Orthognathic Surgery 

The goals of jaw surgery, also known as orthognathic surgery, include the restoration of a normal bite, corrects irregularities of the jaw bones and realigns the jaws and teeth to improve their function, and improves pre-existing facial asymmetries that are associated with the jaw abnormality.

All orthognathic surgeries require three phases of treatment, which involve a multidisciplinary approach form a team of physicians/caregivers:

  • Orthodontist
  • Surgeon
  • Dentist
  • Craniofacial Team Coordinator

Other caregivers involved may include a nutritionist, psychologist, speech/physical therapist, and social worker.

Presurgery

The orthodontist is the key provider of care, preparing teeth for upcoming surgery, commonly by using orthodontic hardware (braces) to reposition the teeth. Orthodontist and surgeon communication is key during  this phase, as the surgeon will guide the orthodontist on how to maneuver the teeth prior to jaw surgery, and the orthodontist will guide the surgeon as to how to move the jaw bones to achieve the absolute best occlusion (bite relationship) for the patient. Duration is anywhere from 6-18 months, depending on the severity of the bite/jaw abnormality. A consultation with a surgeon and an orthodontist is essential early, and you (your child) should anticipate a prolonged course of therapy prior to surgery. During this phase, your surgeon will outline to you the surgical plan, developed by the careful analysis of your (your child’s) digital photography, x-rays, and dental casts.

If you (your child) do not have an orthodontist involved in your (your child’s) care, please ask your surgeon for a referral. Here at The University of Chicago, we have a team of orthodontists who specialize in this type of diagnosis, and we can refer you (your child) to one that is convenient for you in terms of your location.

Surgery

Surgery, as outlined by the surgical plan, is performed, typically about 3-5 hours, depending on the type. Double-jaw surgeries typically take longer than single jaw surgeries. Once again, the surgical plan requires that your surgeon has the following:

  • Digital photography -- performed in the surgeon’s studio 
  • X-rays (panorex, AP/lateral cephalogram, submental vertex view)— provided by the orthodontist
  • Dental casts and acrylic splint(s)—provided by the orthodontist

Most surgeries require a 1-2 day hospital stay. In the first 12-24 hours, patients are monitored carefully in an ICU/step-down setting. The diet will be established (see below) and a nutritionist will provide you with a customized diet plan tailored to your caloric needs. Patients are discharged with appropriate prescription medications to minimize discomfort, and prevent infection. Your surgeon will contact you (via phone call or electronic mail) to see how you (your child) is doing the day after discharge.

Postsurgery

The patient is checked by the surgeon to ensure proper healing after surgery, and to make sure that the facial and dental relationships are acceptable. Follow-up visits proceed approximately every two weeks until the bones are almost healed (6 weeks). Standard protocol for elastic wear is for the first two weeks after surgery in a continuous fashion; after these two weeks have passed, you (your child) will be placed on a regimen of “guiding elastics”, where the dental elastics are kept on for most of the day, and just removed for meals. After the first two weeks post-surgery, the patient will also be switched from a full liquid/pureed diet to a soft diet. Please refer to our Soft Diet Instruction Sheet for further details. 

Four weeks after surgery, the dental elastics will be removed and discontinued from the post-surgical regimen. Six weeks after surgery, the patient will be referred back to their treating orthodontist, who will begin the “finishing touches” on the teeth.

What should I expect after surgery?

After surgery, mild discomfort/soreness can be expected for the next week, which is controlled by pain medications (over the counter Tylenol, Motrin, or prescription Tylenol with Codeine). Acute swelling after surgery can peak (get worse) 72 hours after surgery, and can take 2 weeks to resolve. Other symptoms, such as nasal congestion, mild nasal discharge, sore throat, mild ear aches, can be anticipated. 

In most cases, your (your child’s) upper and lower teeth will be bound together with dental elastics, simply another measure used to stabilize the correction and allow the bones to heal. If segmental surgery on the upper or lower law is performed, the jaws may be wired closed for further stability.