Corrective Jaw Surgery (Orthognathic Surgery)
Corrective Orthognathic Jaw Surgery is performed usually in conjunction with your orthodontist to correct a wide range of minor and major facial skeletal and dental growth irregularities. Some of the conditions that usually require corrective jaw surgery are:
- Misalignment of the jaws and teeth
- Facial injury or birth defects
- Protruding jaw
- Receded chin
- Open bite (space between the upper and lower front teeth when the mouth is closed)
- Unbalanced or asymmetric facial appearance from the front or side
- Chronic jaw or jaw joint (TMJ) pain and headache
- Inability to make lips meet without straining
- Difficulty chewing or biting food
- Excessive wear on teeth
- Sleep apnea
Corrective jaw surgery can improve chewing, speaking, and breathing. Furthermore, it can improve facial harmony by realigning the jaws in their proper relationship to each other. People who may benefit from corrective jaw surgery include those with malocclusion (abnormal bite) that results from either misaligned teeth and/or jaws. In some individuals, the jaws grow at different rates and directions causing the alignment issues.
What is involved in corrective jaw surgery?
Your surgeon, orthodontist and dentist work together to evaluate and treatment plan your need for corrective orthognathic surgery. At Virginia Facial Surgery, Dr Mueller works closely with the local orthodonstists, determines which corrective jaw procedures are appropriate, and then performs the actual surgery. It is very important to understand that your treatment may take several years to complete. This is because your treatment begins with your orthodontist placing braces on your teeth. It may take 1 – 3 years before you are ready for the surgical phase. Because your teeth are being moved so that they fit together better after surgery, it may at first appear that your bite is getting worse before it gets better. Once the jaws are repositioned, the teeth should fit together properly. The surgical procedure may involve moving the upper jaw, the lower jaw and the chin. Occasionally, the nose needs to be addressed as well. The procedure is performed in the hospital and may in some instances involve an overnight stay. The procedure is performed with general anesthesia. You sleep through the entire procedure and have no recollection of the procedure at all. The bones are moved, reshaped, and put back together with small titanium plates and screws. No, the plates will not set off the metal detectors at the airport. The procedure is performed inside the mouth, and only occasionally, very small incisions are made outside the mouth.
Will my jaws be wired closed?
The short answer is No. Prior to the advancement of titanium mini-plates, the jaws had to be wired closed in order to hold them still for healing. Now, Dr. Mueller uses titanium mini-plates and screws to hold the bones rigid. Only in the rare instance where stability may be an issue, Dr. Mueller will place wires for two weeks. Most patients only have small orthodontic elastics in place for a couple of weeks to guide them into their new bite.
Surgically-Assisted Rapid Palatal Expansion(SARPE Procedure)
In a normal bite (occlusion), the upper teeth overlap the lower teeth by about half the width of the upper tooth. When there is large discrepancy of overlap due to transverse (right to left) jaw growth problems, the upper teeth can reside on the inside of the lower teeth in the back sections of the mouth. The result of this is called a cross-bite. We correct posterior cross-bites as soon as we see them because we can obtain more room for other un-erupted teeth. Also, a posterior cross-bite, if it is only on one side, can cause the lower jaw to grow asymmetrically to that side. Therefore, correction of a posterior cross-bite helps prevent asymmetrical growth of the lower jaw. Rapid palatal expansion is often used to correct this problem. Since palatal expansion involves separating the bones that make up the hard palate and join in the midline (called the palatal suture), it is better to perform this procedure at a younger age before the palatal suture becomes fused. The bones of the palate begin to fuse at the onset of puberty. Therefore, rapid palatal expansion should be performed between the ages of 7 – 11. If it is required after the age of 11, a surgically assisted rapid palatal expansion (SARPE) procedure is necessary.
What if I am over the age of 11?
With adolescents and adults, Dr. Mueller can expand the maxilla by using an RPE and having surgery performed. This procedure is called Surgically Assisted Rapid Palatal Expander (SARPE). During the procedure, Dr. Mueller opens the palatal suture with side releasing incisions and activates the RPE appliance. Patients or a caregiver will turn the expander with a key after the surgery. The key is provided by your orthodontist, and Dr. Mueller will instruct you on how and when to turn the key. As the key is turned, the gentle “pulling pressure” that the bone realizes actually stimulates the bones to grow as the bones are separated.
How long do I have to turn the key?
After Dr. Mueller determines you that you have turned the expander enough, and the cross-bite is eliminated, the RPE is left in place for about three months. This is so that the palatal suture can be closed with new bone formation and become stable. If an RPE is removed early, some of the width gained could be lost.
During the expansion, a space (a gap called a diastema) will develop between the central incisors. This is normal and expected. When it is time for the RPE to be removed, your orthodontist will then put braces on your upper teeth and will begin to close the gap.
After surgery, you will be on a liquid diet for 24 hours. After that, you will be on a full liquid to soft diet for several weeks. Dr. Mueller encourages optimal nutrition in the postoperative healing phase and advocates the use of vitamins, minerals and protein supplements. Although some patients lose weight after surgery (an average of 5 – 10 pounds), they typically return to their preoperative weight once they resume a normal diet in 6 – 8 weeks.
You will have swelling for 1 – 2 weeks. Head elevation, ice packs and anti-inflammatory drugs are used to keep the swelling down. Maintaining immaculate oral hygiene is also very important. Tooth brushing along with antibiotic and saline rinses are recommended.
Once the healing phase is completed, your orthodontist will begin the final phase of tooth movement. This final phase of treatment may take from 3 – 12 months to finalize your bite.
Rapid Palatal Expander
A Rapid Palatal Expander (RPE) is an upper jaw (maxilla) appliance that places pressure on the upper jaw by turning a midline screw. The pressure separates the mid palatal suture thus making the maxilla wider, which can correct cross-bites and create space. RPEs are used often to correct posterior cross-bites.
The RPE is made by an orthodontic lab to custom-fit your teeth.
How will the palatal expander feel?
After you turn the expander you will feel pressure. The pressure lasts for about 4 to 5 minutes. The pressure feels like taking your thumb and pushing on your teeth. So, an expander is not painful. You will have some pressure after activation for a few minutes and then it dissipates. Dr. Mueller will see you periodically after the surgery to monitor the healing and expansion.