Jaw Surgeries – In Which Cases Is Orthognathic Surgery Applied?

Misalignments between the lower and upper jaws are common complaints from many of our adult patients. These misalignments are caused by genetic problems that affect both the soft tissue, i.e., the aesthetic area, and the relationship between the teeth. One of the parents or relatives usually has it because such problems are passed down genetically.

What kind of complaints do these patients present?

In general, our patients are unhappy with their aesthetic appearance. In some cases, the lower jaw is forward, and the chin is very prominent. The upper jaw is very recessed, and the upper teeth are barely visible. Since the upper teeth are set back, the support and volume of the upper lip are also reduced. At the same time, there are issues related to chewing function. The misalignment of the jaws means that the upper and lower teeth do not fit together properly, and the ideal contact points of the teeth are lost. As a result, patients cannot perform an effective chewing motion. In some severe cases, it becomes difficult to bite with the front teeth. The teeth are unable to cut or crush food properly, negatively affecting digestive system health. Sometimes, the lower jaw is not only forward but also asymmetrical, turned to the right or left. This issue can arise because one side of the lower jawbone grows more than the other. The opposite relationship can also occur: the upper jaw may be positioned forward, and the lower jaw set back. The upper teeth are more prominent, while the lower chin is recessed. This leads to both aesthetic and chewing function issues. Additionally, since the lower jaw is small and recessed, patients may experience breathing difficulties, such as sleep apnea. The tongue is trapped backward due to the small lower jaw, causing airway obstruction, leading to complaints of snoring at night. In this case, the lower jaw needs to be adjusted to an ideal size, increasing the space for the tongue and preventing airway obstruction. Advancing the lower jaw can largely resolve snoring or apnea. Another issue that may arise is related to phonation, where sounds are not properly produced during speech. The disruption in the contact of the front teeth causes problems with sound articulation, and the tongue's position, which enables speech, is also less than ideal. This situation negatively impacts speech. Jaw surgery is necessary to address these issues related to the jawbones, and it's not a condition that can be resolved solely with orthodontic treatment.

What process awaits a patient with such a problem with their jaws and teeth? How long does the treatment take?

Before starting orthodontic treatment, there must be no cavities in the teeth or infections in the gums. If there are size issues with the teeth, these irregularities should be corrected with bonding or veneers. Only then can we begin orthodontic treatment. At the very start of the treatment, we take intraoral and extraoral photos, along with tomography or radiographs from the patient. We use special planning programs to digitally plan orthodontic treatment and the post-surgical jaw alignment, as well as the final profile view. We apply the orthodontic treatment according to this plan.

How do we perform orthodontic treatment, and how long does it take?

Orthodontic treatment can be applied using either braces or clear aligners. If the crowding is severe, the treatment can last around 8-10 months; for moderate cases, around 5-6 months. If there is no crowding, braces can be placed immediately to begin preparing for surgery. During surgical preparation, guide plates are made according to the digital program plan, indicating how much the jaws will be moved. Such surgeries are performed under general anesthesia by oral surgeons or aesthetic plastic surgeons. It is a team effort, and the surgeon or plastic surgeon is involved even during the planning of the jaw surgery. During the surgery, no external work is done on the face, leaving no scars. The jaws are repositioned and fixed with plates and mini screws. After the healing process, if the patient wishes, these plates can be removed, although it's not necessary. The surgery typically takes around 2-3 hours.

What challenges await after the surgery?

After surgery, there may be mild swelling on the face, and difficulties with eating and drinking for about a week. For the first week, a liquid diet is required, followed by a transition to soft foods. Patients experience rapid improvement day by day. Thanks to advancements in surgical tools, which minimize trauma, there is much less swelling than before, and the healing process is shorter as a result. Post-operatively, orthodontic treatment continues for a while to monitor healing and make a few aesthetic adjustments. In the most severe cases, the entire treatment process takes about a year and a half. For cases with less severe crowding, the orthodontic treatment is shorter, and the entire treatment can be completed within six months. There is also the 'first surgery' concept, where surgery is performed first, followed by orthodontic treatment. This allows for a rapid change in appearance, and dental problems are corrected with orthodontic treatment after the surgery.

Are patients satisfied after this procedure? Does their quality of life improve?

Yes, we usually ask every patient after this procedure if they are satisfied. If the procedure had to be done again, would they undergo it? We generally receive positive responses. This is because our patients experience improvements in both their appearance and chewing ability. Additionally, their phonation improves, allowing them to produce sounds more clearly.

Is it absolutely necessary to undergo these procedures?

It's not absolutely necessary, but if there is dental crowding, the risk of cavities increases. Excellent oral care is needed to prevent decay caused by crowding. Also, if the teeth do not close properly, there may be functional issues, leading to joint problems. If jaw surgery is not possible, splints or surface adjustments to the teeth can alleviate some of the damage caused by jaw misalignment. Crackling or popping sounds may be heard when opening or closing the jaw. For these reasons, treating jaw misalignments can be beneficial for long-term health.

Will the face look different after jaw surgery?

Yes, after jaw surgeries, it is possible to see that the patient's appearance reaches the desired aesthetic norms from both the profile and frontal views. The teeth-lip relationship, the forehead, the tip of the nose, the upper and lower lips, and the chin projection become harmonized and complement each other. Patients with a recessed upper jaw also have underdeveloped cheeks; during surgery, the forward movement of the upper jaw increases cheek volume. Or, in cases of a recessed lower jaw, the jaw gains volume after the operation. In patients with a forward lower jaw, the increased prominence of the upper jaw reduces the prominence of the lower jaw, making it less noticeable. For patients who show excessive gums when smiling, a surgery to move the upper jaw upwards results in a smile where the gums are much less visible, contributing to a more aesthetically pleasing appearance.