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Orthognathic surgery also known as correct jaw surgery involves shifting your teeth and jaw into a new position.
This usually, but not always, means that orthognathic surgery is about the bite, the way that top and bottom teeth meet in the correct manner.
We can also talk of orthognathic surgery as being about straightening jawbones. Not quite making them straight, but arranging them so that they are straight, proper and in order. During the development process it is possible for growth to become out of such proper order.
The lower jaw can be too far forward, too far back, for the bite – technically the occlusion - to work properly for example. The mandible – the lower jaw – can then be adjusted to make the whole system of the mouth work as it ought to.
Other developmental problems are possible, uneven development on one side or another. Accidents do happen and if they involve significant injury to the jaw the same techniques might be used to repair.
Orthognathic surgery is a description of the area where the work is done, not of the one specific technique. The problems in this area of the body, the jaws, the occlusion, can be many and varied. Orthognathics is the branch of medicine specialising in treating the problems and conditions in this area.
It is not a particular or the one and only operation or treatment. Orthognathic surgery is best understood as a part of the series of methods to treat problems with the jaws and mandible, bite and occlusion.
The starting point of the spectrum is dentistry and as problems and treatments become more difficult it shades into orthognathics and surgery.
It's not unusual for growth of various parts of the body to get a little out of step during the maturation process. The operation of the jaws requires that when the process is complete that the varied parts match properly. Sometimes this doesn't happen and around puberty and just afterwards is when this becomes clear.
Most orthognathic surgery is upon post-pubertal teenagers. This is when the mismatches in bone growth, position, become apparent as permanent problems.
It is also only at this point that they can be fixed without the possibility of further growth and changes complicating matters further.
A malocclusion, for example, where the jaw or perhaps teeth positions mean that chewing properly is not possible.
This can lead on to speech problems and also to pains in the jaw joints as attempts to overcome the problem are made. The solution is to operate to change that positioning of the jaw and or the teeth – that's orthognathics.
It is possible to think of orthognathics as merely cosmetic and in the simplest cases it probably is. As the problem being addressed becomes more complex it moves to something wholly necessary.
It is necessary to wait until puberty, the end of growth, to see what the adult presentation of the jaw, the mandible, will be and thus the final position of the bite or occlusion.
The first stage then is braces and the movement of the teeth under the care of an orthodontist. After perhaps 18 months comes the orthognathic surgery to change the presentation of the jaw and the underlying bones.
Then another period with braces and the orthodontist. The total time might be up to three years or so. The necessity of the late starting point and the time of treatment still make it possible to finish by the time adulthood really starts.
NHS treatment tends to be limited to only the most severe cases. The rationing is to only those conditions that are severely life limiting.
Part of the concern about the underlying condition is about presentation of the person to the outside world.
Facial proportion, aesthetics even, is a part of the initial concern, not just bite. This clearly will involve psychological issues – psychological, not psychiatric – and full support on this issue is part of the course of treatment.
They depend upon the specific used at what time. It is though bone surgery, therefore there will be recovery time.
Orthognathic surgery can involve breaking a bone, cutting one, inserting a plate to such a gap. These are not trivial matters, and it will take 4 to 6 weeks off work for bones to knit properly.
The actual operation itself will be done under a general anaesthetic. This has its own recovery time of until the next day at minimum.
Given that it is the jaw, or jaws, that are being operated upon limited diets – a significant reduction in chewing for example – will be required immediately afterwards.
Given the difficulties in being accurate here the specific recovery time is best discussed with the surgeon who will advise on that required for the particular procedure being done.
There will be pain and bruising, the pain can be kept under control – pain relief drugs are remarkably effective these days. Pain relief might be necessary for a couple of weeks.
The bruising will fade over the period which should be taken off work or study anyway.
External scarring is not a risk as orthognathic surgery uses the inside of the mouth as the entry point.
If metal plates are used they will be of titanium which, luckily, does not set off airport screening machines. Nor is it allergenic or reactive with the human body.
The specific risk with orthognathic surgery is of nerve damage. This can lead to numbness around the jaw, or of the tongue, the lips.
This is not certain, but it is a possible side effect of this significant surgery to the jaws.
It is always possible that the surgery will not work. The risk is then that further procedures will be necessary. The risk here is reduced as far as possible by the planning that goes into the initial operation.
One significant risk of orthognathic surgery is not doing it. Some of the justification for it is indeed cosmetic, aesthetic or presentational.
Yet significant problems with the bite can store up problems for the future. Attempts to compensate for an occlusion, entirely natural ones, can then further damage both bones and muscles – the damage is more difficult to repair than correction in the first place.