Orthognathic (Jaw) Surgery
Orthognathic surgery refers to “straightening of the jaw(s) using surgery” [ortho – straight, gnathic – jaw(s)]. Whereas orthodontic treatment corrects the position of the teeth, orthognathic surgery positions the bones of the jaws (maxilla/mandible). One or both jaws may be surgically repositioned during the one operation. This involves making cuts (osteotomies) in the bones and moving the cut segments into their predetermined position under a general anaesthetic. The surgery is normally preceded by a period of orthodontic treatment so that post-operatively both the teeth and the bones will be in their correct position. Finally, a short period of orthodontic treatment is then usually required to complete the alignment of the teeth.
All surgery carries potential risks. With orthognathic surgery, the major risks include bleeding; poor blood supply to the osteotomised jaw segments; infection; unfavourable bone cuts/splits; permanent numbness/tingling to lips, cheeks, and/or teeth; incorrect positioning of the jaws/segments; jaw joint problems; and damage to teeth. Your Surgeon will discuss these with you in more detail during your consultation appointments in the Rooms. Please remember however, that in the vast majority of cases, any associated problems are minor and easily attended to.
A positive approach is extremely important both before and after jaw surgery. Various studies support the fact that positive thinking can assist the body during the process of healing. The support of your family in the days and weeks following your surgery will also aid your recovery.
A pre-anaesthetic consultation and examination, coupled with investigations such as blood tests, may be required before surgery. Your admission to Quay Park Surgical Centre or Ormiston Hospital is normally on the day of surgery. The necessary anaesthetic and hospital forms need to be completed and returned before this.
If you wish to talk with the anaesthetist before your admission, this can easily be arranged. The anaesthetist may also wish to meet with you beforehand if there are any issues arising from your anaesthetic questionnaire or your pre-operative investigations.
You must not have anything to eat or drink for 6 hours prior to your surgery. If you are a smoker, you are advised to stop two weeks before your operation. On the day of surgery, you should take all your usual medication (unless otherwise instructed) with a small sip of water.
NOTE: If you are diabetic and/or are taking blood-thinning medicines (e.g. Aspirin) you will need to discuss this with your surgeon or anaesthetist. Normally, Aspirin should be stopped 10 days prior to your operation. All herbal remedies, including St. Johns Wort, Arnica and Garlic, should be discontinued 1 week beforehand.
In the vast majority of cases, the jaw bones will be held in their new position by small metal plates and screws. The “hardware” is not normally removed unless it becomes problematic. At the end of the operation, orthodontic elastics may be placed temporarily to guide the jaws together and in doing so, optimise the way that the top and bottom teeth fit together. Rarely, your jaws may need to be wired together.
Pain - Some pain can be anticipated, but in most cases it is mild to moderate and satisfactorily controlled with analgesic medications. As a comparison, the pain is usually not as bad as that experienced after the removal of wisdom teeth. You should also expect to have a sore throat following your surgery. The soreness is caused by the irritation of the anaesthetic breathing tube and also the presence of a throat pack used during the procedure. The soreness of the throat rarely lasts longer then several days.
Swelling - Swelling is a normal after-effect of surgery, the degree of which varies between individuals. More swelling usually occurs with lower jaw surgery than with surgery involving the upper jaw, and usually peaks the day after the operation. Your appearance will begin to improve as the swelling resolves. Since almost all the surgery is performed from inside your mouth, your lips will be stretched and slightly abraded, especially at the corners. Swelling of the lips can be minimised by applying a medicated cream which will be prescribed in some cases. The use of Vaseline on your lips is also encouraged. Be careful to apply this to the red part of the lips only in order to prevent a rash developing on the adjacent skin.
Bleeding - It is common to experience some minor bleeding following surgery, and minor nose bleeds may be expected for a period of one to two weeks following upper jaw surgery. Bleeding into the soft tissues will produce bruising and this can be quite extensive. In the early stages bruising will be over the jaws but it may spread down the neck and even to the upper chest.
NB: It is unusual for blood loss at the time of surgery to be severe enough to require transfusion, but very occasionally transfusions may be required. Patients may elect to donate some of their own blood beforehand on the off chance that a transfusion is required. Special arrangements must be made several months in advance if this choice is made.
Infection - Infection is possible after any type of surgery. You will be given antibiotics both during, as well as after the operation to help prevent this. If an infection should develop it is usually very easily treated.
Tingling/Numbness - You will experience altered sensation or numbness, particularly in the lower lip/chin in association with lower jaw surgery; and in the upper teeth following an upper jaw procedure. While the nerve fibres are healing, you may encounter strange sensations or tingling. Normal sensation usually returns in six months or less. On rare occasions, the altered sensation may be permanent.
Mobilising & Breathing Exercises - You will be encouraged to get out of bed, sit up and walk around as soon as possible following the surgery. You will also be asked to take frequent deep breaths to help your lungs recover from the anaesthetic. The earlier you are up and about, the more normal you will feel. This will also help to reduce the risk of other complications developing.
Clear Fluids - As soon as possible after surgery, you will be encouraged to drink clear fluids. You will usually be able to drink directly from cup or glass and the use of a straw is rarely necessary. Sometimes the use of a special “feeding cup” may be recommended. It is important that you drink adequately so the intravenous fluids may be discontinued. An average adult requires approximately 2.5 to 3 litres of fluid a day. Whilst this may seem like a large volume, it can be achieved easily by frequent sipping.
Tooth Cleaning - You will be encouraged to brush your teeth four to six times per day, especially after eating, paying particular attention to keeping the brush in direct contact with the teeth. Usually a small (children’s size) soft toothbrush is sufficient. In addition to brushing, a mouth rinse should be used. A Chlorhexidine mouthwash (e.g. Savacol) is the most effective antibacterial mouthwash and should be brushed onto the teeth and orthodontic appliances.
Speech - The ease with which you can communicate and be understood is variable; however your speech will improve with practice. It is important that you try to speak more slowly, concentrate on each word and be willing to persevere. The muscle movements associated with normal swallowing and speech function also help to disperse accumulated fluid within the tissues and thus reduce the post-operative swelling.
Nasal Congestion - Nasal congestion may occur both from the tube(s) placed in the nostrils during surgery and also from surgical procedures involving the upper jaw. When this occurs, the congestion can be managed by using nasal sprays and cleansing the nostrils. Cotton buds soaked in warm water may be used to remove nasal secretions. If a nasal spray is required, it should be sprayed with sufficient force for you to taste the medication. Relief should occur in 3-5 minutes. The nasal congestion will usually resolve 1 to 2 weeks after surgery.
Weight Loss - Weight loss of 2-5kgs may be anticipated during the early post-operative period. In most cases, this is due to a loss of appetite coupled with the wearing of elastics. After the first week, your appetite should have improved enough to maintain and possibly increase your weight.
Jaw Stiffness & Jaw Joint Noises - After orthognathic surgery, the jaw joint will be stiff for several months. The best exercise to overcome the stiffness is normal jaw activity such as chewing. Sometimes clicking or grating noises in the jaw joint may occur as the jaw begins to function. These noises may be permanent but do not usually affect jaw function.
Post-Surgical Movement (Relapse) - When teeth and jaws are moved by orthodontics and surgery, the goal is to place them in a more favourable position. Many forces have been responsible for the growth and consequent positioning of the jaws and teeth. The muscular forces that caused the original growth problem and the jaw relationship are still present. 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 almost always occurs.
In the first 24 hours after your operation, only members of your immediate family will be able to visit you, but after the first day other visitors will be allowed, provided they understand that extended visits by large groups of people will be tiring for you. You should warn your family or other visitors about the temporary swelling and bruising you are likely to have so they will not be unduly worried about you.
Most patients are ready for discharge from hospital 2-3 days after their surgery. For the first few days after arriving home, it is essential you have somebody with you to help you with your diet and your general needs. All patients who have had corrective jaw surgery involving their top jaw are asked to remain in Auckland for a minimum of 5 days afterwards.
Analgesics (pain relief medication), an antibiotic, and a mouthwash will usually be prescribed. Some patients will also be prescribed a nasal spray as discussed.
The medication which you receive to minimise your swelling will also lift your spirits immediately after surgery. However, three or four days after the operation, you will experience an emotional letdown. This period of “blues” or depression will last for two or three days. Your family should be made aware of this so that they can help you through this.
You will be provided with detailed dietary information, but feel free to improvise as much as you like. As your food will initially be in liquid form, there is a reduced amount of fibre. This may result in several days of constipation following the surgery. Fruit juices (especially, prune juice) are effective laxatives. Should these measures fail, mild liquid laxatives are available at pharmacies without prescription.
A review appointment will be made, usually 1 week after the surgery. This is normally followed by appointments at approximately 1 month, 3 months and 1 year post-operatively, at which time further facial x-rays are taken. You will also continue to see your orthodontist afterwards and they will usually take more study models and photographs after 3 months.
After the surgery you are encouraged to keep yourself occupied, both physically and mentally. It will help if you set yourself some goals such as reading a book or two. As your strength returns, you should gradually increase your level of activity. After a short period of time you will be able to resume your normal activities. Swimming or other active sports which are likely to make you short of breath should be avoided.
NOTE: It will be helpful if you can bring this information with you to the hospital so that you can read it again in the days immediately following your surgery. Please contact us if you have any questions or are unsure about any of the information provided.