looks like there is more than there actually is.  For patients who have their upper jaw repositioned the nose will be filled with blood clots for the next few days making it harder to breathe through your nose.  You may swallow some of this blood and saliva mixture and it may make you feel sick.

Eventually this nasal congestion will clear.  Nose blowing should be avoided.  Do not use steam inhalations for the first few weeks as this may trigger bleeding.  

 Like any operation there is a chance of infection.  You can reduce your likelihood of infection by keeping your mouth clean before and after the surgery. To help prevent infection you will be given antibiotics and antiseptic mouthwash for 2 weeks afterwards.  Look at our advice page of how to clean your teeth and braces (Braces, Retainers and Dental Health).  Smoking will greatly increase the risk of infection and for your safely is advised that you quit before starting your treatment.  

 The jaw bones are the framework for the face.  When the jaws are repositioned the soft tissues (muscles and skin) will move accordingly and there maybe subtle changes.  Changes are unique to each patients and your surgeon will explain to you at consultation. For example, if you have your upper jaw repostioned further forward you may find your nostrils may be a little wider.  

 

Relapse is when the teeth start to move back to their original position.  It chance of relapse is due to many factors.  If you do not wear your retainer you will get relapse despite having surgery.  Some bites are more prone to relapse and your consultant will tell you if you are at a higher risk.  The further the jaw is moved, the more the risk of relapse. 

 Small adjustments are may be made by the orthodontist with the use of elastics after surgery.  On rare occasions the powerful jaw muscles can pull the repositioned jaws after the anaesthetic wears off.  This can damage the plates or the bone surrounding the screws and the jaws may move a few millimetres out of places.  Rarely the position of the jaws is not as predicted and may require a short anaesthetic to adjust them.

As with all operations there is an exceptionally tiny risk of being allergic to the anaesthetic or not waking up afterwards.  Modern anaesthetics are extremely safe and so the risk maybe even lower.  If anyone in your immediate or extended family has had problems with anaesthetics, please tell the anaesthetist.  

Side effects such as nausea when waking up is fairly common and everybody will be given some anti-sickness medication when they are asleep.