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Orthognathic (jaw) surgery

Jaw surgery aims to re-position your jaws to improve the gap between the lower and upper jaws. It helps teeth to bite together better and improves the balance of your face. Your jaw surgery may be on either your upper or lower jaw (single jaw osteotomy), or both jaws (bimaxillary osteotomy).

Who is orthognathic surgery for?

This surgery can help if the bones of your face and jaws are out of balance with one another (it is not always possible to align the teeth and bite using braces only due to the bone structure of your face).

Surgery will only be offered if it is appropriate and if you are prepared to undergo treatment (including braces) which can take 2-3 years to complete.

What needs to happen first?

There are several things that need to happen before we can do the operation:

Orthodontic treatment

You will have numerous appointments with the orthodontist, as orthodontic treatment is needed before and after your operation to make sure your teeth move with your jaw. This may involve wearing braces for a lengthy period of time (for approximately 18 months before surgery and six months after, or until your teeth are finely adjusted and stabilised) and will be followed up with a removable retainer brace worn at night to hold your teeth in their new position.

Oxford orthodontistsSalisbury orthodontists

Planning appointment

You will be invited to a planning appointment once your pre-surgery orthodontic treatment is complete. This takes place at the orthognathic clinic for your centre (see Oxford Newbury Orthognathic clinic and Salisbury Joint Orthognathic clinic).

Planning appointments are very busy, with multiple assessments, and you will be at the hospital for most of the day. Assessments / activities include:

  • Medical photography – to have images done.
  • X-rays – you will have a Cone Beam Computed Tomography (CBCT) (a 3D image of  your teeth and bony facial structures) and lateral cephalogram (an x-ray of the side of your face).
  • Speech assessment – a speech and language therapist will assess whether the surgery poses a risk to your palate function (which in turn can affect your speech). Most patients who have this surgery do not have a problem with speech afterwards, but there is further treatment that can help if your speech is adversely affected by the surgery and this is successful for the majority of people. Oxford speech and language therapistsSalisbury speech and language therapists.
  • Psychological assessment – you will meet with a clinical psychologist to ensure that you understand the process and discuss your expectations for surgery. Oxford clinical psychologistsSalisbury clinical psychologists.
  • Impressions (moulds) – the orthodontist will take a set of impressions (moulds) of your teeth. The laboratory technicians will then make plastic wafers that will fit over your teeth to assist the surgeon during the operation.
  • Surgeon’s appointment – the surgeon will explain the fine details of the proposed operation, so you know what to expect.  Oxford surgeonsSalisbury surgeons.

Sometimes it isn’t possible to do all the assessments on the same day. You will be asked to come back if this is the case.

Pre-operative assessment

This is the last appointment before your surgery, where we carry out pre-operative checks and check the wafers. This is an important appointment where we will make final decisions about your operation and it is essential that you attend – your operation may be delayed if you miss this.

It usually takes place in the oral surgery department, with the surgeon.

What does the operation involve?

Jaw surgery is carried out inside the mouth so there are no visible scars. Occasionally tiny incisions are made on the bridge of the nose or under the jaw line but these will be almost invisible a few weeks after surgery.

Double jaw surgery (bimaxillary osteotomy)

The upper and lower jaw are cut precisely to avoid damaging teeth and the nerves in the upper and lower lips, gums and roof of the mouth. The upper and lower jaws are re-positioned to correct the bite of the teeth. Plate and screws are then placed in the jaw bones to fix then and allow the bone to knit together and sit in the correct place.  These are very small titanium plats and screws which normally stay in place indefinitely.

Lower jaw surgery (mandibular osteotomy)

The lower jaw is cut precisely to avoid damaging teeth and nerves in the lower lip. The lower jaw is re-positioned to improve the bite and the position of the chin.

Are there any risks/ side effects?

There are potential complications with any operation. Complications with this type of surgery complications are rare, but it is important that you are aware of them and have the opportunity to discuss them with your surgeon.

  • Bleeding – some oozing from the cuts inside your mouth on the night of the operation is normal and to be expected. Significant bleeding is very unusual but, if it happens, can usually be stopped by applying pressure with a rolled up handkerchief or swab to the area for at least 10 minutes.
  • Numbness – your bottom lip will be numb and tingly after the operation, similar to the sensation after having an injection at the dentist. This numbness may take several months to disappear and, in a small number of cases, may be permanent. Occasionally there can be an uncomfortable / burning sensation known as disaesthesia.
  • Infection – the small plates and screws that hold your jaw in its new position are usually left in place permanently. Occasionally they can become infected and need to be removed; this is not normally a problem until several months after surgery.
  • Adjustment of the bite – in the weeks following surgery, it is often necessary to put elastic bands on your orthodontic braces to guide your bite into its new position. Rarely, if your new bite is not quite right, a second small operation may be needed to re-position the fixing plates and screws.

After the operation

A follow up appointment will be given to you before you leave hospital. You should expect to see your surgeon in the Oral Surgery Department around 7 days after your operation. All other follow up appointments will be arranged from there. Patients are usually seen 1 week, 2 weeks and 4 weeks after the operation, before returning to their routine orthodontic appointments.

Your braces are normally removed approximately six months after your operation. Retainers will be provided after your treatment has been completed to be worn on a night time basis.

If you need advice or have a medical problem after surgery, please call your Oral Surgery Department:

Outside of normal working hours (evenings and weekends) please contact the on call member of staff via the hospital switchboard. See Oxford centre – find and contact us  and Salisbury centre – find and contact us for the switchboard numbers.

Orthognathic surgery

Further information