What is orthognathic surgery?
Orthognathic Surgery is a branch of Oral and Maxillofacial Surgery that encompasses a group of surgical procedures whose main objective is to correct dentofacial deformities resulting from unsatisfactory positioning of the dental arches and facial bones in relation to the base of the skull, often compromising the correct functioning of the jaws and causing changes in facial aesthetics. It is considered a functional aesthetic surgery..
Clinical Diagnosis
Initial Consultation The initial consultation is very important. During this consultation, the patient will be clinically assessed, with an emphasis on visual analysis of the face and clinical evaluation of dental occlusion. During this consultation, the surgeon will seek to understand the patient's main complaint and their expectations regarding the treatment. The patient will be instructed on what orthognathic surgery is, the risks, benefits, and limitations of this type of treatment. Imaging tests and complete orthodontic documentation will be requested, including photos, x-rays, models, cephalometric analyses, and CT scans and MRI of the joints when necessary.
Diagnosis of Facial Deformities
The diagnosis of facial deformities is fundamentally clinical, however, several analyses are necessary to help establish precise and reliable therapeutic objectives to restore the patient's normal and functional characteristics to the masticatory system and a more balanced face that is socially considered more aesthetic. Patients who are candidates for orthognathic surgery usually seek an orthodontist in search of a solution for the occlusal alteration, and at this point they discover that their case is not just a dental discrepancy that can be resolved with the installation of braces, but a skeletal discrepancy that requires ortho-surgical treatment (orthognathic surgery) with a multidisciplinary team that involves an oral and maxillofacial surgeon, orthodontist, and in some cases a speech therapist and psychologist.
Case planning With all the exams in hand, associated with the data collected during the initial consultation, we draw up a surgical treatment plan. Each type of deformity requires a different type of planning and surgery. This planning is then discussed with the orthodontist who will try to fit your orthodontic preparation into the surgeon's initial planning. However, the necessary or ideal dental conditions are not always achieved, especially in more complex cases, and the orthodontic preparation may be modified at this stage. Therefore, it is important to note that during the orthodontic preparation, the surgical planning may change depending on the limits that each case may have, and that additional surgeries may be necessary to improve facial harmony.
Facial Deformities
The most common dentofacial deformities are: Mandibular retrognathism: The mandible is smaller than the maxilla or is in a retropositioned position in relation to the maxilla, i.e., with a small and backward chin, generating a convex profile. Mandibular prognathism: The mandible is larger than the maxilla, i.e., with a large and forward chin, generating a concave profile. Maxillary retrognathism: The maxilla is smaller than the mandible or is retropositioned in relation to the mandible, i.e., the middle third of the face is flattened, also generating a concave profile. Maxillary prognathism: The maxilla is larger than the mandible or is positioned anteriorly in relation to the mandible, i.e., the maxilla is projected forward, also generating a convex profile. Long face: excessive maxillary growth in the vertical direction, normally generating excessive gingival exposure when smiling. Facial asymmetry: the mandible or maxilla has grown more on one side than the other, deviating the median line to the right or left. These asymmetries can also occur in association with each other, causing an even greater maxillomandibular discrepancy.
Common questions!
Is there any prevention?
Yes. If the orthodontist identifies maxillomandibular changes around the age of 5 to 7, functional orthopedics can be applied. This technique will help correct facial growth. If the discrepancy is dental, conventional orthodontic treatment can be performed, and the most appropriate age to begin treatment is around 12 to 13 years.
At what age can this surgery be performed?
Orthognathic surgery can be performed from the moment the growth of the facial bones is already defined.
What will be done during the surgery?
After determining how the orthognathic surgery will be performed, the surgeon will reposition the mandible or maxilla, or both. The mandible may be moved forward (advancing the mandible), backward (retracting the mandible), or the maxilla may be repositioned by moving it forward or backward. In many cases, the surgery will be combined, modifying the positioning of both the mandible and the maxilla, and in some cases, mentoplasty (reshaping of the chin) is also necessary. After repositioning the maxilla or mandible, they will be fixed using mini-metal plates (titanium) or bioabsorbable materials. The surgery is performed inside the mouth.
Where is the Surgery Performed?
Orthognathic Surgery is performed in a hospital setting under general anesthesia, and the hospital stay is relatively short.
What is the recovery period? Patients usually recover in around 3 to 4 weeks, depending on the case.
Does health insurance cover this treatment?
Yes, some health insurance plans have a waiting period for these procedures, while others do not. However, if the patient has a health insurance plan, the plan may cover the hospital expenses required to perform the surgery. However, the fees for surgical planning and orthodontic preparation are the patient's responsibility.