Do you have a recessed chin? Do you have an underbite? Do you have a protruding chin? Do you have an overbite? Do you wish to change the contour of your jaw and chin? Read the information below to learn about your best options for orthognathic surgery (a form of oral surgery and reconstructive facial surgery) offered by Denver orthognathic surgeon, Randolph C. Robinson, MD, DDS, FAACS:
Orthognathic surgery corrects midface and jaw deformities to treat four main problems. These problems are: 1) airway obstruction (obstructive sleep apnea or OSA), 2) temporomandibular joint problems (TMJ), 3) occlusion (bite) problems that affect chewing, speech and tooth wear, and 4) facial esthetics. The cause of these problems is usually related to disproportionate growth, either in the maxilla (the upper jaw) or the mandible (the lower jaw). These growth patterns can be due to familial traits, functional problems like thumb sucking and mouth breathing, specific craniofacial syndromes, cleft lip and palates, craniofacial clefts, or trauma.
Dr. Robinson is one of Denver’s premier orthognathic surgeons. If you have questions about orthognathic surgery, please contact our office to schedule an appointment. Dr. Robinson takes the time to sit down with you to thoroughly discuss your medical history and treatment options.
Who Needs Orthognathic Surgery?
Orthognathic surgery can also called jaw reconstruction or chin reconstruction. With this procedure, the tissues and bone are manipulated to improve the function and appearance of the jawline or middle of the face. Tissue or bone may be augmented, removed, or reshaped.
Most of time the surgery isn’t performed until your face has fully grown. This is usually about 16 years old for girls and 18 for boys. The two exceptions to this rule would be cases when the airway is restricted on children due to facial deficiency or the deformity is so substantial that it greatly affects the patient’s function and social interactions. In these cases, it is anticipated that a revision surgery will likely be necessary. Usually the surgery is medically necessary because it is correcting a functional defect. Many insurance companies have specific language in their contracts relating to the coverage provided for orthognathic surgery.
Orthognathic surgery is commonly performed in conjunction with orthodontic therapy. The reason for this is that most of the time the teeth are in the wrong position because they position themselves to compensate for the skeletal growth problem. The orthodontist must move the teeth into the most stable position in the bone and then the surgeon moves the bones so airway, joints, teeth, and face all look good and work well together. It usually takes about 12 months in braces to prepare for the surgery.
If you don’t have an orthodontist, contact our office for a referral.
The Orthognathic Surgery Procedure
Orthognathic surgery is performed under a general anesthesia and takes 1-6 hours depending on the specific needs of the patient. The patient spends one to two nights in the hospital or surgery center. The anesthesia is performed by a physician anesthesiologist who is watching over the patient during the entire operation. All breathing tubes are removed before the patient wakes up but most patients have a resulting sore throat for a few days.
All the incisions are made inside the mouth so there are no scars on the face. Rarely is it necessary to make a small incision in the cheek or neck skin to secure a holding screw. The bones are cut with a saw and then held in the new position with titanium bone plates and screws. The plate is a thin piece of titanium with holes for screws in it and bridges the gaps along the bone cuts. The plates are usually left in position and do not comprise enough metal to set off the alarms at the airport security checkpoints.
The most common upper jaw surgery is the Le Fort I maxillary osteotomy. It is named after Dr. René Le Fort, a French anatomist/surgeon who described the fracture patterns in the midface in a publication in 1901. These same fracture patterns are used to describe the bone cuts in elective maxillofacial and craniofacial surgery.
The most common lower jaw surgery is the sagittal split mandibular osteotomy. It is usually performed on both sides of the jaw and, therefore, called the bilateral sagittal split osteotomy or BSSO. This operation was developed by Dr. Hugo Obwegeser from Zurich, Switzerland in the 1950’s. It allows for the jaw to be advanced, set back, rotated or canted while keeping the temporomandibular joints in position.
After the surgery the patient’s teeth are not wired together but held in position using small orthodontic rubber bands. Most patients do not have a lot of pain associated with orthognathic surgery but more a sense of swollen pressure. The nose may feel congested for a few days and the swelling of the lips makes eating and drinking difficult.
The swelling is usually the largest on the third day and then begins to go down. The bruising is usually not severe but can last for a week or two. Most patients have some restlessness, anxiety and agitation for a week and low energy for about two weeks. Patients can begin to take short exercise walks at two weeks and light workouts at four weeks.
After about one week most patients are able to change the orthodontic elastics themselves. They can also advance their diet to eating non-chew foods, for example, scrambled eggs, mashed potatoes, overcooked macaroni and cheese. They can also brush their teeth more effectively but they are not to use alcohol containing mouthwashes. The typical amount of weight loss is 10 pounds.
Most patients are placed on antibiotics for the first week to help prevent infections and steroids to decrease the swelling. The pain relief medication is taken as needed but most patients are encouraged to stay ahead of the pain by anticipating when to take the next dose. Most of the time a home suction unit is provided for the patient to suction their mouths during the first few days. Some patients also require anti-nausea medication.
After six to eight weeks the bones have healed and the patient is referred back to the orthodontist to begin the final bite adjustments. This process takes about 6 to 9 months following surgery. Some patients also require some rebuilding of their teeth because of the wear caused by the deformity in the beginning.
Dr. Robinson is always willing to talk to you about possible risks and complications for any procedure. Generally, complications are very rare. However, permanent numbness of the lower lip occurs about 15% of the time. All patients have some transient numbness with the sagittal split osteotomy of the lower jaw. This is because since the surgeon must split the bone around the nerve. It often gets partially stretched and traumatized. It may take up to two years to determine if the complication is permanent.
Other complications include infection, bleeding, jaw pain, bone or tooth damage, paralysis, reaction to medication or anesthesia, slow healing, or breathing problems.
Rarely is it necessary to redo the surgery, but if relapse is substantial or there is a later growth change, then it may be important to redo the operation.
- Do not eat or drink anything after midnight the night before surgery.
- Wear loose, comfortable clothing that you do not mind getting soiled or bloody. A button down shirt is easier to manage than a pullover.
- Take a multi-vitamin with iron daily, beginning one month prior to surgery.
- Take 1,000mg vitamin C, in (4) 250mg doses, daily, beginning 2 weeks before surgery.
- Arrange for possible time off work or school. Most people only need one to two weeks off.
- Bring a writing tablet or tablet notebook to help you communicate after surgery.
- Obtain a blender to help with the post-operative diet.
- Arrange for both a suction unit and a humidifier. The humidifier helps keep the nasal passages moist and loosens dried blood.
- Arrange for someone to care for you who can be attentive to your needs – walking, eating, and bathing – the first 48 hours after leaving the hospital or surgery center. This person may need to help you bathe, too.
- Keep head elevated on two pillows for two weeks. This position aids in decreasing facial swelling.
- Diet: Do not chew anything; your diet should be fluids only. For the first several days, use a syringe or a squeeze bottle that injects the fluid in your mouth. Take medications by syringe also. You may advance the diet as you choose, remembering to protect the operative areas. Adequate nutrition and maintaining body weight is important for recovery. Plan to eat small “meals” at least six times per day. Allow extra time at first.
- Apply Vaseline to the lips, as needed.
- Brush the teeth gently the first week with a soft toothbrush and your choice of toothpaste. Do not brush the gums until the second week. Always protect the incision sites until they are healed.
- Use a decongestant nasal spray to dry up the oozing and open the nasal passages. Use this decongestant only for three days. Otherwise, rebound swelling may occur in the nasal tissues, making breathing more difficult.
- Use a saltwater nasal spray, such as Ocean Spray, to break up any blood or mucous clots in the nose. This infusion can be done over the sink as often and in whatever amounts as desired.
- Use a humidifier at night, aiming the vaporized water gently across the face to help keep the nasal passages moist.
- Apply ice to the face for the first 24-36 hours to decrease the amount of swelling. After this time, it may be continued as a comfort measure, but is no longer necessary. Heat may be applied after 36 hours if it is comforting.
- Do not use mouth washes containing alcohol, unless they are diluted in a 1:3 ratio with water, because the alcohol will irritate the incisions.
- Rinse with warm salt water, either by cup or with the feeding syringe, beginning the day after surgery, and continue for seven days. (Dilution: 1/2 teaspoon of salt in 1 cup of lukewarm water).
- You may shower or bathe the day after surgery. Make sure that you can sit in the shower or have someone with you to steady you. After surgery, it is not uncommon to feel light-headed upon standing, especially while taking a warm shower.
- You may use regular soap and shampoo, even if there was a bone graft taken from the scalp or hip. If a hip graft was taken, then a shower is preferred so the donor site (site of bone removal) is not soaking in bath water. Bathing after surgery will lift your spirits.
- Do not lift anything over ten pounds for two weeks. Contact sports should be avoided for at least eight weeks. Make sure to ask your surgeon any other questions you might have regarding activity.
- Avoid sun exposure and use a sunblock with at least a 20 SPF with a broad-brimmed hat, since darkening of any incision on the skin can occur for up to six months.
- If your teeth are held together with wires, keep wire cutters with you at all times. Most patients wear these cutters around their necks on a shoe lace.
- Call your surgeon with any questions and especially if:
- excessive pain is unrelieved with medication
- temperature is greater than 101.0° F by mouth
- excessive bleeding or rapid swelling occurs
- breathing is difficult
- you experience a sudden shift of the bite or bones
- Take one multiple vitamin with iron (on a full stomach) and 1,000 mg of vitamin C, in four 250 mg doses, daily for six weeks following surgery.
Learn More About Your Orthognathic Surgery Options in Denver, Colorado
If you want to learn more about orthognathic surgery and how it might benefit you, please contact our office. We will arrange an appointment to talk to Dr. Randolph Robinson. He is one of the most respected orthognathic surgeons in Denver, Colorado.