KidsMD Health Topics

Orthognathic Surgery

  • At Boston Children’s Hospital, the majority of orthognathic (jaw) surgeries are successful — and the dedicated staff is here to support you throughout your treatment. 

    Here are some basics about orthognathic surgery:

    • Orthognathic (jaw) surgery refers to an operation, which consists of changing the positions of the maxilla (the bone that forms the upper jaw), the mandible (the bone that forms the lower jaw) and/or the alveolar bones (the bones that support the tooth sockets).
       
    • A balanced occlusion (bite) occurs when all of your upper and lower teeth are correctly aligned. Your upper front teeth should slightly overlap your lower front teeth when you bite your teeth together.
       
    • If your jaw is not properly aligned, you may have difficulty eating, chewing, biting into foods, speaking or breathing.
       
    • Orthognathic (jaw) surgery is used to move one of the jaws to allow the upper teeth and the lower teeth to contact each other.  This operation is used for a severe malocclusion (irregular relationship between the teeth of the upper jaw and the teeth of the lower jaw), whichcannot be fixed with orthodontic treatment (braces) alone.
       
    • In addition to correction of malocclusion, orthognathic surgery can improve the facial appearance. 
    How Boston Children’s approaches orthognathic surgery

    Boston Children’s is one of the only hospitals in the country with a designated specialist in orthognathic (jaw) surgery. Our Oral and Maxillofacial Surgery Program works with orthodontists at the hospital and in the community to take care of children who need this operation.

    Orthognathic (jaw) surgery: Reviewed by Shelly Abramowicz, DMD, MPH
    © Boston Children's Hospital; posted in 2012


    Boston Children's Hospital
    300 Longwood Avenue
    Boston MA 02115 

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    Fax: 617-738-1657

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  • What is orthognathic surgery?

    Orthognathic comes from the Greek word “orthos,” which means straight, and “gnathos,” which means jaw. Orthognathic surgery is a set of surgical procedures used to correct jaw abnormalities resulting from skeletal problems. 

    Who needs orthognathic surgery?

    This operation is an option for people with malocclusion (misalignment of the teeth) that cannot be fixed with orthodontics alone. Proper alignment of the teeth and jaws will improve your ability to chew and bite into foods as well as the appearance of your smile and facial profile. 

    Common jaw abnormalities include:  

    Lower jaw problems

    • A small or underdeveloped lower jaw maycause difficulty biting into food and/or breathing. Your upper teeth may jut out or overlap your lower teeth, causing your chin to look receded.
    • A large or overdeveloped lower jaw may cause your chin to appear too far forward and your lower teeth may overlap your upper teeth, causing difficulty biting into food and chewing.

    Upper jaw problems

    • A small or underdeveloped upper jaw can cause your teeth to look receded.
    • A long or overgrown upper jaw may cause your teeth not to overlap, and your smile may show mostly gums.  

    Uneven jaws

    • The jaw can grow at different rates, causing jaw or facial asymmetry. Your face can appear off-center and your upper or lower teeth may shift to one side.

    When is orthognathic surgery typically performed?

    Oral and maxillofacial surgeons typically choose to correct these problems after your jaws have stopped growing. This usually occurs during late adolescence or early adulthood.

    CAUSES

    What causes jaw abnormalities?

    Jaw abnormalities can be caused by congenital (present at birth) defects, a genetic tendency for the jaws to grow at different rates, jaw injury or fracture, or a late growth spurt.

    SIGNS AND SYMPTOMS

     Jaws that are not properly aligned may cause the following problems: 

    • Difficulty chewing food
    • Difficulty biting into food
    • Increased risk of teeth getting worn down
    • Breathing problems

    What is the long-term outlook?

    While orthognathic surgery is quite involved and can sometimes include years of preparation, operations are successful in fixing jaw abnormalities and improving facial appearance.

  • How do doctors decide whether orthognathic (jaw) surgery is appropriate?

    During the initial consultation, your oral and maxillofacial surgeon will review your history and perform a clinical evaluation. 

    Records from your orthodontist or dentist will also be reviewed.  These include:

    • Diagnostic radiology (X-rays)
    • Diagnostic photos
    • Models of your child’s teeth made from plaster 

    Once all the information is obtained, the surgeon will then discuss the case with your orthodontist. Prior to your operation, your case will be presented and discussed at an Orthognathic Conference, which is attended by consulting surgeons and orthodontists.

    At this conference, the group will determine and develop a plan to achieve the best functional and esthetic outcome based on all of the information gathered. Then we will meet with you and your family to discuss the results and outline the next steps in treatment.

  • 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.

  • At Boston Children’s Hospital, we are continually learning from our experiences with patients, evaluating the most current data, studying the causes of diseases and new treatments, and aim to develop innovative methods for caring for kids.

    Our Oral and Maxillofacial Surgery team has developed a comprehensive research program focused on developing new techniques and increasing the knowledge of common conditions. Our aim is to translate the knowledge gained in the laboratory back to the clinic in order to improve care for your child. Some of the areas we are currently studying include:

    • orthognathic surgery
    • temporomandibular joint disorders
    • improving clinical trials

    The bottom line: Our research results in innovative treatments that help your child recover faster.

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