This type of treatment is not compulsory or life saving for any patient and, whilst there is a very small risk of not waking up after a general anaesthetic, this must be balanced with how much the tooth/jaw position is a concern to the patient and whether an operation can definitely improve jaw position.
Immediately following a general anaesthetic, you may feel tired, dizzy or weak. You must have someone to collect you and stay with you for the first 24 hours.
During the first 24 hours, you must not drive or operate any motorised vehicle or electrical equipment, sign any legal documents, make any important decisions, or drink any alcohol.
You may feel weak or dizzy at times during your first 7 – 10 days. If this happens, sit down until the feeling passes. You may also have the postoperative “blues”, though this should soon pass.
This is usually a very safe procedure, which is carried out regularly in this hospital by specialised and experienced clinical staff.
Complications with this type of surgery are, fortunately, rare and may not apply to you, but it is important that you are aware of them. Your surgeon and orthodontist will discuss your individual risk rates for your treatment.
The most commonly reported complications are:
Numbness
Your lips, chin and gums may all be numb immediately after your operation. The upper lip recovers relatively quickly, while the lower lip is much more variable and may take six to nine months to get normal feeling back.
In 30% of cases, there may be some permanent loss or alteration of sensation, but the lips look and move normally, and surveys suggest that this rarely bothers patients.
Infection
The small titanium plates and/or screws are usually left in place permanently. In less than 10% of cases, the plates may have to be removed if they should become infected. If this is the case, the plates can be removed during a short day case procedure.
Readjustment of the bite
Occasionally, patients may wake up from their relaxed state (caused by the anaesthetic) and the strong jaw muscles then alter the position of the jaw. Although the bite may be only a few millimetres out of place, a second operation to adjust the bite fixation may be necessary.
Surgical Relapse
With most patients, significant relapse is not a problem. However, in those who are having complicated surgery (movement of 10 mm or more in one jaw, patients previously having had a cleft palate, or those with a particularly unusual bite), relapse can occur, where the muscles, skin, tongue and lips of the face pull the face and teeth towards their original position. If relapse does occur, it is exceptionally rare for this to be significant. However, there is also orthodontic relapse and long-term, age changes which the orthodontist will discuss with you.
Blood loss
Blood loss is usually minimal and a blood transfusion is rarely needed; less than 1% of our patients have needed a blood transfusion.
Limitations of mouth opening
There may be limitations of mouth opening, but this resolves as healing progresses. Symptoms of jaw pain and dysfunction can be made worse by jaw surgery.
Changes to the shape of the nose
An operation on the top jaw may alter the shape of your nose.
The main problems after surgery are numbness and swelling and often some bruising, rather than pain.
Everyone is different, but most patients find the swelling is at its worst at 36 – 72 hours after the surgery, and then gradually goes down over the next fortnight.
To help to reduce the swelling you will be given a Hilotherapy mask that fits closely over your face. The mask is connected to a Hilotherapy machine that pumps cold water around the mask, reducing pain, swelling and bruising.
Your final appearance will initially be masked by the swelling and may take several months to emerge as the shape of your face adjusts.
Pain and discomfort is worse during the first 24 hours, and will be controlled with regular pain killers. You may find it uncomfortable breathing through your nose, especially if you have upper jaw surgery and you may have a sore throat following your anaesthetic.
You may also feel uncomfortable and “sorry for yourself” for the first few days, but this normally settles over time. In our experience, older patients seem to find these symptoms worse and take longer to get over their operation than younger patients.
When you are ready for your operation, you will again be seen on a joint orthognathic surgery clinic for your team to discuss with you once more your expectations and proposed surgical movements.
Planning continues with the production of surgical plastic wafers that fit over and between the teeth guiding your surgeon at the time of surgery.
To make these wafers you will need some further moulds of your teeth, facial measurements and, in some cases, a 3D Cone Beam Computed Tomography (CBCT) scan is required.
A CBCT scan is a low-dose x-ray examination, which produces a very precise 3D image of your teeth and bony facial structures.
In total, the treatment usually takes about two and a half to three years, with the surgery occurring between 18 months and two and a half years after the start of orthodontics.
Please note that missed appointments and any breakage of the braces lengthen the period of orthodontic treatment.
If your jaws are to be moved into an improved position, it is important that your teeth are also moved so that they will meet better after the operation.
Fixed “train track” type braces are fitted about 18 months before surgery (but it may take longer). They are worn for up to six months after surgery, until the teeth are finely adjusted and stabilised.
Lastly, there will be a period where a removable retainer brace is worn at night that holds the teeth in their new position.
We only perform jaw surgery if it is appropriate, if the patient wants it to be done and the patient is keen to undergo treatment.
It is not always possible to change your teeth and bite using only braces (orthodontics). This is because the bones of your face and jaws, in which the teeth sit, may be out of balance with one another.
Orthognathic surgery is able to improve large gaps between the jaws and balance the shape of your face.
Your treatment is carried out within Sheffield Teaching Hospitals, and is led by a team made up of consultants: a maxillofacial surgeon and an orthodontist
Our consultant orthodontists are qualified orthodontists who have undergone specialist hospital training to enable them to treat your complex problems.
Our consultant maxillofacial surgeons have undergone a full surgical training coupled with dental expertise.
All surgeons are on the General Medical Council Specialist List for Oral and Maxillofacial Surgery.
Sometimes other health professionals may need to be involved in your care. This might include dietitians, speech and language therapists, clinical psychologists and psychiatrists.
During this surgery the upper and lower jaws are cut precisely, to avoid damaging important structures like the teeth and the nerves which give feeling to the upper and lower lips, gums and roof of the mouth. The upper and lower jaws are then repositioned to correct the bite of the teeth.
Animation showing the proposed plan of a typical double jaw surgery procedure.
The jaw bones are then fixed using plates and/or screws, which allow the bone to knit together and to heal in the correct position. These are very small titanium plates and screws, which normally stay in place indefinitely.
Braces are then used to settle the bite over a period of at least six months.
Surgery aims to produce a well balanced facial appearance and a good functioning bite.
Lower jaw surgery (Mandibular osteotomy)
During this surgery the lower jaw is cut precisely, to avoid damaging important structures like the teeth and the nerves which give feeling to the lower lip. The lower jaw can then be repositioned to correct the bite of the teeth, and to improve the position of the chin.
The jaw bone is fixed by plates and/or screws, which allow the bone to knit together and heal in the correct position. These are very small titanium plates and screws, which normally stay in place indefinitely.
Braces are then used to settle the bite over a period of at least six months.
The aim is to produce a well balanced facial appearance and a good, functioning bite.
Upper jaw surgery (Maxillary osteotomy)
During this surgery the upper jaw is cut precisely, dividing the top jaw and repositioning it in a new position, correcting the bite of the teeth.
The jaw bone is fixed by plates and/or screws, which allow the bone to knit together and heal in the correct position. These are very small titanium plates and screws, which normally stay in place indefinitely.
Braces are then used to settle the bite over a period of at least six months.
The aim of the operation is to produce a well balanced facial appearance and a good, functioning bite.
Chin surgery (Genioplasty)
During this surgery the chin is divided and repositioned in its new position.
The chin bone is fixed by small titanium plates, which allow the bone to knit together and heal in the correct position. These plates normally stay in place indefinitely.
The aim of this surgery is to produce a well balanced facial appearance.
Upper jaw widening surgery (SARPE)
During this surgery the roof of your mouth is surgically divided.
After a period of 3 – 5 days’ healing, you will be instructed to turn the screw in your upper brace appliance to gently widen the top jaw in very small amounts. You will carry on turning the screw, twice every day, for a number of days, until the desired widening is achieved.
This will produce a large gap between your upper central incisors, which will gradually start to close as your teeth drift towards each other over the next few months. New bone forms in the gap, and fixed braces are then used to straighten your teeth and further close the gap.
