Jaw Surgery(Orthognathic Surgery)

Since orthodontic treatment is a time-consuming process and the goals to be reached must be determined at the start of treatment, it is in the patient's interest that the team consist of people who work in harmony with one another. During orthodontic treatment, brackets (hooks) are bonded to the patient's teeth, and wires and elastics (rubber rings) are applied to arrange the alignment, angles and spacing of the teeth. After the teeth are brought to the desired position, detailed measurements determine in which direction and how far the lower and upper jaws will be moved, and the bite plates (splints) needed to achieve these movements during surgery are prepared.

The operation must always be performed under general anaesthesia given by an anaesthesia team with which the plastic surgeon is accustomed to working. Close monitoring of these patients' vital signs and airway during and after the operation is essential. Since the dental relationships of these patients will be adjusted during the operation, it is not possible to intubate them through the mouth (insert a tube). For this reason, they need to be ventilated with a tube running from the nose to the windpipe (nasal intubation). Especially in operations where the lower and upper jaws are to be related to each other, jaw fixation is performed at the end of the operation and the lower and upper jaws are fixed to each other with elastics (intermaxillary fixation). In this case, securing the patient's airway is the responsibility of an experienced anaesthesia team.

Orthognathic surgery operations are generally performed through incisions made in the oral mucosa (incisions not visible from the outside). The procedure of cutting the bones is called osteotomy. The osteotomy performed for the upper jaw is called a Le Fort I osteotomy, and the osteotomy performed on the lower jaw is called a bilateral sagittal split osteotomy (BSSO). The operation performed to adjust the position of the chin tip is called genioplasty. These three procedures make up a very large proportion of the operations performed in orthognathic surgery. However, there are also rare procedures, generally applied in patients with advanced deformities due to congenital anomalies. These are the Le Fort II osteotomy, in which the midface (the area around the nose) is shaped together with the upper teeth; the Le Fort III osteotomy, in which the whole face is separated from the skull and shaped; and the Monobloc osteotomy, in which the face is shaped including the forehead. In addition, in situations where there is not enough bone or the bones must be separated from each other a great deal, there are also procedures in which the bones are cut and advanced slowly day by day (distraction osteogenesis) to reduce the risk of non-union. These procedures are possible only with the use of devices called distractors, which allow controlled advancement of the bones.

After the procedure, until the incisions inside the mouth have healed and/or until the lower-upper jaw fixation is released, patients need to be fed first with liquids only and then with a blended soft diet. While healing is completed within weeks in simple interventions, as the procedure becomes more complicated a convalescence (recovery) period requiring months may be needed.

Generally, in patients who have had bone fixation, pain is not the main complaint; oedema (swelling) and bruising in the mouth and/or facial region are the more important problems. In general, these problems also resolve by themselves within a few weeks without the need for treatment. Especially after BSSO and genioplasty procedures performed on the lower jaw, there may be loss of sensation affecting the lower lips. Although in a very large proportion of patients this complaint also resolves by itself within 3-6 months after surgery, before being taken to surgery patients should be informed that, if loss of sensation in the lower lips occurs, there is also a risk that it may last for life.

After the lower-upper jaw fixation has lasted about 2-6 weeks, patients' orthodontic follow-up may need to continue for about another 3-6 months.