Jaw surgery corrects facial imbalances and allows the jaw bones to fit together correctly. If the jaw is not lined up properly, it may lead to pain when chewing and difficulty speaking or even breathing. Others may just not like their jaw’s appearance, causing self-esteem issues. Jaw surgery, which can bring relief and a better quality of life, may involve the top or bottom jaw, or both.
What Is Jaw Surgery?
The jaw has many parts and functions:
- The upper jaw (maxilla) gives shape to the middle of the face and forms a boundary between the roof of the mouth and the nose area.
- The lower jaw (mandible) is the bone that moves as your mouth opens and closes to speak or eat. It supports your bottom teeth and your tongue. It provides shape to your chin and lower face.
When consulting with a specialist for jaw surgery, you may hear some medical terms. They may include orthognathic, which refers to the causes and treatment of bones of the jaw that are not in proper position (aligned). Osteotomy, another term you may hear, refers to surgery on the jawbones.
There are three types of the osteotomy
- Maxillary (top part of the jaw) osteotomy: The surgeon cuts the bone above the teeth and moves the jaw and the upper teeth forward until they fit appropriately with the lower teeth.
- Mandibular (bottom part of the jaw) osteotomy: The surgeon cuts behind the molars and down the jawbone and moves the jaw either backward or forward to a new position.
- Bimaxillary (both parts of the jaw) osteotomy: The surgeon will perform two procedures to correct more complex facial issues that involve both the upper and lower jaw.
The type of osteotomy you may need depends on many aspects of your jaw area, including how well your teeth meet when you close your mouth, how far forward your jaw protrudes, or whether your jaw is too far back.
- Genioplasty: Sometimes jaw surgery involves orthognathic surgery plus genioplasty, such as if your chin is too far back (receding). This type of surgery moves the chin bone to a better position and may or may not require a chin implant that provides a more balanced, natural appearance.
- Temporomandibular joint surgery: Surgery on the jaw joints range from minimally invasive outpatient surgeries to more complicated open-joint surgeries that require a hospital stay.
- Cleft palate repair: Children, adolescents, and adults may need this type of surgery, depending on the severity of their condition. For some adolescents and adults, specialists recommend correcting the jaw issues before other surgeries that are considered more cosmetic. Correcting a cleft palate can entail multiple operations in the jaw, lips, and nose area.
Who Performs Jaw Surgery?
In most cases, a dental professional called an oral and maxillofacial surgeon will perform your surgery. These dental specialists are trained to diagnose and treat any conditions related to the head, neck, face, and jaws or the tongue, cheeks, gums, and lips (soft tissues of the mouth).
Before jaw surgery, you will probably have seen an orthodontist for a consultation or tried braces to fix the problem. The surgeon will usually work closely with your orthodontist, from the start of planning to the final stage of the surgery.
Before surgery, an orthodontist may try to use braces to move your teeth into a position that will help your teeth fit together more comfortably after your surgery has been completed.
If you undergo this process, be patient. Although it may feel like your teeth are not fitting together properly, the teeth will fit together (into occlusion) more efficiently for eating and comfort after the surgery. For some people, braces also will be needed after the surgery to continue moving the teeth.
Purpose of Jaw Surgery
Jaw surgery may be considered if you experience any of the following:
- Trouble or discomfort closing your lips
- Front and back teeth do not touch properly and can’t be corrected by an orthodontist
- Trouble speaking
- Difficulty swallowing
- Pain when chewing or biting
- Teeth are wearing down too quickly or too much
- Pain in the joint on either side of your jaw (temporomandibular joint)
- Your face appears unbalanced
- Your jaw is restricting your airway, causing a sleep disorder such as obstructive sleep apnea
- A condition called a cleft palate (when a baby is born with an opening or split in the roof of the mouth)
- An accident or trauma to your jaw
Unless it is an emergency, most jaw surgery is delayed until after 14 to 16 years old for females or 17 to 21 years old for males. At that point, the growth of the jaw is usually finished.
Younger children who have a jaw problem that makes it difficult for them to eat or speak may also be evaluated by a pediatric craniomaxillofacial specialist.
As with any surgery, there are risks to jaw surgery, including the following:
- Blood loss
- Nerve injury
- Jaw fracture
- Need for a root canal on certain teeth
- Loss of a portion of the jaw
- Jaw position relapse
How to Prepare
Jaw surgery can take place in a hospital, in an ambulatory surgical center, or an oral and maxillofacial surgeon’s office.
When speaking with your doctor before surgery, be sure to discuss any issue that could affect surgery, such as medicines that you take regularly and any allergies that you have. Ask the surgeon if you should take your regular medicines before surgery.
Stock up on any liquids you may need, such as nutritional drinks and soup as well as foods that are easily pureed. Make sure that you have access to a blender. In addition, arrange for a friend or family member to give you a ride home and stay for a bit after surgery.
What to Expect on the Day of Surgery
The surgery can take from one to several hours to complete and will generally be performed under general anesthesia.
In some cases, however, mandibular osteotomies may be performed with IV sedation and local anesthesia. During the surgery, the surgeon makes incisions inside the mouth to add, remove, or shape the bone depending upon what jaw modifications are needed.
Sometimes small incisions are required outside the mouth, in which case the surgeon will be very careful to minimize any scarring. Inside the mouth, very small screws, wires, special rubber bands, or surgical plates may be used to hold the jawbone together after the procedure.
Any additional bone that is needed can be taken from other places on the body, such as the hip, leg, or rib.
Jaw surgery by an experienced oral and maxillofacial surgeon is usually safe, and infections after surgery are relatively rare. To prevent infection during the operation, you will probably receive intravenous antibiotics. Your surgeon will probably prescribe oral antibiotics for about seven to 10 days following surgery.
Depending upon the surgeon, a mild pain reliever may be prescribed along with a non-steroidal anti-inflammatory medicine such as ibuprofen. For upper jaw surgery, some doctors will also prescribe a nasal decongestant to decrease swelling in the nasal area.
Although the number of return appointments varies depending upon the surgeon, you should be prepared to return to the office for a post-surgery check at one week, four weeks, six weeks, and 12 weeks to catch any possible complications and to ensure that the jaw and bite are stable.
Healing from jaw surgery can take anywhere from six weeks to 12 weeks, depending upon the procedure. After healing, you may need to return to the orthodontist to ensure that your top and bottom teeth fit together properly or to discuss braces that will move the teeth to their final position.
Most patients can expect to return to school or work within 10-14 days after jaw surgery. Facial swelling will probably be considerably reduced by three weeks after surgery. However, complete jaw healing can take between nine and 12 months.
It is important to eat and drink after surgery to continue the healing process. The doctor will probably recommend a liquid diet or a pureed diet for about four to six weeks.
You can puree your food in a blender, food processor, or food mill. If you want easier preparation, you can use already prepared adult nutritional drinks or baby foods and add more flavor by seasoning.
Nutritional supplement drinks will provide additional calories and vitamins. The doctor may ask you to rinse your mouth with water after eating to make sure the surgical area stays clean.
Immediately call your doctor if you have any severe symptoms such as increased swelling two to three days after surgery, difficulty closing your eyes, trouble urinating, or fever. Call 911 if you are experiencing trouble breathing, heavy bleeding, or severe pain, which are medical emergencies.
Relieving pain, improving speech and eating, and increasing self-esteem are just a few of the benefits of jaw surgery. Having a treatment team that includes an orthodontist and an oral surgeon will give you access to experts to help you navigate through your medical decisions. Knowing the risks and how to prepare for surgery will help to reduce stress and improve your recovery.