ORTHOGNATHIC SURGERY – ORAL AND MAXILLOFACIAL SURGERY

Dentofacial skeletal anomalies may result from genetic causes, disease, as a consequence of a differential in growth of the upper facial skeleton to the lower facial skeleton, and due to traumatic events.

These deformities may cause significant functional impairment and may affect mandibular articulation. Orthognathic surgery is the maxillofacial procedure that works in conjunction with orthodontic treatment, to correct these maxillofacial disorders. These problems may involve the mandible (lower jaw) and/or maxilla (upper jaw). Orthognathic surgery (upper jaw). The Orthognathic surgery is performed in conjunction with orthodontic treatment, often including braces before and after surgery to position the teeth in a manner that will provide for an adequate occlusion following surgical reposition of the jaws.

Dr. Espinosa requires the cooperation of a multidisciplinary team whose , which members include oral and maxillofacial surgeons, orthodontists, and cosmetic dentists. This procedure is often performed in conjunction with nose surgery to optimize the results.

FREQUENTLY ASKED QUESTIONS

¿What is involved in the evaluation and diagnosis of orthognathic surgery?

Diagnosis and treatment of maxillofacial disorders may involve a multidisciplinary team of professionals such as dentists, orthodontists, maxillofacial surgeons, and facial plastic surgeons. There are many different types of abnormalities of the jaw structures that can result in facial deformity and improper bite: recessive o receding jaw, prognathia (lower jaw is too large), open bite, or protruding jaw (bimaxillary protrusion). Cephalometric analyses and mandibular measurements can help define the problem.

Clinical photographs and orthodontic x-rays are essential to establish the diagnosis. The surgeon analyzes the patient´s anatomic deformity through computerized images, in lateral and frontal views. The treatment plan will be determined by the medical team and will be divided into phases. The success of each phase depends on the cooperation of every member of the medical team.

¿What is involved in the treatment process of orthognathic surgery?

The first stage of the treatment is the orthodontic intervention. During this phase, the orthodontist aligns the dentition within the dental arch through braces, and prepares the dental arches for the surgical reposition. Dental braces are used to correct malocclusions and once ready for the surgical procedures, the orthodontist and the surgeon will review photographs, x-ray and dental models to finalize the surgical plan. It is possible the patient needs to use braces again after recovery from surgery or retainers when treatment with braces is complete.

¿How the orthognathic surgery is performed?

Every case requires different treatment. The orthognatic surgical procedures depend on the type of deformities of the patient. The surgeon uses orthognatic surgery to reposition one or both jaws, so that the teeth are in proper position after the surgery. Incisions are made inside the mouth and internal sutures will reabsorb. If it is necessary, the remaining internal sutures are removed during the next days after surgery.

¿What kind of anesthesia will be used during the orthognathic surgery?

Orthognatic surgery is a major procedure that requires general anesthesia. Thanks to the advanced techniques for anesthesia major side effects and other problems from anesthesia are not common. Additionally, preoperative routines make possible safer surgical procedures. In order to take precautions and avoid any complication, Dr. Espinosa may order some lab testing to evaluate your general state of health. He will carefully analyze the type of anesthesia according to your procedure. In any case, you will be carefully monitored by your anesthesiologist during and after surgery. Because surgery affects your entire system, it is important for your anesthesiologist to know as much as possible about you. Please inform him about your allergies, medications and past anesthetic experiences. Our Santa Bárbara Medical Center is an accredited surgical center fully equipped to ensure you excellent care. In any case, you will be carefully monitored by your anesthesiologist during and after surgery.

¿At what age is orthognathic surgery performed?

Orthognathic surgery may be performed during adolescence, but this decision depends on the kind of maxillary deformities.

¿What should I expect after surgery?

Immediately after surgery you will wake up quickly and comfortably, feeling no pain and experiencing no anxiousness. Medications may be administered to control post-surgical discomfort or pain. You can expect temporary swelling especially of the lips and cheeks, and perhaps bruising, for the following 72 hours, but this is a normal healing response and should disappear over time. Orthognathic surgery involves surgical procedures such as osteotomy (bone cuts), and incisions of the mucosal soft tissue. Swelling is a process occurring as a physiological response to that surgical intervention. The initial healing phase will take approximately 6 weeks, but completion of the healing process will take 6 months approximately.

Planning your surgery in advance will help you to reduce stress on the day of surgery. You should arrange for someone to drive you home, and to stay with you for the first days following your discharge from our medical center. Your surgeon will recommend you to sleep with your head elevated, and avoid as much activity as possible. Remember, some bleeding after surgery can be considered completely normal. Inform Dr. Espinosa of any abnormal symptoms. You will be asked to use an antiseptic mouthwash several times a day, until the incisions are completely healed. It is critical that you practice the best possible oral hygiene. Please, do not hesitate to communicate with Dr. Espinosa if you are concerned about something you consider significant.

Dr. Espinosa´s special instructions:

Instructions before surgery:

Avoid taking Aspirin (acetyl salicylic acid) or anti-inflammatory medicines.
Stop smoking at least one month before your surgery.
Inform your surgeon about drug allergies, medical treatments, and current medications.
Always have realistic expectations about the results of surgery.

Instructions after surgery:

Before you leave the medical center, make sure you have your surgeon’s prescriptions, medical certification, and date of your first post-operative visit to the office.
During the first few hours after surgery you should have an all-liquid diet. Then a very soft diet is recommended for two weeks. Diet may be advanced as tolerated. For the first days after operation, chewing ability may be reduced due to the fact that maxillo-facial skeletal has changed.
Ice packs immediately following surgery will help decrease swelling. You will be instructed by Dr. Espinosa to use a surgical glove filled with crushed ice over your face, as a compress, for the first 48 hours.
Right after the procedure, eating and talking may be difficult. Your physician will recommend that you try not to talk too much for the first days. Gradually you will develop normal movement.
Keep your head elevated during your recovery. Sleep on your back with your head elevated. It is necessary to sleep strictly on your back so as to prevent swelling on one side or other complications. Sleep on two pillows to keep head elevated or use a wedge-shaped foam pillow. You must sleep face up.
Strict oral hygiene maintenance is essential. Keep your mouth clean. You must use toothbrush from the first day following surgery. Brush gently near the surgical area. Rinse your mouth after every meal from the third day after the procedure, (one half of chlorhexidine mouthwash to one half of physiologic saline moisturizing). Clean above the brackets and around the orthodontic archwires as effectively as possible. Please take great care not to hit the incisions.
You must rest at home during the first 3-5 days.
You are discharged with post-operative oral antibiotics and pain medication. Please follow the dosing instructions. If you have severe pain, inform Dr. Espinosa immediately.
It is normal to feel the sensation of tightness and numbness during the first days following surgery. These symptoms will subside within the first weeks.
The remaining internal sutures are removed during the next 5 to 7 days after surgery.
Lifting heavy things, animals or children may affect the area of surgery. You must avoid any activity that increases the risk of hitting.
In order to reduce swelling, avoid direct sun exposure as much as possible during the first month. You must wear sun block and a covering to minimize sun exposure.
Avoid strenuous activity for the first 3 weeks following surgery. Dr. Espinosa will observe your recovery and will let you know when you can resume your usual physical activities.
Usually, you can resume gradually your normal daily activities in about 8 to 10 days, as long as you do not expose yourself to strenuous activity. You must avoid any movement that increases the risk of hitting.
Swelling in your upper and lower jaw will decrease every day, and after 6 weeks 90% of swelling should be gone. Results will be noticeable 6 months following surgery.
16. Depression is a relatively common finding following orthognathic surgery. As a consequence of the use of medications and anesthesia, and due to the fact that changes in the appearance are not evident immediately after surgery, depression may challenge the patient´s capacity to adapt to this process. Postsurgical discomfort and functional problems may cause dissatisfaction. Prior to any treatment, Dr. Espinosa recommends that you evaluate the implications of surgery and to have realistic expectations about the results. The patient must be emotionally prepared for the complex process following changes to the appearance.

The information provided here is not a substitute for a consultation. Please, do not hesitate to communicate with us if you are concerned about something you consider significant. Remember, the success of your surgery depends very much upon post-operative care. It is crucial that you follow your surgeon’s instructions.