Orthognatic Surgery, Oral, Maxillofacial and Design of Smile
Due to hereditary causes, dysfunctions of growth, illnesses or traumatisms, the maxillary can suffer dramatic alterations that harm the relationship and correct articulation. The Orthognatic surgery is the branch of the maxillofacial surgery that works of the hand of the orthodontics to correct those maxillary and facial deformities that affect in a severe way the aesthetics, the oral function and the psychological well-being of people. This type of malformations can harm the superior maxillary, the jaw or both. All treatment should begin repairing the bad positioning of the dental organs through orthodontics. Once the orthodontist has concluded its work, the maxillofacial surgeon mobilizes the structures appropriately by means of surgery until achieving the appropriate occlusion.
Dr. Jorge Alberto Espinosa Reyes works with the most noted maxillofacial surgeons and specialized odontologists in the improvement of the smile. Also carries out procedures combined as the Orthognatic surgery and nasal surgery, in such way that the results are optimized and diminishes in a substantial way the inability after the surgery.
LUISA FERNANDA SUAREZ NIETO, DENTISTRY OF THE UNIVERSITY OF BOSQUE, REHABILITATIVE, PATHOLOGIST AND SURGEON, PONTIFICIA JAVERIANA UNIVERSITY, COORDINATOR OF THE SERVICE OF DENTISTRY OF THE UNIVERSITY CLINIC TELETON, PROFESSOR OF GRADUATE DEGREE OF SURGERY AND PATHOLOGY OF THE PONTIFICIA JAVERIANA UNIVERSITY
Frequents Questions
 ¿How is done the diagnosis of this class of procedures?
In the diagnosis and treatment of this class of bony malformations specialists intervene in dentistry, orthodontics, maxillofacial surgery and facial plastic surgery.
The malformations can take place for lack of projection of the jaw or of the chin, excess of mandíble projection (prognatism), faulty growth of the superior maxillary, excessive growth of the superior maxillary, inadequate contact of the teeth when closing the mouth (open bite), protrusion bimaxillar (lips exaggeratedly projected by push of the teeth).
Through careful mensurations the differences and the grade of deviation of the facial bones are interpreted. These calculations guide the treatment definitively.
The first step is the valuation for orthodontics and the determination of the aims of treatment. This is carried out through a clinical exam, radiographic proofs (panoramic, of front and profile), and a careful photographic study. Additionally it is fulfiled an exploration of the images by computer where the front and of profile modifications are observed, and the possible results. The analyses show the types of deformations and they indicate a treatment to accomplish. Later on, the professionals design together the procedure that should be effected. The communication between the different specialists and the interdisciplinary planning assures the success of the treatment.
¿What is the treatment about?
After defining the objectives of the treatment, the first step is the orthodontics, where the specialist corrects the form anomalies, position, relationship and function of the dental structures. By means of fixed devices (brackets), made up of elements that are fixed to the surface of the teeth directly, the odontologist manipulates a series of forces that slowly correct the bad position. So that orthodontics don't reach to correct the maxillary situation completely, it is required of surgical support to solve the problem. Later to the recovery of the surgery it is frequent that it is followed the orthodontics treatment again, which allows to sustain the reached achievements and to improve the final results.
¿How is carried out the surgery?
Each case is totally different and depending on the maxillary malformation is planned a particular surgical intervention. Basically the bony structures are mobilized to achieve that superior teeth fit appropriately with the inferior, this is denominated to get the appropriate occlusion. The incisions are carried out inside the mouth and the sutures can be reabsorbed by themselves or to be moved away to the week of the surgery.
¿What type of anesthesia is used?
The orthognatic surgery is a bigger intervention that demands the use of general anesthesia. The anesthetic practice has developed control methods in the supply of the sedation in such a way that the unpleasant effects caused by its use are minimized to the maximum. In any way the specialist anesthesiologist remains attentive to the monitore of the administration of the anesthesia and the pursuit to your corporal functions in the surgery room.
Before your surgery the doctor orders a pre anesthesic control that will guarantee your well-being during the whole procedure. The protocols of pre surgical performance allow to offer you the biggest security. In the pre anesthesic valuation the rules of sedation handling will be evaluated and you will be informed on the anesthetic act that will be practiced. It is recommended to be very clear and to inform previously if you are allergic to some medication.
Dr. Jorge Alberto Espinosa Reyes counts with highly qualified personal and all the monitor systems that allow the pursuit of all your corporal functions.
¿What age is it possible to carry out this surgery at?
After an exhaustive analysis of the case the doctor can indicate this surgery from before the adolescence, although this decision depends in a large part of the class of maxillary alteration.
¿How is the post surgery?
Once finished the intervention you will wake up calm and without pain. After some hours it is possible that you present some nuisances, which can be controlled with the formulated medications. In the orthognatic surgery are carried out surgical courts of the bones and are intervened delicate buccal tissues. The inflammation is an answer hardly natural to the operation and it can be evident up to 6 weeks after the surgery. Past 6 months approximately, and when it has already diminished totally the inflammation, it will be possible to evaluate the definitive results.
It is important that you plan with time the day of your surgery and have to your side a person of whole trust that helps you to go back home and take care of you the first post surgery days. It is recommended to be in bed with the head lifted with the purpose of diminishing the swell.
In all the cases, and for your tranquility, don't doubt to contact Dr. Espinosa who will be attentive to all your recovery process.
Dr. Espinosa recommends:
Before Surgery:
1. Not to consume medications that contains salicylic acid (Aspirin) and derivates.
2. Not to have smoked at least one month before the surgery.
3. To inform from possible allergies to medications.
4. To maintain realistic expectations with regard to the results of the surgery
After Surgery:
1. Check on exit that the formula, disability order and date of medical control order has been delivered.
2. The diet type is prescribed according to the intervention. A very soft diet is recommended by the first two weeks and goes incorporating foods of more consistency according to the tolerance. Initially it will be a little difficult the mastication since the bite has changed.
3. It is advisable a surgical glove full of ice wrapped in a towel on the area and to sleep a little sat down during the first 48 hours.
4. it is possible that you experience certain nuisances when speaking. Avoid to have extensive conversations the first days. With the step of the days you will feel your recovery as you can communicate with more freedom.
5. The oral hygiene should be carried out with soft brush from the first day. Don't forget to fulfill mouthwashes after each food, starting from the third day with a mixture half of chlorhexidine mouthwash and half of normal saline solution. Clean below the brackets and the orthodontic arches having care of not hitting the incisions.
6. You should keep resting at home during the first 3 to 5 days.
7. Inside the formulated medications it is included an analgesic and an antibiotic; take them according to the indications scored in the formula.
8. It can be presented sensation of tension and drowsiness that it will pass when it gives the inflammation. This happens for the proximity of the area from the surgery to the nerves of sensibility of this region.
9. In some cases there will be suture points that will be retired 5 to 7 days after the surgery.
10. To avoid blows in the face don't carry small children or pets after the surgery.
11. To facilitate the resolution of the inflammation; don't be exposed in the sun directly during the first month.
12. Don't do exercises or sports at least during three weeks after the surgery13. En términos generales podrá regresar a su actividad en un lapso de 8 a 15días, siempre y cuando no este expuesto a esfuerzos físico severos o alto riesgo de traumas o golpes en la cara.
13. You will present inflammation in the jaw and chin that it will improve in 90% in a lapse of six weeks. However the definitive appearance will be only established after 6 months of the procedure.
14. You could feel a little depressed after the surgery as a consequence of the anesthesia and the medications, besides not perceiving the changes immediately. It is recommended to get ready emotionally for a gradual adaptation to the changes, to maintain realistic expectations and to offer to the body the enough time for their complete recovery.
15. The previous ones are general indications; don't doubt to call us if you need some explanation. Remember that the success of the surgery depends in large part of the post surgery cares.
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