Jaw Surgery

What are common Jaw problems?
Why is it important to correct your bite?
What procedures are possible?
Is jaw surgery safe?
What are the possible complications?
What are the treatment stages?
What other adjunctive procedures may be recommended?
How long is the typical recovery?
Insurance, Fees and Payment Options

What are common Jaw problems?
If your bite is off, have poor smile, and have poor facial balance, you may have problems with either your teeth position, jaw size relationship, or combination of both. Here are the common signs:
Long face look with a gummy smile, large lower jaw, and possible open bite
Short face look with deep overbite
A gummy smile look
Short chin look with underbite
Sunken upper teeth look
A combination of the above
These problems arise from a poor bite where teeth do not fit well together and there was an excessive or inadequate development of the upper and lower jaws.

Why is it important to correct your bite?
Having a normal bite and correct jaw relationship improves chewing, speech, and aesthetics, and protects teeth from decay, gum disease, and chipping. Patients with facial pain or TMJ symptoms also report improvements following orthodontic and surgical correction of their bite. Corrective jaw surgery may also improve breathing problems and sleep apnea in certain patients.

What procedures are possible?
Patients with jaw size discrepancy may require one of the following procedures:


  • Upper jaw surgery (known as Lefort-I osteotomy): This procedure corrects excess or deficiency of the mid-face region.

  • Lower jaw surgery: Procedure that allows either advancement of retraction of the lower jaw to its proper relationship to the upper jaw

  • Chin surgery: A cosmetic procedure that either augments or retracts the chin for better facial balance




Is jaw surgery safe?
Corrective jaw surgery is safe and predictable when performed by a skilled and experienced oral surgeon. Specialized instruments and techniques are used for jaw surgery. Dr. Kazemi specializes in this procedure and has performed it successfully on hundreds of patients. Procedure is performed in the hospital under general anesthesia with a team of experienced anesthesiologists and nurses. Methodical, exacting, and detailed protocols are followed strictly to make sure every patient has a safe, comfortable, and successful procedure.

What are the possible complications?


  • Infection: This is very rare. Any infection can be successfully treated with antibiotics.

  • Prolonged numbness over lips and chin

  • Relapse




What are the treatment stages?
There are three phases of treatment to correct a poor bite and relationship of the jaws:


  1. Pre-surgical orthodontic treatment: An orthodontist levels and aligns teeth. Takes about nine months to one-and-a half years to complete

  2. Surgical treatment: An oral surgeon manipulates the upper jaw, lower jaw, or both, to achieve the proper relationship of teeth and jaw bones. Surgical correction of each jaw takes about two hours to complete.

  3. Post-surgical orthodontics: Six weeks after surgery, the orthodontist will complete the orthodontic treatment and do final bite adjustments. This phase typically takes three to six months. Once braces are removed, a retainer appliance maybe recommended to maintain position of the teeth and prevent relapse.


 
Initial evaluation
During our first meeting, we will discuss your desires and expectations and the feasibility of surgical treatment. A brief overview of our general treatment approach will be presented at this time. A thorough medical and dental history and examination will be completed, and special X-rays and diagnostic studies may be performed.

Records
Treatment planning for orthognathic surgery is done after careful study of several types of diagnostic records. We can use existing records obtained by your orthodontist or take new records at our office


  • Dental impressions for study models of your teeth

  • Photographs

  • X-Rays


 
During this visit we will discuss your diagnosis and explain the treatment alternatives to you. Ample time is spent answering any questions your may have, and reviewing the sequence of treatment. A predetermination letter will be sent to your insurance company and the fees will be reviewed with you. It’s best to bring your spouse, parent or close friend for this important evaluation.
Pre-surgical orthodontics
Your orthodontist will discuss in detail the orthodontic aspects of treatment. Prior to surgery, the orthodontist will level and align the upper and lower dental arches independently. This can sometimes worsen your bite until the surgery is performed. During this treatment period, it may be necessary to have minor procedures performed, such as removal of wisdom and/or other teeth.

Final pre-surgical records
Within two weeks of your surgical date, final records will be taken. They will be used to finalize the treatment plan, to perform model surgery and fabricate the surgical splints used during surgery. This helps make the surgery accurate and predictable. The treatment plan is thoroughly discussed, consent forms are reviewed, and additional photographs are obtained. Pre-surgical testing and a physical are completed as part of your hospitalization work-up.

Surgery
You will arrive at the hospital at your scheduled time in preparation for your procedure. You will be seen by an anesthesiologist and nurses who will care for you during your operation. Following surgery, you will be taken to the recovery room and then to your room. Most patients go home the next day.

Post-surgical orthodontics
This begins about six weeks after surgery. During this time, your orthodontist will begin fine-tuning your bite and finalizing position of your teeth. This phase may take three to six months. At that time, you will be given a retainer to maintain position of your teeth and prevent relapse.

Post-treatment dentistry
Any required dentistry such as crowns, bridges, or any other restorative work that was delayed until your braces were removed, can now be completed. Your family dentist will be kept informed throughout treatment. The timing of required post-treatment dentistry will be coordinated in cooperation with your orthodontist.

Post-treatment records
Once all treatment is completed, a final set of records will be taken. These records serve as a baseline for stability studies. At this point, you will enter into a period of long-term follow-up care to ensure the long-term stability of your treatment.


What other adjunctive procedures may be recommended?
Adjunctive procedures are frequently performed as part of the overall treatment plan.

Wisdom teeth removal
In preparation for jaw surgery, it is best to remove the wisdom teeth nine to 12 months prior to the operation. This allows proper bone healing in the area where the jaw surgery is performed. However, if time is not available, then it is acceptable to have jaw surgery and wisdom teeth removal at the same time.

Chin augmentation-reduction
The chin may be augmented or reduced to improve facial profile, symmetry, and aesthetics. It is often performed at the same time as the corrective jaw surgery. There are two techniques for augmentation:
Advancing the chin bone: This technique involves sectioning the chin bone and sliding it forward to augment. This is done through the mouth and no outside incision is necessary.

Chin implant:This involves use of preformed and anatomical implants that are available in various shapes and sizes. The implant is placed on top of the chin and fixated. They create a very natural feel and appearance. A small skin incision under the chin is required for this technique.

Cheek-bone augmentation
Patients with a flat cheek bone appearance may augment it using cheek implants. These implants are pre-formed and available in various sizes. They are inserted through a small incision in the mouth. Augmentation can also be performed at the same time as upper jaw surgery.

Liposuction for double chin and neck
The sagging of tissues under the jaw and chin region may be due to aging or to the presence of fat deposits (otherwise known as a double chin). This hanging mound of fat or excess tissue blocks the ideal concavity of the chin-neck profile, and definitely contributes to the appearance of aging.
Liposuction of this region can be performed at the time of corrective jaw surgery. It requires a skin incision in the crease below the chin. There is minimal post-surgical discomfort, and the scar is obscured in a natural skin fold as it matures. A chinstrap-like bandage is usually applied for six days after surgery.

Nasal and septal reconstruction
Cosmetic nose surgery or rhinoplasty affects the overall facial harmony and balance, especially when performed with corrective jaw surgery. It is best to perform the cosmetic rhinoplasty after jaw surgery has been completed to allow the surgeon to achieve a more ideal result and facial balance. We can recommend several very skilled and specialized cosmetic surgeons.


How long is the typical recovery?


  • Most patients return home in one to two days after the procedure.

  • Significant swelling develops in the first 24 to 36 hours and gradually diminishes over seven to 10 days. It usually resolves completely in two weeks.

  • Pain is usually fairly minor and readily managed with Tylenol #3 or Vicodin.

  • Antibiotics are prescribed for 10 days.

  • A liquid diet is recommended for two to four weeks. Patients may then advance to a very soft diet (mashed potatoes, soft pastas, etc.) up to week No. six and then gradually return to a regular diet from the sixth to 10th week.

  • Oral rinses are recommended every one to two hours for the first two weeks.

  • In most patients, the jaws do not require wiring, therefore allowing normal mouth opening which gradually increases after two weeks and returns to normal by the sixth week.

  • Numbness over the upper and lower lips and chin diminishes gradually and returns to a normal sensation usually within six months.




Insurance, Fees and Payment Options
The fees depend on the type of jaw surgery, whether it requires upper, lower, or both, its complexity, and other adjunctive procedures such as a chin procedure or cheek augmentations. Corrective jaw surgery and hospitalization costs maybe considered for benefits under some medical insurances, although many have excluded jaw surgeries or offer very little coverage. If you have insurance and there is possible coverage, then it is best to submit a pre-authorization letter along with necessary records for review.
During your initial evaluation, we can assist you in submitting a pre-treatment letter and obtain your available benefits. Following the procedure, claim forms are submitted for reimbursement. Insurance coverage is never guaranteed and final amount of payment is not determined until a claim has been submitted.
For those with no insurance, we offer short- and long-term payment plans with no interest through CareCredit. We also also arrange a fixed hospital cost for you that will include all aspects of your hospitalization, including operating room, anesthesia, materials, recovery room, and nursing care. This fee is paid directly to the hospital on the morning of your procedure.