Orthognathic Surgery

Orthognathic surgery is needed when hereditary genetic factors, growth abnormalities, or trauma have led to the situation where jaws do not meet correctly and/or the “bite” of teeth is altered (malocclusion) and do not seem to fit with jaws. The family or general dentist is in the best position to advise patients about their conditions initially; however, in some circumstances, many patients themselves recognize that things are “not right” and seek professional help on their own. The management of these conditions (referred to as Dento-facial deformities), requires a specialist “team approach” combining the expertise of multiple dental practitioners: The two specialties involved in this treatment are the Orthodontist the Oral and Maxillofacial Surgeon. They work along with the family or general dentist to assure your maximum oral health.

This joint specialist team approach for management of these conditions, is best exemplified by the affiliated practices of Dr. Ronald Katz with Dr. Kawa and Nicolas Orthodontists, LLP. This “Center of Excellence” is uniquely facilitated by the joint venture and proximity of the practices “under the same roof”. They work with your dentist to give you the professional advice and treatment that will lead to, not only your oral health, but also your general appearance, health and vitality.

The “seamless” convenience of a single location affords the patient the benefit of an intimate and close working relationship, where both Orthodontist and Surgeon are within “arms reach” of each other for consultation and supervision, at any phase of the treatment; and for comment, clarification, direction or change of plan, necessitated by progressive circumstances of treatment. In such a fashion comprehensive care ensues from initial diagnosis through detailed treatment planning and treatment.

Properly planned treatment encompassing not only the dental aspect of the condition, but also the facial esthetic balance and cosmetic concerns of the patient are taken into account when the sequenced treatment is initiated. Treatment usually begins with the initial phases of orthodontic therapy to level and align the teeth within their proper jaw positions. However, in some circumstances, initially surgery is performed for a dental procedure, such as exposure of teeth or removal of wisdom teeth prior to orthodontic management. Then surgical management or reconstruction of the jaws and bony facial skeletal elements then ensues. This is usually accomplished in a single stage surgery of one or two jaws, although on some occasions Staged surgical procedures are necessary to accomplish the optimum outcome for the patient. (i.e Initial Stage I Reconstruction consisting of Surgically Assisted Rapid Palatal Expansion [SARPE] to assist the orthodontic management of the case, prior to definitive Stage II Reconstruction, Osteotomy of the lower jaw). Not infrequently, purely Cosmetic procedures are combined with Reconstructive Orthognathic Surgery to enhance the esthetic facial balance in addition to the functional skeletal and dental outcomes (i.e. Chin advancement or reduction, Rhinoplasty, Nasal/Septal surgery and Malar implants, etc.) Finally, post-operative orthodontic treatment to achieve the final finished functional occlusion (bite) is performed.

Who Needs Orthognathic Surgery?

People who can benefit from orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is a gradual process and in some instances, the upper and lower jaws may grow at different rates. The result can be a host of problems that can affect chewing function, speech, long-term oral health and appearance. Injury to the jaw and birth defects can also affect jaw alignment. Orthodontics alone can correct bite problems when only the teeth are involved. Orthognathic surgery may be required for the jaws when repositioning of skeletal elements is necessary.

Difficulty in the following areas should be evaluated:

• Difficulty in chewing, biting or swallowing
• Speech problems
• Chronic jaw or TMJoint pain
• Open bite (front teeth open when back teeth meeting)
• Protruding, or recessive lower jaw (underbite, overbite)
• Breathing problems
• Sleep Apnea

Any of these symptoms can exist at birth, be acquired after birth as a result of hereditary or environmental influences, or as a result of trauma to the face. Before any treatment begins, a consultation will be held to perform a complete examination with appropriate radiographs (x-rays). During the pre-treatment consultation process, feel free to ask any questions that you have regarding your treatment. When you are fully informed about the aspects of your care, you and your dental team can make the decision to proceed with treatment together.

Both of these patients underwent double jaw surgery along with sliding genioplasty (chin surgery) to correct a skeletal and dental abnormality. Notice the changes in their facial appearance after a combined orthodontic and surgical approach. There are no external scars, as all of the surgery performed is done from inside the mouth.