Orthognathic (Jaw) Surgery
Jaw Surgery
Orthognathic surgery is a procedure to correct irregularities of the jaw bones and realign the jaws and teeth to improve the function of chewing, speaking, and breathing, and to enhance facial appearance. Here's a breakdown of common procedures:
1. Le Fort I Osteotomy (Upper Jaw Surgery):
What it is: This procedure moves your upper jaw (maxilla).
How it works: Your surgeon makes small cuts inside your mouth to separate the upper jaw from the rest of your skull. This allows them to move the jaw forward, backward, up, or down, depending on your needs. Once the jaw is in the correct position, small plates and screws hold it in place.
Why it's done: To correct an upper jaw that's too far forward or back, too high or low, or crooked.
2. Surgically Assisted Maxillary Expansion (S.A.M.E):
What it is: This procedure widens your upper jaw.
How it works: Similar to a Le Fort 1, your surgeon makes small cuts inside your mouth. In addition, a device called an expander is placed between the two halves of your upper jaw. After surgery, you or a family member will gradually turn a screw on the expander, slowly widening your jaw over several weeks.
Why it's done: To correct a narrow upper jaw, which can cause problems with your bite and breathing.
3. Bilateral Sagittal Split Osteotomy (BSSO) (Lower Jaw Surgery):
What it is: This procedure moves your lower jaw (mandible).
How it works: Your surgeon makes cuts inside your mouth to split the lower jawbone on both sides. This allows them to slide the jaw forward, backward, or rotate it, depending on your needs. Small plates and screws hold the jaw in its new position.
Why it's done: To correct a lower jaw that's too far forward or back, or crooked.
4. Genioplasty (Chin Surgery):
What it is: This procedure reshapes your chin.
How it works: Your surgeon makes a small cut inside your mouth or under your chin. They then reshape the chin bone by moving it forward, backward, up, or down. Plates and screws are used to hold the bone in the new position.
Why it's done: To improve the balance and harmony of your facial features by correcting a chin that's too prominent, too weak, or asymmetrical.
5. Bimaxillary Osteotomy:
What it is: This procedure involves moving both the upper and lower jaws simultaneously.
How it works: It combines a Le Fort I osteotomy and a bilateral sagittal split osteotomy, allowing for complex corrections of jaw position and bite.
Why it's done: This is often performed when both jaws need significant repositioning for optimal function and aesthetics. It is also used to treat moderate to severe obstructive sleep apnoea (OSA). By moving the jaws forward, the airway is enlarged, which can dramatically improve breathing during sleep.
General Information:
These procedures are always performed under general anaesthesia, meaning you'll be asleep during the surgery.
You can expect some swelling, bruising, and discomfort after surgery, which will gradually improve over time.
Your surgeon will provide specific instructions for post-operative care, including diet, oral hygiene, and pain management.
Orthodontic treatment is often required before, and after orthognathic surgery.
It is very important to attend all follow up appointments.
What to expect with Orthognathic Surgery
Orthognathic surgery is a procedure to correct irregularities of the jaw bones and realign the jaws and teeth to improve the function of your bite. Your surgeon will work closely with your orthodontist throughout the entire process, ensuring a coordinated and successful outcome. Here's what you can expect:
Before Surgery:
Fasting: You will need to fast for six hours before your surgery. This usually means not eating or drinking anything after midnight the night before your procedure. Your surgical team will provide you with specific instructions.
During and Immediately After Surgery:
The surgery is performed under general anaesthetic, so you will be asleep throughout the procedure.
Hospital Stay: You will typically stay in hospital overnight for a single jaw surgery and for two nights if you are having double jaw surgery.
Numbness: Immediately after surgery, you will likely experience complete numbness in your lips, chin, and teeth. This is a normal side effect and the sensation will gradually return over the coming weeks and months.
Recovery at Home:
Soft Diet: You will need to adhere to a soft, non-chew diet for up to six weeks following surgery. This does not mean a liquid diet. Instead, you can eat foods that require minimal or no chewing, such as soft pasta, mashed potatoes, well-cooked chicken, and blended soups. Your surgical team will provide you with a detailed list of suitable foods.
Swelling: Expect swelling to increase for the first three to four days after surgery. It will then begin to subside, with most of the swelling gone within three to four weeks. However, it may take two to three months for the final traces of swelling to disappear completely.
Oral Hygiene: Maintaining good oral hygiene is crucial during recovery. Your surgeon will provide instructions on how to clean your mouth effectively.
Follow-up Appointments:
Initial Post-Operative Care: You will see your surgeon for follow-up appointments every two weeks after you are discharged from hospital.
Orthodontic Care: You will likely see your orthodontist every alternate two weeks, in between your surgical reviews.
Long Term Care: After the first six weeks, your orthodontist will become the primary clinician guiding your care. Your surgical reviews will become less frequent as your recovery progresses.
Risks
Orthognathic surgery, like any surgical procedure, carries certain risks. It's important to understand these risks before making a decision about whether or not to proceed. However, it's equally important to understand that these risks are significantly minimised when the procedure is performed by highly trained and experienced oral and maxillofacial surgeons. Mr Saha and A/Prof Delpachitra have performed hundreds of successful orthognathic surgeries, including complex cases, which greatly reduces the likelihood of complications.
Nerve Injury:
Inferior Alveolar and Lingual Nerves: These nerves provide sensation to your lower lip, chin, gums, and tongue. During surgery, there's a risk of these nerves being stretched or bruised. This can lead to temporary or, in rare cases, permanent numbness, tingling, or altered sensation in the affected areas.
This is a relatively common occurrence following orthognathic surgery.
Fortunately, in approximately 9 out of 10 cases, full recovery of sensation occurs within 12 months. However, in a small number of patients, some degree of altered sensation may persist.
This could mean that you have reduced sensation in your lower lip or chin, or an altered taste sensation.
General Surgical Risks:
Like any surgery, orthognathic surgery carries risks of:
Bleeding, infection, swelling, bruising, pain, and adverse reaction to anaesthesia.
Serious, but Rare, Risks:
Although rare, there are some more serious potential complications:
Avascular Necrosis of the Jaws: This is a condition where the blood supply to the jawbone is disrupted, potentially leading to bone death. This is extremely rare.
Non-Union of the Jaws: This occurs when the bones do not heal together properly after surgery. This may require further surgical intervention to correct.
These serious complications may require further operations to correct the issue.
Idiopathic Condylar Resorption and Relapse:
Idiopathic Condylar Resorption (ICR): This is a condition where the condyle (the part of the jawbone that articulates with the skull) progressively breaks down. The exact cause is unknown.
ICR can lead to changes in jaw position and bite, potentially causing relapse after orthognathic surgery.
This is more common in young women.
Even with careful surgical planning, and execution, this condition can cause changes to the surgical results.
Relapse: Even with successful surgery, there is a possibility of some degree of relapse, where the jaws shift back towards their original position. ICR increases this risk.
Careful planning, and post surgical retention, greatly reduces this risk.
Important Considerations:
Your surgeon will discuss these risks in detail with you before your surgery and answer any questions you may have.
It is crucial to follow post-operative instructions carefully to minimise the risk of complications.
While the risk of complications exists, orthognathic surgery can significantly improve facial aesthetics and function.
If you have any concerns after your procedure, please contact your surgical team immediately
Fees
Jaw surgery fees can seem complicated, but they're generally divided into a few key categories:
Surgical Fees:
These vary based on the complexity of the procedure.
A surgically assisted maxillary expansion or genioplasty starts from $3,500, while a complex double jaw surgery can range up to $12,000.
Your private health insurance "extras" will provide a rebate for this.
Hospital Fee:
This covers the hospital's facilities and resources.
Usually covered by your "hospital cover" with only your policy excess to pay (typically $0-$500).
If you've already paid your excess this year, you likely won't have further hospital fees.
Anaesthetic Fee:
Varies based on the complexity and length of your surgery.
Expect out-of-pocket costs ranging from $500-$1,500.
Prosthetics:
For procedures that do utilise prosthetics, rest assured that these fees are completely covered by PHI for patients with "Silver" or above tier coverage. However, we strongly advise you speak to your private health insurance provider
This often represents the most significant expense, covering the custom-made plates, screws, and virtual planning used to reposition your jaw.
Costs can exceed $20,000. Due to these high expenses, we strongly encourage patients to have appropriate private health insurance (PHI) cover ("Silver" level or higher) to ensure these costs are completely covered.
Important Note: Not all jaw surgeries require prosthetics. For example, a Surgically Assisted Maxillary Expansion (SAME) does not involve prosthetics, so you wouldn't have this expense.
Specific Item Codes:
Surgically-Assisted Maxillary Expansion (SAME): 46154
Genioplasty: 45761
Bilateral Sagittal Split Osteotomy (BSSO): 46150
Bimaxillary Osteotomy (Bimax): 46153
Bimaxillary segmental osteotomy (Segmental bimax): 46158
Wisdom tooth removal (if needed): 324 (covered by "extras" cover).
Recommendation:
Contact your private health fund using the listed item codes to confirm your exact coverage and out-of-pocket expenses for the surgical, hospital and prostheses fees.
Information regarding the anaesthetist fees will be provided to you before your surgical date.