What is orthognathic surgery?

Orthognathic surgery is what an oral, maxillofacial or craniofacial surgeon does to reposition one or both jaws in the correction of a wide range of minor or major facial and jaw irregularities. In fact, moving the jaws also moves the teeth. Orthognathic surgery is usually done in conjunction with orthodontic treatment, so that the teeth are in proper position after surgery. In many cases, an enhanced facial appearance and a well balanced facial profile and symmetry can also result.

Who needs orthognathic surgery?

Today, through modern technology, a variety of producers are available to correct facial deformities. Among these facial deformities are Prognathism (prominent lower third of the face or mandibular excess) and micrognathism (retruded jaw) with associated malocclusion. A prognathic jaw occurs when the lower jaw is overdeveloped and protrudes out beyond the upper jaw. Majority of these patients have malocclusion meaning that their teeth are not properly aligned and that the bones of the upper and lower jaws are in excess of deficient to produce and aesthetic profile. In the Philippines, treatment and surgery for these kinds of deformities are still not so popular, that is why a lot of Filipinos in all walks of life can be seen hanging around with such facial disfigurement. They are what we commonly describe now as “Babalu” or “Walang Jaw”. Some would use their facial appearance in show business.

The following are some of the conditions that may indicate a need for orthognathic surgery:

• Open bite (space between upper and lower front or back teeth when mouth is closed)
• Unbalanced facial appearance (facial asymmetry)
• Unequal growth of the jaws, injury or birth defects
• Receding chin (Micrognathism)
• Protruding chin (Prognathism- “babalu”)
• Facial injury- old or mismanaged jaw fractures
• Midfacial retrusion after surgery of Cleft Palate/Lip
• Sleep Apnea (breathing problems- heavy snoring and difficult breathing)
• Difficult chewing or biting food

How is orthognathic surgery done?

In the past, these were just treated by dental surgeons by pulling out all the teeth thinking that these can be controlled by prosthetic dentures. Most of them think that this can be treated by purely orthodontic treatment mobilizing only the teeth but not the jaws. Repair of a protruding or recessed jaw is a major surgical procedure. It is performed in the hospital, under general anesthesia, and it takes anywhere from 2-6 hours. Before surgical treatment is undertaken, various work-ups are done such as Cephalometric evaluations, Panoramic x-ray of the jaws, dental model cast and cutting and photography. The cooperation between the orthodontist and maxillofacial surgeon serves as basis for the general acceptance of combined orthodontics and surgical treatment of jaw problems as the treatment of choice. In some occasions, prior to actual surgery, orthodontic treatment (pre-surgical orthodontics) is first done to facilitate actual occlusion during surgery. After surgery, final orthodontic tooth movement is usually necessary to fine-tune your bite. The latest surgical procedures now are done without incisions of the skin of the face to expose the jaw in making the bone cuts but everything inside the mouth. During the last decade, closure of the mouth takes at least 6-8 weeks and the patient is fed through the nasogastric tube inserted through the nose. With the latest technology of internal rigid fixation in maxillofacial surgery to stabilize segments of the jaw, closure of the mouth is only 5 days. Hospitalization is decreased to at least a week, the patient can eat through the mouth in a week time, and the possibility of relapse and complications has been avoided.

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