Orthognathic surgery

Orthognathic surgery (/ˌɔːrθəɡˈnæθɪk/); also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and face related to structure, growth, sleep apnea, TMJ disorders, malocclusion problems owing to skeletal disharmonies, or other orthodontic problems that cannot be easily treated with braces. Originally coined by Harold Hargis, this surgery is also used to treat congenital conditions such as cleft palate. Typically during oral surgery, bone is cut, moved, modified, and realigned to correct a dentofacial deformity. The word 'osteotomy' means the division, or excision of bone. The dental osteotomy allows surgeons to visualize the jawbone, and work accordingly. Orthognathic surgery (/ˌɔːrθəɡˈnæθɪk/); also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and face related to structure, growth, sleep apnea, TMJ disorders, malocclusion problems owing to skeletal disharmonies, or other orthodontic problems that cannot be easily treated with braces. Originally coined by Harold Hargis, this surgery is also used to treat congenital conditions such as cleft palate. Typically during oral surgery, bone is cut, moved, modified, and realigned to correct a dentofacial deformity. The word 'osteotomy' means the division, or excision of bone. The dental osteotomy allows surgeons to visualize the jawbone, and work accordingly. The operation is used to correct jaw problems in about 5% of general population presenting with dentofacial deformities like maxillary prognathisms, mandibular prognathisms, open bites, difficulty chewing, difficulty swallowing, temporomandibular joint dysfunction pains, excessive wear of the teeth, and receding chins. Many surgeons prefer this procedure for the correction of a dentofacial deformity due to its effectiveness. It is estimated that nearly 5% of the UK or USA population present with dentofacial deformities that are not amenable to orthodontic treatment requiring orthognathic surgery as a part of their definitive treatment. Orthognathic surgery can be used to correct: A disproportionately grown upper or lower jaw causes dentofacial deformities. Chewing becomes problematic, and may also cause pain due to straining of the jaw muscle and bone. Deformities range from micrognathia, which is when the mandible doesn't grow far forward enough (over bite), and when the mandible grows too much, causing an under bite; all of which are uncomfortable. Also, a total maxilla osteotomy is used to treat the 'long face syndrome,' known as the skeptical open bite, idiopathic long face, hyper divergent face, total maxillary alveolar hyperplasia, and vertical maxillary excess. Prior to surgery, surgeons should take x-rays of the patient's jaw to determine the deformity, and to make a plan of procedures. Mandible osteotomies, or corrective jaw surgeries, benefit individuals who suffer from difficulty chewing, swallowing, TMJ pains, excessive wear of the teeth, open bites, overbites, underbites, or a receding chin. The deformities listed above can be perfected by an osteotomy surgery of either the maxilla or mandible (whichever the deformity calls for), which is performed by an oral surgeon who is specialized in the working with both the upper and lower jaws. Orthognathic surgery is also available as a very successful treatment (90–100%) for obstructive sleep apnea. Orthognathic surgery is a well established and widely used treatment option for insufficient growth of the maxilla in patients with an orofacial cleft. There is some debate regarding the timing of orthognathic procedures, to maximise the potential for natural growth of the facial skeleton. Patient reported aesthetic outcomes of orthognathic surgery for cleft lip and palate appear to be of overall satisfaction, despite complications that may arise. A potentially significant long-term outcome of orthognathic surgery is impaired maxillary growth, due to scar tissue formation. A 2013 systematic review comparing traditional orthognathic surgery with maxillary distraction osteogenesis found that the evidence was of low quality; it appeared that both procedures might be effective, but suggested distraction osteogenesis might reduce the incidence of long-term relapse. Although infrequent, there can be complications such as bleeding, swelling, infection, nausea and vomiting. Infection rates of up to 7% are reported after orthognathic surgery; antibiotic prophylaxis reduces the risk of surgical site infections when the antibiotics are given during surgery and continued for longer than a day after the operation. There can also be some post operative facial numbness due to nerve damage. Diagnostics for nerve damage consist of: brush-stroke directional discrimination (BSD), touch detection threshold (TD), warm/cold (W/C) and sharp/blunt discrimination (S/B), electrophysiological tests (mental nerve blink reflex (BR), nerve conduction study (NCS), and cold (CDT) and warm (WDT) detection thresholds. The inferior alveolar nerve, which is a branch of the mandibular nerve, must be identified during surgery and worked around carefully in order to minimize nerve damage. The numbness may be either temporary, or more rarely, permanent. Recovery from the nerve damage typically occurs within 3 months after repair. Orthognathic surgery is performed by an oral and maxillofacial surgeon in collaboration with an orthodontist. It often includes braces before and after surgery, and retainers after the final removal of braces. Orthognathic surgery is often needed after reconstruction of cleft palate or other major craniofacial anomalies. Careful coordination between the surgeon and orthodontist is essential to ensure that the teeth will fit correctly after the surgery. Planning for the surgery usually involves input from a multidisciplinary team, including oral and maxillofacial surgeons, orthodontists, and occasionally a speech and language therapist. Although it depends on the reason for surgery, working with a speech and language therapist in advance can help minimize potential relapse. The surgery usually results in a noticeable change in the patient's face; a psychological assessment is occasionally required to assess patient's need for surgery and its predicted effect on the patient.Radiographs and photographs are taken to help in the planning. There is also advanced software that can predict the shape of the patient's face after surgery, which is useful for the planning and also explaining the surgery to the patient and the patient's family.