What is Jaw Surgery?
Jaw Surgery can have a dramatic effect on many aspects of your life. While the appearance of your face may be enhanced as a result of treatment, the core objective with Jaw Surgery is to correct for health and medical issues
The line between Jaw Surgery for aesthetic purposes and medical necessity is often blurred. A small lower jaw and receding chin not only affect appearance, but are likely a sign of snoring, sleep apnoea and disturbed chewing function.
The cornerstone of Jaw Surgery is realigning the jaws and teeth, in order to improve the way they work together. The reasons that lead people to seek out Corrective Jaw Surgery are numerous.
You may be suffering from obstructed breathing, and are looking for a permanent cure to your snoring, sleep apnoea, and breathlessness.
You may wish to correct issues with facial imbalance, such as the appearance of a weak chin, a receding jawline, or a pronounced overbite.
It might be that you have difficulty chewing or eating, are damaging your teeth by the way you bite, or experience chronic jaw joint (TMJ) pain.
Regardless of your motivation, when seeking the benefits of Corrective Jaw Surgery, it is important to locate a clinic of professionals that are highly qualified, respected, and experienced.
Remember that the elements essential to successful Jaw Surgery are an expertly determined diagnosis, a meticulous planning process, and treatment that is completed with care and precision.
What can be fixed with Jaw Surgery?
There are many issues that can be treated successfully by Corrective Jaw Surgery. You may be wishing to...
- Relieve airway obstruction and improve exercise tolerance
- Treat sleep apnoea, snoring, and sleep-disordered breathing
- Enable proper nasal breathing and eliminate chronic mouth breathing
- Be able to bite and chew using all of your teeth
- Have a balanced bite that minimises the excessive wear of teeth
- Close an open bite, or spacing, between the top and bottom front teeth
- Allow your lips to close without straining
- Address imbalance of facial appearance or jaw proportion
- Correct the sense of a receding lower jaw and chin
- Correct the sense of a prominent lower jaw
- Correct the sense of middle face collapse
- Alleviate chronic jaw, jaw joint (TMJ) pain, and headache
What Jaw & Facial conditions do we commonly see?
Humans tend to be visual by nature, so we have described these conditions mainly in terms of their physical features. Generally this helps people with identifying a condition that may affect them.
It is important to remember that while the focus of these descriptions is on physical appearance, the features described are signposts for possible health, medical, and functional issues.
A lower jaw & chin that look small or set back
A short lower jaw is produced by a lack of normal tongue growth. The tongue plays a major role in stimulating the front of the lower jaw to grow, and abnormal tongue growth prevents the lower jaw from reaching a normal size.
The upper jaw and the nasal airway are often very narrow, and there is usually obstruction of the major airway behind the tongue. Signs also include a small lower jaw and chin, 'bucky' front teeth, and varying levels of teeth crowding.
The obstructed airways increases the risk of snoring, and the development of sleep apnoea later on in life. There can also be difficulties with speech, as well as disturbance to normal chewing ability.
A mid-face that looks sunken in or set back
A lack of upper jaw growth is usually due to obstructed nasal breathing during childhood development. The upper jaw ends up being small in 3 dimensions, being a combination of narrow, short, and set back.
This gives the impression of exaggerated growth of the lower jaw. The short length of the upper jaw results in an underbite, and places overemphasis on the size of the lower jaw and chin, which are usually normal in size.
A lack of upper jaw growth often leads to difficulty with chewing, a damaging bite, and excessive wearing of the teeth. A bad bite affects the way the jaws come together, and can lead to asymmetrical growth of the lower jaw.
Front teeth that don't touch when biting
An anterior open bite is characterised by a lack of contact between the front teeth. This can involve purely the teeth (dental open bite), or both the teeth and underlying jaw structures (skeletal open bite).
In a skeletal anterior open bite the upper jaw and palate are often very narrow, and the lower jaw is usually asymmetrical.
The condition is most commonly due to continual open mouth breathing during childhood, a product of allergy-related nasal obstruction. The resulting narrow upper jaw and nasal airway obstructs the normal flow of air when breathing.
Thumb or dummy sucking, as well as possible tongue thrusting can lead to an anterior open bite. Usually this starts of as a dental anterior open bite which will spontaneously resolve if the behaviour stops.
If the behaviour does not cease then the open bite will start to involve the skeletal structure of the face. This skeletal anterior open bite may not resolve without surgical intervention as an adult.
An anterior open bite can impair the ability to bite and and chew, as only the back teeth touch when eating. This leads to the excessive wear and early loss of these teeth, and increases the risk of damaging jaw joint conditions.
A lower jaw that looks too big or far forward
This is defined by orthodontists as a class III malocclusion, where the bottom teeth are positioned further forward relative to the upper teeth.
The primary issue is the discrepancy between upper and lower jaw growth. The cause of this is likely to be chronic nasal obstruction, with excessive vertical down-growth, and further asymmetry of the mandible.
A long face with excessive gum display
Maxillary Vertical Excess is the exaggerated downward growth of the tooth containing portion of the upper jaw. What appears to be a 'gummy smile', is in reality a substantial increase to the height of the upper jawbone.
The facial contours are often characterised by a long, tapering face due to this exaggerated vertical growth, the upper palate and nasal airway are often constricted, and the lips are unable to close.
The lower jaw often responds by also increasing in downward growth, exacerbating the appearance of a 'long face'. The likely cause of this condition is chronic nasal obstruction and open mouth breathing during childhood.
Severe asymmetry of the jaws & face
Hemifacial Microsomia affects the normal development of the lower half of the face, most commonly the ears, the mouth, and the lower jaw. It likely results from a disruption to the early stages of embryological development.
Its severity can vary, with a possible involvement of the earlobe, cheekbone, jaw joint, and vertical part of the lower jaw, and overall there is obvious asymmetry to the appearance of the face.
The uneven growth of the lower jaw generally leads to impaired chewing ability, difficulty with speech, and airway blockage that can be so severe, that breathing is almost completely obstructed.
Upper & lower jaws that are both set back
BiMaxillary retrusion is characterised by a lack of development of both the upper and lower jaws. There is often severe dental crowding that is commonly treated by extraction-based orthodontic treatment.
There is a sense of lower facial recession, which may be highlighted by a large nose, a small chin, and prominent fat around the neck and chin. Extraction-based orthodontics generally exacerbates aesthetic and functional issues.
A complete lack of lower jaw development
Juvenile Rheumatoid Arthritis (JVA) that targets the the jaw joints, can lead to rapid jaw joint deterioration which then severely impairs the growth of the entirety of the lower jaw.
The lower jaw may be so small, that there is a complete lack of contact between the upper and lower teeth. Complications arise in the form of upper airway obstruction, disturbed chewing function, and bad neck posture.
What are the different types of Jaw Surgery?
Orthognathic surgery is often referred to as Jaw Surgery. It involves surgery to either the upper or lower jaws, and often involves both.
Jaw surgery is used to surgically reposition the jaws into the "correct" skeletal position, thereby treating conditions of the jaw and face related to the skeletal structure of the face.
Corrective Jaw Surgery realigns the teeth and jaws to improve the way they work together. Each procedure has its specific purpose and issues that it aims to correct.
The Jaw Surgery process usually makes use of a combination of procedures, which are designed specifically to treat your key health, functional and aesthetic concerns.
Upper Jaw Surgery (Maxillary Le Fort 1)
The Le Fort I is used to correct abnormalities of the midface, by modifying the reposition the upper jaw. The upper jaw can be moved forward to correct an underbite, and improve the way the teeth come together when chewing.
Moving the upper jaw forward increases the size of the airway as it transitions from the nose to the throat. This can improve breathing obstruction and sleep apnoea that is caused by the position of the upper jaw.
From a cosmetic perspective, the upper jaw can be pushed up at the front to eliminate excessive gum display, and reduced at the back to close an open bite where the front teeth are unable to touch.
Lower Jaw Surgery (Mandibular BSSO)
The Bilateral Sagittal Split Surgery (BSSO) is used to correct the length and position of the lower jaw. The lower jaw can be moved forward to correct an overbite, which improves how the teeth come together when chewing.
A small lower jaw has to slide forward excessively to bring the teeth together, which places chronic stress on the jaw joints. Advancing the lower jaw brings the teeth into a normal bite, improving the function of the jaw and jaw joints.
Advancing the lower jaw pulls the tongue forward and creates more room in the mouth for it to sit. This increases the volume of the major airway behind the tongue, allowing for improved breathing and exercise tolerance.
Upper & Lower Jaw Surgery (BiMax)
BiMax surgery is used to correct the position of both the upper and lower jaws within the same procedure. It is a very exacting technique that requires a high degree of surgical skill and a very precise planning process.
BiMax can treat an array of functional and aesthetics issues, including sleep apnoea and snoring, jaw joint TMJ pain, facial asymmetry, jaw disproportion, and bite issues that can't be fixed by simple orthodontic treatment.
The amount of tension created by moving both jaws together at once is significant. The risk of relapse from moving the jaws a significant distance is an important factor when considering BiMax as your surgical option.
Chin Surgery (Genioplasty)
Genioplasty is a procedure used to correct how far forward the chin projects, the symmetry of the chin point, and the shape and contour of the chin. It is often an performed as part of a sequence of surgical jaw procedures.
While generally perceived as a purely cosmetic procedure, Genioplasty provides significant medical benefit. One of the structures holding your airway open, is a large muscle attached to the inside of your chin bone.
Moving your chin forward pulls this muscle forward as well, which assists in opening up or 'tenting' the major airway behind the tongue. Patients generally report an improvement in breathing following a Genioplasty procedure.
Upper Jaw Widening Surgery (SARME)
Surgically Assisted Rapid Maxillary Expansion (SARME) can be used to widen a narrow upper jaw in adults, or teenagers that have finished growing.
Non-surgical expansion of the upper jaw using a fixed orthodontic appliance is commonly used in growing teenagers. However once growth ceases at about 16 - 18 years of age, the bony structures in the upper jaw fuse together, and jaw expansion then requires the assistance of surgery.
The upper jaw is expanded at home over a 2-3 week period so that it approximates the width of the lower jaw. Progress is usually monitored by your orthodontic practitioner.
The SARME procedure is often used in preparation before surgery to reposition the jaws.
IMDO (Lower Jaw Distraction Surgery)
Intermandibular Distraction Osteogenesis (IMDO) is a combined surgical and orthodontic technique initially developed to correct a small lower jaw in teenagers and young adults.
It is now used successfully in some adults of a broader age range, and for a wider variety of medical conditions. IMDO is more conservative than other forms of jaw advancement, with faster recovery, better outcomes, and fewer risks.
IMDO allows for precise control over how far the jaw is advanced, as it is grown by 1mm a day over a 2-3 week period. The amount of advancement can be significantly greater than what can be achieved with traditional jaw surgery.
Is Jaw Surgery an option for me?
Orthodontic treatment can straighten teeth, but cannot correct underlying issues with the jaws. If you want to treat problems arising from structural issues with your jaws, this will usually require Corrective Jaw Surgery.
If structural issues are minor, and related symptoms do not concern you, then simple orthodontics may be appropriate to straighten your teeth. More complex issues may require the management of a Jaw Surgery specialist.
Jaw Surgery has advanced enormously in recent years. Despite this, there are some orthodontists don't feel comfortable with Jaw Surgery, and may not offer you a surgical option when seeking their opinion.
Some orthodontists may only offer to camouflage structural issues. Teeth may be removed to relieve crowding in jaws that have inadequately grown, which can create room to straighten the remaining crooked teeth.
Jaw repositioning splints may be used to push the lower jaw forward in attempts to make it grow. This doesn't work, common sense says it doesn't work, and more importantly, neither does the science says it works.
Tot truly correct your main concerns we need to identify and treat the underlying cause. If you have crowded teeth and breathing issues because of a small lower jaw, than the obvious fix is to make your lower jaw bigger.
This will create enough space to relieve your crowding without the need to remove teeth. It will give your tongue room for it to lay forward comfortably, and allow for unobstructed breathing when sleeping.
If you think you have disproportionate jaw or facial features, you should seek a surgical opinion prior to orthodontic treatment. A consultation does not commit you to surgical treatment, but it does make sure you know all your options.
This is especially important if you have been recommended treatment that involves removing teeth. Surgical treatment aims to keep all of your teeth, and may become compromised if you wish to pursue Jaw Surgery in the future.
What is the Jaw Surgery process?
Consultation | Jaw Surgery is a highly technical and personalised form of treatment, so this first consultation is very important. We will look at your oral and medical health to make sure Jaw Surgery is a good option for you.
This visit will usually involve x-rays and photos. We want you to explain your goals in detail so that we know precisely what your expectations with treatment is.
Planning | We will need you to have a CT scan of your jaw and facial structures, so that we are able to correctly diagnose your condition and plan for your treatment.
With this scan we can produce an intricate 3D recreation of the structures of your face, so that we can precisely identify the cause of your concerns. We will then be able to show you what we will be able to achieve with surgery.
Orthodontics | The first aspect of the surgical process usually involves orthodontic alignment of your teeth. The purpose of this is to create the ideal fitting surface between your upper and lower teeth after surgery.
Your orthodontic practitioner is responsible for this aspect of treatment. There will be communication between the surgeon and your orthodontic practitioner to ensure the bite required prior to surgery is attained.
This allows us to realign your jaws in a very precise fashion, and makes your surgery a predictable and stable process.
Jaw Surgery | When your teeth are in the correct surgical alignment, you are ready for surgery. At this stage your bite will probably look weird, but this is because your jaws will be moved into a position where your teeth fit together and look "normal" after surgery.
We will acquire new 3D scanning of your jaws and face to plan your surgery. We will take optical scans of your teeth to create precise digital models. We integrate these for the final surgical planning process, and for the manufacture of your of surgical splints.
A further conslutation with your surgeon will involve virtual movement of your jaws in 3D to predict the ideal surgical outcome. This will be used to produce surgical guides that position your jaws precisely during your Jaw Surgery procedure.
What is the recovery from Jaw Surgery like?
The length of stay in hospital is determined by the type of procedure performed and by you the patient. After surgery you will be connected to a drip which administers pain relief on demand with the push of a button. When this is no longer required you are usually ready to go home.
You will have been given a script prior to surgery (get it filled and ready before your surgery)that will contain all the medications required during your post op recovery at home.
You will feel uncomfortable, your jaws will be in a position you are not used to, but you should not be in pain. Jaw surgery is not usually painful. This may be hard to believe, but since your nerves are generally bruised following surgery, you should feel little in the way of pain. By the time feeling returns to your face, most of the pain is gone.
You may experience a bit of pain when you yawn, sneeze and cough. It may also hurt if your jaw spasms, which can happen in the first month, but generally you should experience little in the way of pain at all.
Swelling will mostly settle within about 2 weeks, however it can take several months for it to fully resolve. It will take 3 months for your jawbones to fully heal.
What can I eat after Jaw Surgery?
You’ll be on a strict dairy free liquid diet immediately following jaw surgery. Buy lots of Resource supplement shakes and learn to make smoothies, because these will be your staple foods for at least the first 2 weeks.
It is important that your diet is dairy free. Dairy tends to stick to the sutures and is a great source of food for bacteria. Therefore restricting dairy foods while the sutures are in place reduces the chance of developing an infection.
You’ll probably have to administer your food through a syringe for the first week. We will supply you with syringes and wide straws to help with this. Once your surgeon gives you permission to start chewing again, you can begin to eat soft foods such as pasta and mashed potatoes.
During the weeks following your re-entry into the realm of chewing, you’ll be able to eat what is comfortable. Don’t expect to tear into a steak as soon as you’re allowed to chew again, though.
Eating during your recovery will be made easier if you have the following:
- A blender
- Smoothie materials (anything that is dairy free and will blend to a smooth consistancy)
- Smooth soups
- Protein and supplement shakes such as "Resource" which is dairy free
- Prune juice (An excellent source of fibre)
Staying adequately hydrated is the most important thing to remember during your recovery, as well as consuming enough fibre to keep your digestive system working properly.
We recommend having the ingredients at home ready for your post op recovery. Storing ingredients to be blended in the freezer is a great way to prevent the drink from overheating when blending.
Are there any risks with Jaw Surgery?
This is not an exhaustive list and not all of these are relevant to every type of surgery. Your surgeon will discuss the specific risks associated with your proposed procedure.
Pain and discomfort are well controlled with IV pain relief in hospital, and then by prescription pain relief and anti-inflammatories on discharge.
Bleeding may occur in the first 24-48 hours after surgery. To minimise this we advise no spitting or vigorous rinsing, blowing your nose, or touching incisions with your fingers or tongue. Sucking on ice will help control bleeding. Bleeding after 24-48 hours may indicate infection.
Swelling is normal and will usually peak within 48 hours after surgery, and gradually resolve over a couple of weeks. IV anti-inflammatories will be given during your procedure, and also during your hospital stay. Oral anti-inflammatories are then prescribed for you once you get home. How much you will swell depends on the procedure as well as how your body reacts.
Bruising may become evident on the face, neck, and sometimes the chest, as your swelling begins to settle down.
Numbness is completely normal after surgery, and may affect areas of your lips, gums, and lower face after jaw surgery; and in the upper teeth/hard palate following an upper jaw surgery procedure. While the nerve fibres are healing, you may encounter itching or tingling sensaions. In most patients sensation returns to normal within three to six months.
Nasal congestion is common after surgical procedures involving the upper jaw. This will be controlled in hospital with a small suction tube and a nasal spray, the latter of which you will continue to use when you leave hospital. It is important NOT to blow your nose at this stage.
Limited facial movement is a result of post-operative swelling and jaw stiffness, limited mouth opening is normal after major jaw surgery (BiMax). Jaw function will gradually improve and mouth opening will return to normal within 4-6 weeks after surgery.
Wound separation is rare. In the event that it does occur, poor oral hygiene is usually the cause.
Impaired healing of bone is rare in healthy individuals. Medical conditions that affect the body's ability to heal increase the risk of this happening. Impaired healing will usually require an additional surgery.
Relapse. The muscular forces that caused the original growth problem and the jaw relationship are still present after surgery. As a result, there is a small chance that the jaw(s) and teeth will move back towards their original position. This is termed relapse. Many things are done throughout treatment to counteract relapse, but some degree of relapse is not uncommon. Relapse is more likely to occur in the lower jaw when it is moved forward more than 10mm using conventional bilateral sagittal split osteotomy. Using IMDO (Intermandibular distraction osteogenesis) we are able to achieve growth of 15mm in the mandible. Relapse may also occur with large movements of the upper jaw.
Loss of teeth is a risk, but a very small one. A tooth may "die" and require extraction if the bone surrounding it is cut during surgery. This is usually only a possibility if you have severe dental crowding in the site of a planned surgical cut. Your surgeon will identify if this is a specific risk for you.
Depressed mood is not unusual immediately following your surgery. You will be in hospital for a couple of days in an environment you are not used to, and without friends or family constantly at your side. You may be frustrated at difficulty in communicating. Pad and pen are recommended.
You will be recovering from the effects of the anaesthetic which will often make you feel lethargic as well as the physical symptoms of the surgery. Going through any surgical procedure is not going to be a holiday.
To achieve your desired outcome there are steps to follow and several weeks of recovery. Please be patient, prepared and have realistic expectations. The final results are worth it.
‘Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.’