Frequently Asked Questions
What are the benefits
of corrective jaw surgery?
Chewing – People with jaw
and bite problems often avoid certain foods that
they are unable to incise or chew completely.
Correction of these problems may allow these
individuals to enjoy a more healthy varied diet.
Digestion- The
digestive process begins in the mouth, where
food is incised and crushed so that it can be
properly digested once swallowed. A poor bite
that doesn’t efficiently process food in the
mouth may lead to problems with digestion.
Treatment that improves chewing function may
improve digestion.
Jaw and Jaw
Joint Pain - People with certain jaw
and bite problems, particularly a small lower
jaw, may experience discomfort in their jaws or
jaw joints. Often it is because they have
developed a habit of protruding their jaw
forward to form a better bite, or to hide the
appearance of a weak chin. This may cause
tension in the jaw muscles and joints,
eventually leading to jaw discomfort or temporal
headaches. Although it cannot be guaranteed,
correction of these jaw and bite problems often
reduces or eliminates jaw and jaw joint pain.
Tooth Wear - Teeth that do
not meet properly may eventually lead to
excessive tooth wear. This is especially a
concern for anterior open bite problems, where
only the back teeth make contact. Correction of
the dental malocclusion will help to protect the
teeth from excessive wear.
Mouth
Breathing - Certain jaw problems that
lead to difficulty bringing the lips together
result in mouth breathing. While the jaw problem
may not be the cause of mouth breathing
(theories assert that mouth breathing from
chronic nasal obstruction is the root cause of
the jaw problem), the effect is often dry mouth
and inflammation of the gum tissues. Corrective
jaw surgery that allows the lips to come
together without straining helps to reduce the
inflammation caused by a chronically dry mouth.
OSA (obstructive sleep apnea)
- OSA is a problem of upper airway collapse
during sleep. Not only does this condition
impair good restful sleep leading to daytime
sleepiness, it has other serious health
consequences, including high blood pressure,
heart disease, and depression. While corrective
jaw surgery is not a first-line treatment for
OSA, it may be an alternative when other
treatments have failed or are poorly tolerated.
While this is especially true of individuals
with recessed jaws, it may also be an option for
those with OSA who have normal jaw development.
What is the recommended age for corrective jaw
surgery?
Unless there are exceptional circumstances,
we do not proceed with orthognathic surgery on
patients who have not completed skeletal growth,
especially those with an underbite. This is
because they may grow out of the correction and
a second surgery would be necessary. There is
really no upper age limit, as long as the
patient is healthy.
I have impacted wisdom teeth. Do they need
to come out ahead of time, or can they be taken
out during my corrective jaw surgery?
Opinions differ regarding impacted wisdom
teeth. It is our routine to have impacted lower
wisdom teeth removed in young adult patients at
least six months prior to orthognathic surgery
involving the lower jaw, but longer is
preferred. This is because wisdom tooth removal
is generally uncomplicated at this age, and the
most common orthognathic surgery procedure on
the lower jaw is easier without the presence of
wisdom teeth. In older adults, wisdom tooth
removal can be more complicated. In these
instances, we may recommend removing the wisdom
teeth when the corrective jaw surgery is done.
Orthodontic treatment is almost always
needed. When the jaws are misaligned, the teeth
naturally compensate somewhat for the skeletal
problem. That is to say, the teeth will
naturally crowd or tilt in a way that lessens
the true extent of the skeletal misalignment.
Prior to surgery, the orthodontist needs to move
teeth into a position that allows for a correct
bite when the jaws are surgically aligned. After
surgery, the orthodontist must usually fine-tune
the bite in order to create the best possible
dental occlusion.
How long will my orthodontic treatment take
before I am ready for corrective jaw surgery?
That all depends upon how much preparation
your orthodontist must do to prepare you for
surgery. This process may take as little as a
few months if the teeth are not overly crowded
or misaligned, or it may take up to a year,
especially if the plan calls for removal of
certain teeth and orthodontic closure of the
resulting spaces.
Will I wear my braces
during corrective jaw surgery?
Yes, your braces provide the necessary
“handles” for the jaws during the procedure.
Although it is seldom necessary to wire the jaws
together after surgery, the jaws must be fixed
together during certain parts of the operation.
The braces facilitate this process.
I read that screws and
plates are used in corrective jaw surgery. Are these
eventually removed?
Screws and plates are inserted to fix the
jaws in their corrected alignment. Even though a
healed jaw does not require this hardware for
strength, it is not routinely removed. The
screws and plates have the same titanium
composition as dental implants, a biomaterial
that has been studied extensively and has no ill
effect on the body. Due to the small size of the
hardware, most patients have no awareness that
it is present. On infrequent occasions when a
plate or screw must be removed, it can often be
done in the office.
How long will the
surgery take?
The length of surgery depends upon the
complexity of the case. Routine surgery on one
jaw generally takes ninety minutes to two hours.
Surgery that involves multiple procedures may
take as long as three to five hours.
Is there a lot of pain
after corrective jaw surgery?
While pain is an expected side effect of most
surgery, many corrective jaw surgery patients
tell us that their post-surgical discomfort was
much less than they anticipated. We of course
prescribe the pain medications you may need to
transition through the recovery process with the
least amount of pain as possible.
Is there a lot of
swelling and bruising after corrective jaw
surgery?
Swelling and bruising varies and may not be
relative to the extent or complexity of surgery.
In general, younger patients tend to swell more
and bruise less, while older adult patients tend
to bruise more and swell less. Much of the
swelling and bruising resolves within the first
few weeks, but it may take up to a year for the
swelling to completely resolve. Ice packs,
elevation of the head while sleeping, and use of
the facial muscles will help the swelling to
resolve more quickly.
Are there ever
complications from corrective jaw surgery?
As with any surgery, corrective jaw surgery
carries certain risks that must be weighed
against the benefits of treatment. These risks
include, but are not limited to pain, infection,
decreased sensation or numbness, bleeding that
could be potentially serious, jaw joint
problems, and damage to normal structures such
as the teeth, gums, and bone. There could be
healing problems that may require more surgery,
and there are certain risks associated with the
general anesthesia that is necessary for
corrective jaw surgery. These risks are
discussed in detail at your first visit.
Problems with the bite often go hand in hand
with an imbalance in facial proportions, such as
a weak or strong chin, or a “gummy” smile.
Depending upon the severity of the condition,
appearance changes may range from subtle to
significant. These changes may at first be
masked by swelling, but in time the result will
become apparent. We always plan the surgery for
a result that appears natural and non-surgical.
The Case Studies illustrate some aesthetic
changes that occur as a result of treatment.
Patients having uncomplicated surgery on one
jaw often go home the day of surgery. Patients
having more comprehensive surgery can expect to
stay in the hospital overnight. If desired, a
family member can generally stay with the
patient overnight, but this must first be
approved by the Charge Nurse.
Most corrective jaw surgery patients will
resume regular activity within a few weeks, but
it will take a few months before you are ready
to engage in contact sports and strenuous
physical activities.
We begin to determine the answer to this
question at your very first office visit. As we
are not contracted with any insurance companies,
if your insurance plan only provides benefits
for treatment by in-network doctors, then with
few exceptions the surgery would not be covered.
If your plan permits you to see any doctor, then
all or part of your surgery may be covered. We
are familiar with the terms of coverage for most
of the major insurance plans, and we will assist
you throughout the insurance process by
submitting the necessary preauthorization and
claim paperwork. When benefits are denied
(corrective jaw surgery excluded from coverage
or no benefits for out-of-network providers) we
can discuss potentially affordable options.
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