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About orthognathic surgery

At Boston Children’s Hospital, the majority of orthognathic surgeries (corrective jaw surgery) are successful — and our dedicated staff is here to support you throughout your treatment. Whether you suffer from an overbite, or an underbite, our specialized oral and maxillofacial surgeons will help provide the answers you’re looking for.

What is orthognathic surgery?

  • Orthognathic surgery or 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), which cannot be fixed with orthodontic treatment (braces) alone.
  • In addition to correction of malocclusion, orthognathic surgery can improve the facial appearance.

Common procedures performed as part of our Orthognathic Surgery Program include Le Fort I osteotomy, bilateral sagittal split osteotomy, malar implants, and genioplasty. Your surgeon will discuss each of these with you a develop an individual treatment plant that will give you the best possible result.

Who can benefit from orthognathic surgery?

  • Patients with dentofacial deformities such as underbite, overbite, crossbite, open bite, and facial asymmetry often pursue jaw surgery. After jaw surgery, patients can expect improved bite alignment and more efficient, safer, and comfortable chewing function.
  • Orthognathic surgery is also frequently necessary to correct skeletal and bite relationships in patients with cleft and craniofacial deformities. Orthognathic surgery is part of the treatment plan that is developed as part of care in the Cleft and Craniofacial Center. Jaw surgery may improve bite function, facial symmetry, breathing and sleep, and 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. Jaw surgery at Boston Children’s is a precise and well-planned procedure. During a preoperative records visit, our trained staff will obtain two- and three-dimensional facial photographs, digital impressions of the teeth, and a three-dimensional facial X-ray (CBCT). We then use this information to perform virtual surgery in a computer simulation program. The virtual surgery creates a prediction of a patient’s postoperative result, which can be shared with the patient. Our surgeons also use the virtual surgery to create bite splints that are printed on a 3-D printer and sterilized. These splints are then used during the operation to ensure that the desired result is achieved. 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 Cory Resnick, DMD, MD
© Boston Children's Hospital; posted in 2019

Contact us to learn more about orthognathic surgery in Boston

Boston Children's Hospital
300 Longwood Ave.
Boston, MA 02115

617-355-7252
Fax: 617-738-1657

FAQs

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.

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 may cause 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.

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.

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.

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

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

  • Aligning your teeth before orthognathic surgery: 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 before orthognathic surgery: 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.

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

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

  • Bilateral sagittal split osteotomies (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.
  • Le Fort I 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.

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.

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 six to eight 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.

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

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.

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 & 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 patient resources page, 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 on sites linked from this page. Links are simply provided as another resource. The American Association of Oral and Maxillofacial Surgeons offers an informative page about orthognathic surgery.

Practitioners Who Specialize In This Condition (5)

Bonnie L. Padwa, MD, DMD

Bonnie L. Padwa, MD, DMD

Oral Surgeon-in-Chief, Section of Oral and Maxillofacial Surgery
Professor of Oral and Maxillofacial Surgery, Harvard Medical School
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Cory M. Resnick, MD, DMD

Cory M. Resnick, MD, DMD

Attending Physician, Oral & Maxillofacial Surgery Program
Associate Professor, Harvard Medical School
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