Orthognathic Surgery Treatments & Care

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There are a few steps you will go through before your surgery: 

Aligning your teeth

Prior to the operation, an orthodontist will place braces on your child’s teeth.   The orthodontist will move the teeth into the correct position during monthly adjustments.  The surgeon will use the braces during the operation.  Then, the braces will remain in place after the operation for a few months, depending on your child’s teeth and the type of operation. 

Checking your progress

Throughout the orthodontic treatment, progress records of your child’s jaw and teeth will be reviewed. Once operation is scheduled, your child’s surgeon will discuss the type of operation and expected outcomes with you. 

What happens during orthognathic surgery?

Your child will be under general anesthesia. Depending on the type of operation and condition, the procedure can take anywhere from 2 to 8 hours. 

There are different types of orthognathic procedures.  The three most common ones are: 

Bilateral sagittal split osteotomy (lower jaw surgery)

  • The surgeon makes the incision inside the mouth usually behind molars. The jawbone is then cut and moved forward, back or rotated.

 Lefort osteotomy (upper jaw surgery)

  • The surgeon makes the incision inside your child’s mouth behind the upper lip.  The jawbone is then cut and moved forward, back or rotated.  

Genioplasty (chin surgery)

  • The surgeon makes an incision inside your child’s mouth behind the lower lip. The chin is then cut from the lower jaw and moved forward, back, down, or rotated. 

Will my jaw be wired shut?

It is unlikely that your jaw will be wired together. Once the jaw is placed in its new position, it is secured with small metal plates and screws. In addition, elastic rubber bands are used to guide your new bite. 

What should I expect after surgery?

Your child may initially feel anxious after surgery because of a sore throat, clogged nose, lip numbness, and difficulty eating. It is important to help your child remain relaxed by helping him or her breathe slowly and deeply. Remember that the first week is the most difficult.  

Pain and bleeding

  • It is unlikely that your child will have severe pain following the operation because of the associated numbness. Some blood may ooze from the nose or mouth during the first 24 hours. Some slight nasal bleeding from the breathing tube is also possible.  

Swelling and bruising

  • There will be swelling and potentially some bruising after the operation. The swelling will typically be worst on the third day after surgery – and then will gradually lessen over the next few weeks. Most of the bruising will fade by the second week. 

Numbness

  • Some numbness of the lower and upper lips, nose and cheeks is normal for few weeks or months after surgery. Approximately 5 to 10 percent of patients will have permanent numbness in one or more areas. This ONLY affects the sensation of the lips, nose, chin, tongue or cheeks. It DOES NOT interfere with movement of the face. 

Eating

  • During the first few days after the operation, you may use a flexible syringe to place food in your child’s mouth, because using a cup may be too difficult.
  • The majority of patients must remain on a soft, non-chew diet for approximately 6-8 weeks.
    • Most patients average a seven- to 10-pound weight loss during this recovery phase.
    • Do not use this phase as a diet opportunity, since proper nutrition and calorie intake are critical for healing. 

Speaking

  • Speech may feel awkward because of the new position of the teeth and the numbness in your jaw. This will get better as the swelling decreases. You can have notebooks or a whiteboard at your child’s bedside for the first few days after surgery.  However, it is important to encourage speaking, which will help aid in the healing process. 

How long will recovery take?

Initial healing of the jaws takes around six weeks, while complete healing of the jaws takes up to a year. 

What does the follow-up appointment involve?

You will meet with your surgeon weekly during the first month.  After about six weeks, your child will return to the orthodontist to begin finalizing his bite. Post-surgical orthodontic treatment can last up to one year. It is essential that your child follow the orthodontist’s instructions to get the best results. 

What makes Boston Children's approach unique?

The Oral and Maxillofacial Surgery Program at Boston Children’s Hospital offers comprehensive evaluation and correction of the upper jaw (maxilla) and lower jaw (mandible). Our highly experienced oral and maxillofacial surgeons are known locally and nationally.

Coping and support 

We understand that you may be worried about your child’s operation. There are many resources to support your whole family—within Boston Children’s, in the outside community and online. 

Boston Children’s resources for families:

  • Patient education: From the very first visit, our staff will be on hand to walk you through your treatment and help answer any questions you may have. They will also reach out to you by phone, continuing the care and support you received while at the hospital.
     
  • Patient to patient: Want to talk with someone else who had orthognathic surgery? We can put you in touch with other patients who have been through similar experiences and can share their stories.
     
  • Social work and mental health professionals: Our social workers and mental health clinicians can offer counseling and assistance with issues such as coping with your condition, preparing for, and recovering from your operation and dealing with financial difficulties. 

On our For Patients and Families site, you can read all you need to know about: 

OUTSIDE RESOURCES

Please note that neither Boston Children’s nor the Oral and Maxillofacial Surgery Program unreservedly endorses all of the information found at the site listed below. This link is simply provided as another resource.

  • The American Association of Oral and Maxillofacial Surgeons offers an informative page about orthognathic surgery.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital 300 Longwood Avenue, Boston, MA 02115 617-355-6000 | 800-355-7944

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