Orthognathic Surgery

Jaws and faces develop together as determined by inherited tendencies and functional or environmental influences.Occasionally problems occur with development resulting in misalignment of teeth, jaws, or both.The resulting malocclusion{bite problems}can frequently be managed by orthodontic treatment to properly align the teeth.Orthodontists are limited by the width and length of the alveolar bone{bone which holds the teeth}.If the distance between the upper and lower teeth is too large to allow orthodontics to align the teeth properly,the problem involves a misalignment of the jaws.Treatment by orthodontic therapy alone in such cases can only treat part of the problem.Corrective jaw surgery in conjunction with orthodontic treatment will allow for the total correction of the problem.Such treatment is like going to a baseball game.Corrective jaw surgery gets you in the ballpark and orthodontics takes you to your seat.

Orthognathiccomes from the Greek meaning “straight jaw” or make the jaws straight.It is not a new concept.The first published case of orthognathic surgery was in 1849, just 3 years after the discovery of anesthesia by a dentist Horace Wells. Simon Hullihen described a procedure still used today to repair a jaw deformity in a lady who, as a child, had accidentally ingested lye causing extensive burns and deformity of the mouth.The procedures we use today to repair jaw deformities have been used for many years and are tools that we adapt to each individual person’s needs.There is no “cookie cutter” approach to surgery.The operation is used to fit the patient’s needs, not the opposite.The goal of treatment is to establish optimal form and function of the teeth, at the same time maximizing esthetics.When you place the jaws and teeth where they are suppose to be, everything looks its best.

Jaw growth problems can result from excessive growth or insufficient growth in any dimension. Often growth problems involve bones attached to the jaws or portions thereof. Injuries to developing jaws, birth defects, hereditary influence and environmental/functional factors can all result in malalignment of the jaws and resulting malocclusion. The underlying skeletal deformities may have an associated esthetic imbalance. Simply put, if the jaws aren’t right, it doesn’t look right either. Surgical planning has the goal of returning the bones and teeth to their ideal position. Planning involves as the first objective maximum benefit to the bite and the way the teeth will function together. Attention to esthetics {the way things appear} is also considered because it is possible to fix the jaws and teeth and make people look worse. We try to maximize esthetics in the process of correcting the functional jaw problems.


Treatment planning consists of collaborative efforts on the part of the surgeon, the orthodontist, and the patient’s general dentist. A problem list is generated for all the data and the patient’s list of concerns. We utilize photographs, x-rays, study models of the teeth, and sometimes computer planning to develop a plan which best solves all the problems on the list. The initial consultation is informational only, talking about general concepts, risks and treatment alternatives. An initial examination helps us guide the patient and parents to determine if they wish to proceed with treatment. The second appointment is for obtaining records. After the second appointment, a treatment plan is made, consultation is obtained with the orthodontist and dentist. The third appointment is made to present the results of the treatment plan, discuss the risks and benefits of the proposed surgery and determine if there is still interest to proceed.

If everyone is in agreement to go forward with the surgery, a letter is written to the insurance company to pre-authorize and determine whether it will be paid for by insurance. Because orthognathic surgery almost always requires hospitalization with considerable associated expense, it is best to know whether that cost will be covered before ever beginning treatment. On occasion, despite not having insurance coverage, patients decide to go forward with surgery. Orthodontic preparation requires a number of months before surgery allowing time to financially prepare for these costs. Hospitals, anesthesia and doctors will negotiate prices for services not covered by insurance.

Initial treatment most often involves orthodontic alignment of teeth to allow the teeth to properly fit together in the new bite. Because combined orthodontic/surgery treatment involves positioning teeth ideally in their respective jaws, often orthodontics before surgery may necessarily result in the patient’s malocclusion initially becoming worse. After progress models of the teeth determine that the teeth are in optimum alignment, plans are made for the surgery. Following surgery, the patient may remain in the hospital for several days. Some swelling and discomfort can be expected but it is controlled with medication and improves quickly over time.

The results of orthognathic surgery are some of the most gratifying of all the surgeries we perform. Patients are quickly transformed by the surgery, often changing in appearance and personality. Though the completion of treatment may continue for a number of months to complete orthodontic finishing, patients can immediately see the improvement and anticipate the day when the braces are removed and treatment completed.

If you have been told you need and are considering having orthognathic surgery, our staff would be glad to set up a time for an initial evaluation.