Orthognathic Surgery

Orthognathic surgery is a type or surgery for the surgical correction of imperfect formation of the jaws and teeth, which are too severe to be corrected using orthodontic procedures such as braces. It can be a way to correct the any imbalance between the upper and lower jaws, enabling a proper bite as well as enhancing the appearance of the lower jaw and chin.

What are the benefits of orthognathic surgery?

• Improvement in the chewing functions of teeth and increased ease in biting down.
• Reduction in wear and tear, and breakdown of teeth over several years of use.
• Correction of imbalance in any facial features, especially weak chins, deep-overbites and underbites.
• Improved symmetry of facial features, especially in the middle and lower face.
• Improvement in smiles in cases where large areas of the gums are visible while smiling
• Improvement in smiles in the cases where lips cover all the teeth while smiling
• Correction of any facial defects present as a result of trauma
• Relief for patients of sleep apnea.

How is orthognathic surgery done?

Usually, orthognathic surgery involves one of three kinds of osteotomies or bone surgery to correct any deformity of the jaw or lower face. These are as follows:

1. Le Fort I-type osteotomy – This type of osteotomy involves surgically altering the bones of the mid-face to alter the position of the nasal tip, upper lip and the section in between (the Cupid’s bow). This type of surgery can also be used in case of corrective surgery for cleft lip and palate.
2. Sagittal split ramal osteotomy – This type of osteotomy is used in the correction of the lower face. It is the typical process involved in correction of an inward or outward protruding jaw.
3. Horizontal osteotomy of the symphysis – Apart from using a chin implant to augment a weak chin, a horizontal osteotomy or genioplasty can be carried out. It allows for the repositioning of the chin in multiple planes, can be used to correct microgenia (small, rounded chin) or macrogenia (strong, protruding chin) as well as asymmetry of the chin.

What are the risks or complications associated with this procedure?

1. Numbness – There may be some numbness in the upper and lower lips. The upper lip regains sensation very soon after the surgery, but the lower lip may take 6-9 months to regain full sensation. It is highly unlikely that patients will experience any permanent numbing sensation.
2. Infection- There is a risk of infection of any metallic plates that may have been set in place to allow for reconstruction of the jaw. This is a rare occurrence and usually only takes place once the plates have performed their function of reshaping the bone.
3. Readjustment of the bite – In the aftermath of surgery, a slight movement of the jaw may displace the bite. This can require a short, second surgery to correct the bite and re-adjust the plate-fixation.
4. Relapse of the procedure – In a very small fraction of patients, especially those with severe jaw abnormalities such as cleft palate, a revision of the surgery may be required due to relapse.

What should you consider before having the surgery?

Orthognathic surgery is a reconstructive procedure for a condition that is rarely life-threatening or overly troublesome. You must undergo the surgery only if you have committed to a course of treatment that may last 12-24 months. As with any other surgery, orthognathic surgery is contraindicated for the following patients with:

• Certain underlying medical conditions, systemic diseases or bleeding dyscrasias
• Factors in the area surrounding the surgical region that may affect wound healing
• Unfavourable vascularity or blood supply in the surgical area
• Unpractical and unreasonable outcomes of the surgical procedure
• A history of poor medical compliance
• A long history of smoking, oral tobacco or betel-nut use
• Poor oral hygiene

In summary, orthognathic surgery is a highly specialized elective surgical procedure that can be carried out to correct any abnormality or asymmetry in the mid or lower face by means of bone surgery. It can be a valuable tool to improve jaw function and facial appearance.

As with any surgery, orthognathic surgery is associated with risks and complications that can be minimized by choosing a highly qualified, well-experienced cosmetic surgeon to oversee your procedure.

Dr. Debraj Shome is a very accomplished oculoplastic and cosmetic surgeon who has several accolades to his name.