Orthognathic surgery corrects jaw misalignment to alleviate symptoms and create balance.
When the teeth and jaws are misaligned, a condition called malocclusion, and cannot be corrected with orthodontics alone, an orthodontist may recommend visiting a surgeon. Jaw surgery, called orthognathic surgery, can move the jaws into a more favorable position to eliminate the discrepancy between the upper and lower jaws. Once the jaws have been moved to a proper position, an orthodontist can align teeth into their optimal position.
You may be referred to a jaw surgeon before or during orthodontic treatment, or after braces are removed. Your surgeon will review the advantages and disadvantages of both a surgical and nonsurgical approach so that you can make the right decision for you.
Orthognathic surgery helps to straighten or realign the upper and lower jaws, correcting skeletal deformities such as receded or protruding jaws, an open bite, or a crossbite. Depending on the specific reason for surgery, the jaw may be lengthened or shortened, moved forward or backward, or up or down, resulting in a more aligned bite and improved facial appearance.
While most jaw surgeries are performed for corrective and functional reasons, it’s important to choose a surgeon who is experienced in facial aesthetics, as adjusting the jaw makes a significant impact on your appearance.
Planning and recovery
What to expect
You and your doctor will discuss in detail your concerns, anticipated results, advantages, and disadvantages of surgery and how the procedure will be performed. In most cases, your surgeon will work with an orthodontist and other dental specialists to carefully plan the surgery and treatment after surgery, using imaging and models of your jaw and teeth. Finally, a presentation will be reviewed that shows the typical results as well as a diagrammatic representation of the surgical procedure.
It’s important to understand this type of surgery is generally a longer-term commitment. It will likely involve dental and/or orthodontic work before and after the surgical procedure, in several stages:
- Your doctor will remove any teeth necessary and place orthodontic bands on your teeth.
- Pre-operative orthodontics will be used to align teeth in their optimal positions in each arch (nine to 18 months, on average).
- After surgery and recovery (four to six weeks), orthodontics will again be used to perfect the bite (three to six months).
- Orthodontic bands are removed.
- A retention device will be used to stabilize teeth (six to 12 months).
On the day of the procedure, you will receive anesthesia through an IV. Your doctor will separate and reposition the jaw in proper alignment. In most cases, all incisions are made inside the mouth, eliminating any external scars. Tiny screws or metal plates may be used to hold bone in the proper position, and your jaw may be wired shut during the initial healing process. In some cases, extra bone may be added, or bone may be reshaped or removed for a better fit. In many cases, a procedure is also performed on the chin at the same time to balance the new bite.
Recovering after jaw surgery
You’ll likely spend a night or two in the hospital before being discharged home with instructions and medications from your doctor. Swelling after surgery is normal, and lips may be chafed, stretched, and swollen. Swelling and pain will typically peak a few days after surgery, and then resolve within a few weeks.
In the initial period after surgery, you’ll be on a liquid diet and progress to eating soft foods before returning to your normal diet after several weeks. Depending on the procedure, your jaw may need to be wired shut for a few days or several weeks. However, this isn’t necessary in all cases. Initial healing may take about six weeks, and complete healing up to three months.
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Craniofacial Plastic Surgery
Stephen Bradley Baker, MD,DDS
Pediatric Plastic Surgery, Craniofacial Plastic Surgery & Plastic Surgery
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3800 Reservoir Rd. NW Washington, DC 20007
110 Irving St. NW Washington, DC 20010
Frequently asked questions
Am I a candidate for orthognathic surgery?
You may be a good candidate if:
- You’re physically healthy
- Your expectations are realistic
- You understand the risks that come along with surgery
- Your teeth and jaws are not properly aligned
- Orthodontic work alone will not correct your bite
- You are having difficulty chewing food or have jaw pain or headaches because of misalignment
- You have trouble speaking and breathing because of misalignment
Are there alternatives to jaw surgery?
The combination of surgery and orthodontic treatment makes it possible to treat jaw abnormalities that can’t be corrected solely with orthodontic treatment. If you have a discrepancy in jaw alignment, three options are possible to correct the problem:
- Growth modification. In growing children, dentofacial orthopedics (headgear, etc.) can non-surgically modify jaw position to some extent, if done early.
- Orthodontic compensation. To avoid surgically moving the jaws, an orthodontist will move the upper and lower teeth together without properly aligning the jaw relationship. This approach may require extraction of normal adult teeth. While the teeth may appear aligned, the aesthetics of the face frequently are compromised. The most common example of this is the orthodontic correction of the overbite, which is caused by a small mandible (lower jaw). Ideally, the lower jaw would be advanced to restore the proper relationship to the upper jaw. If compensation is used instead, the upper teeth are pulled backward to meet the lower teeth. Unfortunately, the upper lip falls backward, too, which causes the nose to appear larger, the lower jaw is protruded, and the chin projection is weak.
- Orthognathic surgery. Combined protruded orthodontic and surgical correction is considered the best treatment for abnormal jaw relationships once growth has ceased. By properly restoring the relationship of the upper and lower jaws, the desired alignment can be achieved while also optimizing facial form and aesthetics.
How much does orthognathic surgery cost?
The costs for jaw surgery vary based on your specific needs. Insurance coverage is often available when your insurance carrier determines the procedures to be medically necessary to address deformities or functional problems.
When you come in for your consultation visit, we will be better able to discuss fees in detail with you. Our staff will also review the financing options available and help with insurance approval questions.
What are the goals of treatment?
At MedStar, we believe it’s important to implement the plastic surgery principles of facial aesthetics while achieving the optimal alignment and maintaining facial proportion. Our goal is to develop a treatment plan that not only provides an immediate result, but also one that will continue to be optimally aligned and aesthetically pleasing with age.
There are typically three goals of surgery:
- Function. Functional and aesthetic deformities often co-exist; when they do, treatment should be designed to correct both. The treatment of patients with poor function but good aesthetics is particularly challenging. In these cases, careful planning must avoid worsening the aesthetics while providing optimal functional dental relationships.
- Aesthetics. Because of our expertise in plastic surgery, the MedStar team plans surgery to place the jaws in a position that will avoid a prematurely aged look and enhance the longevity of youthful facial features as you age.
- Stability. Accurate treatment planning and meticulous orthodontic and surgical practice are essential to achieving not only good function and pleasing aesthetics but also a stable overall result. Here, communication between the team — including you, the patient — is key.
What are the risks of orthognathic surgery?
As with any surgery, jaw surgery does pose some risks. These risks include:
- Anesthesia complications
- Damage to bone, teeth, or gums
- Loss of a portion of the jaw
- Nerve damage
- Additional surgery to address sinus complications or unanticipated
changes in jaw healing
Is orthognathic surgery covered by insurance?
Insurance coverage is often available when your insurance carrier determines the procedures to be medically necessary to address deformities or functional problems. It’s always best to discuss coverage with your insurance carrier and the steps necessary for approval. Our office will assist you with paperwork needed for pre-approval.
Do I need a referral to your office?
If you’re exploring options for insurance coverage, you may need to request a referral from your primary care doctor, depending on your health insurance plan. Check with your carrier to see if medical coverage is an option for you and, if so, whether a referral is required.