Orthognathic

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also known as
Upper and/or Lower Jaw Surgery

Common Description

Orthognathic surgery, strictly speaking means, surgery for re-positioning the jaw.

It involves reconstruction or repositioning of the upper and/or lower jaw and is often done in conjuction with other soft tissue procecdures like: rhinoplasty, cheek augmentation and genioplasty (moving the chin).

These procedures are sought by those who feel unhappy with the shape and size of their face and/or smile, when the jaws are malpositioned so that teeth do not meet, when the face is assymetrical, when the face is long or as part of treating facial syndromes or after facial fracture/trauma.

Medical Description

Le Fort I, II, III osteotomies of the mid-face.

Mandibular osteotomies (sagittal split, subsigmoid +/- genioplasty)



Characteristics

  • Maxillary Hypoplasia - when the upper jaw is small or recessive
  • Maxillary Hyperplasia - when the upper jaw is protrusive (over bite) or long (Gummy Smile)
  • Mandibular Hypoplasia - when the lower jaw is small or recessive
  • Mandibular Hyperplasia - when the lower jaw is too big
  • Microgenia - when the chin is recessive or undergrown
  • Facial Assymetry - when one side of the face has grown more/less than the other or because of trauma
  • Long Face Syndrome - when there is an overall increase in facial height (gummy smile)
  • Facial Syndromes - Cleft Lip and/or Palate, Hemifacial microsomia ,Crouzon Syndrome,
  • Sleep Apnoea - when there are breathing difficulties due to recessed jaws

Our Recommendation

It is most commonly performed when growth is complete, from mid to late teenage. It can of course be done during adulthood.

Preparation for Orthognathic Surgery will include short or long term orthodontic management.

Secondary soft tissue surgery done in conjunction with Orthognathic surgery is done at least 12 weeks after the initial surgery.

Every patient is unique and every patient requires a unique plan to achieve their desired outcome.

The best way to acheve the outcome you desire is be completely open and honest in your consultation with Professor David about your expections.

You should always think very carefully about your options before proceeding to surgery. Undergoing surgery is YOUR CHOICE, make sure you are comfortable with the explanations you have received, that you understand what you have been told and that you have a full appreciation of what to expect post-operatively.

DDMS Process and Procedure

The techniques used are:
- Advance the upper jaw
- Raise the upper jaw
- Recess or advance the lower jaw
- Move the jaws from side to side
- Alter the angles of the lower jaw

Pre-Op Preparation

1. You will need a referral to see Professor David.

2. Professor David will assess you and establish if you are a suitable candidate for the surgery. Should that be the case he will arrange for you to be assessed by the multidisciplinary team, which can include a: dentist, orthodontist, ENT surgeon and a social worker.

3. Once you have seen the multidisciplinary team a "Planning Meeting" will be arranged to discuss the options for surgery and how to acheive the best outcome. It is usual to undertake orthodontic management for a period of time prior to surgery being undertaken in order to ensure that the teeth and jaw are in good position prior to surgery.

4. You will then have a last "Planning Meeting" with Professor David and your orthodontist and a surgery date will be set.

Post-Op Recovery

1. You will be admitted to hospital on the day of your operation.

2. You will meet your anaesthetist and speak with Professor David prior to surgery commencing.

3. The surgery will take 1 - 3 hours depending on what is being treated and the desired outcome .
You will then go to the Intensive Care Unit for 24 hours following surgery. When the jaws are moved you will have a acrylic plate (Wafer) in situ, which covers the teeth of the upper jaw and your upper and lower jaw will be connected by soft elastic bands, so the nursing staff in ICU will keep a close eye on you and your breathing. Don't worry you will still be able to eat!

4. You will then stay in hospital for 2-4 days. After discharge from hospital you will keep the wafer in for a number of days. and you will visit Professor David in his rooms for a number of post-operative appointments. You will need to stay on a soft diet for 3 weeks following the surgery.

FAQs

Q:  Will I look different?
A:   Yes. The degree varies on the outcome desired and Professor David will discuss this with you.

Q:  How long before I can resume normal activities?
A:   2 - 3 weeks.

Q:  Does "soft food" mean liquified?
A:   No! Just avoid hard fruit and vegetables (like apples), chewy meat and bones, lollies and crusty bread.

Q:  Will I be able to talk with my jaws joined by elastic bands?
A:   Yes. Your speech may be slurred temporarily due to swelling and the Wafer.

Q:  Will it hurt?
A:   Most people describe it as uncomfortable, but not painful. Mild pain relief can be taken with good results.

Q:  Will I be swollen and/or bruised?
A:   The majority of swelling is gone after 2 weeks and bruising is minimal.

Q:  When will I know what the outcome looks like?
A:   The change/s will be immediately obvious, but swelling may not reside completely for 3 months.

Q:  Will there be any nerve damage?
A:   Most people have some numbness which (in 90% of cases) will resolve completely over time.

Advice for Carer's

Any surgery can be uncomfortable and we encourage carers to be supportive of patients in the post-operative period. Most importantly, the end result will not be evident until at least 3 months have passed, so making judgements on the outcome should really be reserved until then.

Summary

Locations
Adelaide
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Jakarta
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Surabaya
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Denpasar - Yayasan Senyum
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Govt Funded Medicare and Private Health rebate


Contact Information

David David Medical Services
226 Melbourne Street
North Adelaide
South Australia, 5006
T (61) 8 8267 1466
F (61) 8 8267 3403
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