Have you just had jaw surgery, or has your orthodontist recommended it? In this article, we will discuss everything you need to know about the surgery and the treatment process.
Jaw surgery, also known as orthognathic surgery, is often incorporated into orthodontic treatment for patients with misaligned jaws. As orthodontists, we often recommend jaw surgery when a patient’s bite, jaw alignment, or facial structure requires correction beyond what traditional braces can achieve. Surgery allows us to correct skeletal imbalances between the upper and lower jaws, ensuring a functional bite and improving facial aesthetics. When the jaws are misaligned, it can lead to issues with your bite, making everyday activities like eating and speaking more difficult.
Types of Jaw Surgery
There are three main types of corrective jaw surgery:
Upper Jaw Surgery (Maxillary Osteotomy): This surgery is used when the upper jaw is misaligned—either retruded or protruded, and possibly too long vertically with a gummy smile or short vertically, when teeth are not displayed enough.
Lower Jaw Surgery (Mandibular Osteotomy): This procedure is necessary when the lower jaw is out of alignment, either protruding too much or retruded.
Double Jaw Surgery (Bimaxillary Osteotomy): This surgery is recommended when both the upper and lower jaws are misaligned and need to be realigned simultaneously.
Chin Surgery (Genioplasty): Occasionally the chin may be repositioned to idealise the facial form. The chin may be advanced, set back, shortened, lengthened or centered dependent on the requirements for optimal facial balance.
The Role of Orthodontics in Jaw Surgery
Jaw surgery is a multi-step process that works in tandem with orthodontic treatment, typically taking place over the course of two to three years.
Conventional or consensus combined surgery and orthodontics involves preparing the most of the tooth positions prior to definitive surgery, which is performed 2/3 -3/4 of the way through the orthodontics.
Occasionally the orthodontist and surgeon may choose to perform the surgery prior to or in the early stages of orthodontics. This timing is referred to as “Surgery First” and there are specific reasons why this may be performed. This may be discussed with your orthodontists and surgeon.
Here’s a breakdown of how orthodontics plays a role in the overall process:
Pre-Surgical Orthodontics: Before the surgery, orthodontic treatment is essential to prepare your teeth. We use braces or clear aligners to move the teeth into a position where they can fit properly once your jaw is realigned. This step can take anywhere from 9 to 18 months, depending on the severity of your case. The goal is to align the teeth as closely as possible so that they fit properly after surgery.
Surgical Phase: The braces or clear aligners are usually in place during the surgery. The surgery itself is carried out by an oral and maxillofacial surgeon and involves repositioning the upper jaw (maxilla), lower jaw (mandible), or both as well as the chin. The surgery corrects jaw structure issues that cannot be fixed through braces alone, such as a severe overbite, underbite, when jaw is too far forward or backward. The upper jaw may be simultaneously moved upwards to decrease a gummy smile or downwards to increase tooth display when not enough tooth is displayed when smiling.
Post-Surgical Orthodontics: After surgery, the realigned jaws and teeth need to be further fine-tuned to achieve the best bite and appearance. At this stage, orthodontic treatment resumes with braces or other appliances, such as elastics, to ensure that the teeth stay in their new positions. We also make any final adjustments necessary to ensure the best bite and aesthetic results. This phase typically lasts 6 to 12 months.
Post-Surgery Orthodontic Treatment: What to Expect
Elastics and Orthodontic Adjustments
After your jaw surgery, you will likely notice that your teeth are held together, often with removable orthodontic elastics. These elastics help stabilize your bite and encourage proper healing of your jaws. They serve to maintain alignment while minimizing swelling and discomfort during the initial stages of recovery. Over the course of your 6-week recovery period, these elastics will be gradually loosened, and any pins used to secure them will be removed at your 6-week follow-up appointment. As part of your orthodontic treatment, your orthodontist will monitor and adjust your elastics to ensure they continue to facilitate healing while promoting the best possible dental alignment.
Bleeding and Bruising Post-Surgery
It is normal to experience some mild oozing or redness in your saliva after surgery. Occasionally, you may notice larger clots being dislodged or slight bleeding from the nose. This is all part of the healing process. However, if you notice excessive bleeding or bright red blood, it's crucial to contact your orthodontist or surgeon immediately. Bruising is especially common after lower jaw surgeries and may extend down your neck and chest, although it is less frequent after upper jaw procedures.
Swelling and Recovery Support
A cooling pad wrapped around your head and jaw area will help manage swelling after surgery. The cooling pad issued as required, replenishing ice as needed. The cooling treatment will be most effective in the first 1-2 days following surgery, helping to minimize swelling. The cooling pad wrap is typically removed the day after surgery, though some cases may require it to stay in place for up to two days. Swelling typically peaks around days 3 or 4, and keeping your head elevated—using 2-3 pillows or a recliner—during recovery can help reduce swelling. Expect the swelling to decrease gradually, but it may take several weeks for it to resolve completely.
Pain Management and Medications
When in hospital, you may have had access to a pain pump for better pain control. If you're recovering at home, you will likely be prescribed oral pain medications, often in liquid form, and may also be given antibiotics for about a week. If your surgery involved the upper jaw or nasal area, it is essential to avoid blowing your nose for about two weeks. You may also receive a decongestant nasal spray to aid with breathing. A steroid dose pack may be prescribed by the surgeon to assist with inflammation.
Hydration is key to reducing nausea from the pain medication, so it’s important to stay well-hydrated. Eating something before taking your pain meds can help minimize nausea. While itching may occur as a side effect of the medication, it typically isn’t an allergic reaction. If itching becomes bothersome without a rash, you might consider lowering your dose or taking an antihistamine, such as Benadryl.
Dietary Guidelines Post-Surgery
During your recovery, you will need to follow a no-chew diet for approximately four- six weeks. We will provide you with a helpful guide called “Dinner Through a Straw,” which includes recipes to help you maintain a healthy diet while recovering. You may lose a few kilos during the first few weeks (typically 4-6 kilos), but by eating frequently, focusing on protein, and increasing calorie intake, you can minimize weight loss and support a faster recovery.
Mouth Care and Oral Hygiene
Keeping your mouth clean is crucial to your recovery. In the first week, this can be challenging, but it’s essential to start brushing the outside of your teeth gently with a soft child’s toothbrush as soon as possible. Warm saltwater rinses (1 teaspoon of salt in 240ml of warm water) should be done at least three times a day, starting as soon as you can. If elastics are part of your orthodontic treatment, we will give you specific instructions on how to manage them.
Returning to Work, School, and Exercise
You’ll likely need to take at least 2-3 weeks off from work or school to recover from surgery. After two weeks, many patients feel better, but due to dietary adjustments and reduced energy levels, it can take up to six weeks to feel fully recovered. During this time, avoid strenuous exercise and refrain from contact sports (such as football or basketball) for at least three months to avoid any risk of trauma to the face.
Throughout this period, your orthodontist will closely monitor your progress and help you adjust your treatment plan as needed to ensure optimal results.
Moving Forward
We hope you now have a better understanding of everything involved with jaw surgery and what to expect in the coming weeks. You should feel confident about your treatment. If you have any questions or concerns about your orthodontic treatment in general, please call us at 1300 067 846.