Orthognathic Surgery

What is orthognathic surgery?
What are the age limits?
Where is surgery performed?
Is orthognathic surgery covered by insurance?
What are the treatment options for the lower jaw?
What are the treatment options for the upper jaw?
Patient recovery

What is orthognathic surgery?
Orthognathic surgery is surgery to correct jaw size discrepancies and malocclusion related to skeletal deformities. Patients often present with malocclusion and facial imbalances. Patients should be seen by an orthodontist and an oral surgeon prior to initiating any treatment. Initial orthodontic treatment is geared to leveling and aligning the teeth in their respective arch and to de-compensate their position. Orthognathic surgery then follows to correct the jaw size discrepancies and establish proper skeletal and dental relationships. This may involve surgeries on the upper jaw, lower jaw, or both. Following six weeks of healing, orthodontic treatment is started again to correct any remaining occlusal discrepancies. A chin surgery may also be done to improve facial balance and symmetry.

What are the age limits?
Orthognathic surgery is performed following completion of the growth phase. This occurs earlier in females, generally between ages 15 and 17 and slightly later in males, between ages 18 and 21. Corrective jaw surgery may also be safely performed in adults as late as their 50s or 60s, if indicated.

Where is surgery performed?
Orthognathic surgery is performed at a hospital under general anesthesia as an out-patient or with a one- to two-day stay. Dr. Kazemi performs all of his orthognathic surgeries at the Washington Hospital Center. The procedure generally takes about 2 to 2.5 hours for the lower jaw and another 2 to 2.5 hours for the upper jaw.

Is orthognathic surgery covered by insurance?
Orthognathic surgery may be considered under medical insurance, provided it is proven medically necessary. As each insurance plan is different with specific benefits and exclusions, it is best to submit a pre-authorization before initiating any treatment. Pre-authorization may require a letter indicating the planned treatment, photos, models, and X-rays for possible review. If coverage is declined, patients can proceed with surgery as self-pay or obtain a health loan through a third party financing company. We can assist patients with this process. We also help patients contract with the hospital for a pre-determined hospitalization fee, paid by patients on the day of surgery directly to the hospital.

What are the treatment options for the lower jaw?
Lower jaw surgery may be done to advance, set back, or correct an open bite, or correct asymmetry. The procedure most commonly used is called bilateral sagittal split ramus osteotomy (BSSRO). The procedure involves precision osteotomy of the mandible at the ramus region through an oral incision, repositioning, and fixation using micro-screws. This technique is used to correct many types of lower jaw deformities.

What are the treatment options for the upper jaw?
Upper jaw surgery may be done to advance, set back, shorten, elongate, or correct an open bite, or correct asymmetry. The procedure most commonly used is known as Lefort I osteotomy. This involves precision osteotomy of the maxilla above the root apices extending posteriorly through the maxillary sinuses. The maxilla is repositioned according to a treatment plan and rigidly fixated using micro-plates and screws. Lefort I osteotomy may be done as a one-piece (the entire maxilla intact) or a two-piece (maxilla is sectioned in the midline) procedure which allows correction of transverse discrepancies at the same time. In rare instances, a three-piece Lefort I osteotomy is done to allow independent repositioning of the pre-maxilla from the posterior segments. The one-piece Lefort I osteotomy is certainly the most predictable and best surgical approach whenever possible.

Patient 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.) for up to six weeks, 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.