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Date issued: January 2024 

Review date: January 2026 

Ref: B-370/Maxfax/KD/Orthognathic Treatment v3

PDF:  Orthognathic treatment final January 2024 v3.pdf[pdf] 144KB

You have been referred to us for specialist advice and treatment. Now that we have listened to your concerns and examined you, we have recommended a combination of orthodontic treatment (braces) and surgery (an operation) to correct the positions of your teeth and jaws. This treatment is complex and lengthy, but the good news is that the majority of patients who undertake such treatment find that they have more self-confidence after treatment, that eating is easier and that the appearance of their face and teeth improves.

At this stage you will probably have lots of questions. This information sheet is designed to answer the most common questions we are asked. If you have any other questions that this leaflet does not answer, or you would like further advice, please ask your orthodontist or surgeon.

Why is it necessary to have surgery to correct my teeth?

The way your teeth look and the way they bite together is partly determined by the position of your jaws. Sometimes, as in your particular case, it is not possible to correct the positions of the teeth without also correcting the position of the jaws. Jaw surgery is needed to do this.

Why is it necessary to wait for surgery until I have stopped growing?

The jaws follow the growth rate of the rest of the body. Most growth is complete by the age of 18 years. Surgery earlier than this may mean that treatment is unsuccessful because of continuing growth of the jaws. The earliest time surgery is normally considered is in the late teens.

Why do I need my teeth straightened before surgery?

It is important that your teeth are straightened so that they meet together correctly after your operation. A good bite between the teeth helps to maintain the jaw positions after surgery and will give the best possible result. Fixed orthodontic appliances (fixed braces) will be used to move your teeth to their new positions. Your orthodontist will talk to you and give you more information about fixed braces and how to look after them.

How long will I have to wear fixed braces for?

You should expect to be wearing fixed braces for at least 2 years in total. Braces are usually worn for about 18 months before surgery. The braces stay on your teeth during the operation and are usually worn for 3-9 months after surgery. But don’t be surprised if your treatment takes longer than 2 years.

How often will I need to come for brace adjustments?

After fitting your braces we will see you every 6-8 weeks for adjustments. Each appointment will last about 15 minutes. At certain times during treatment, especially immediately before and after surgery, we will need to see you more often and for longer appointments. You will need to have time away from college/work to come to your appointments.

Will I need to have any teeth removed?

It is sometimes necessary to remove some teeth before fitting the brace, to provide space to straighten your remaining teeth. The need for this depends entirely on your particular problem and will be discussed with you in detail by your orthodontist and surgeon. If you have wisdom teeth that are in a poor position, it may be necessary to remove these at a separate operation before jaw surgery.

What will the surgery involve?

Your surgery will take place under a general anaesthetic (you will be completely asleep). The operation will be carried out from inside your mouth. A cut will be made through the gum to gain access to your jawbones.  The bones will be cut with a small saw to allow them to be broken in a controlled way. The jaws will then be moved into their new positions and held in place with small plates and screws made of titanium (these plates and screws are normally left in place forever). The gum will be stitched back into place with dissolvable stitches that take about two weeks to fall out. Different operations are needed to correct different problems and your surgeon will explain the exact details of the surgery that you will need.

How long will the operation take?

The operation will take several hours to complete. The time taken varies depending on the particular type of operation and our surgeons will discuss this with you.

Will I have my jaws wired together?

Because each jaw is fixed using small plates and screws, you will be able to open your mouth almost immediately after the operation. Very occasionally it may be necessary to use wires to hold top and bottom jaws together. The likelihood of this happening to you will be discussed with you before the operation.

How long will I be in hospital for?

You will be admitted to Hospital (Lynher Ward) for approximately 2-3 days.

Will there be any scars on my face?

Most operations are carried out from inside the mouth, so there should be no scars on the outside of your face. Your surgeon will discuss with you any likelihood of approaching the operation site from outside the mouth.

Will I be swollen or bruised after the operation?

All patients experience facial swelling and bruising after surgery, some patients more than others. Swelling is most noticeable immediately after the operation, and it may take several months to go away completely. Your surgeon may suggest medication that you can take before your surgery to reduce the swelling after the operation.

Will I be in pain after the operation?

All operations result in a degree of pain and discomfort, but this does vary from person to person. Some people who have had jaw surgery do find it painful, but others find that pain is not a problem. While you are in hospital we try to control any discomfort with appropriate drugs. You will be discharged from hospital with tablets to help you deal with any further discomfort.  Immediately after the operation your throat may be uncomfortable and swallowing can be difficult to begin with. If you are worried about pain please talk to us.

What will I be able to eat after the operation?

Immediately after the operation you will probably find that you cannot open your mouth widely.  A very soft diet is recommended for you at this stage. Your orthodontist will give you some ideas and recipes for suitable meals.  Foods such as scrambled eggs, omelettes, rice, pasta, mince, stews, soups and pureed foods are all good choices. Approximately 6 weeks after your operation you will be able to eat a fairly normal diet, but you will still need to avoid very hard or chewy foods for 3 months after your operation.  Immediately after the operation, you will probably find that you lose weight. Most patients lose approximately 7-14 lbs, but this is fairly quickly regained.

Will I feel tired after the operation?

Most patients feel quite tired after surgery. It usually takes a few weeks to get back to normal, but for some patients it can take longer. It is our experience that most patients feel a bit depressed for a couple of weeks after the operation, due to discomfort, swelling and tiredness.

Will the treatment change my appearance?

As you know, your treatment is to correct the position of your teeth and to change the relationship between your jaws. Movement of your jaws will change your facial appearance and we will try to describe and show you the changes that we expect as a result of surgery. If you are having treatment because you are unhappy with the appearance of your jaws, then you are likely to be happy with the changes achieved.

A change in appearance can sometimes be quite difficult to deal with, for you and your family. If you are worried about this, please tell us and we can arrange support.

Will the operation be successful?

The surgeons and orthodontists who will be involved in your treatment have considerable expertise and experience in orthodontic and surgical treatment of this kind. In our experience, such operations result in substantial improvement in the function and appearance of the jaws and face.

Your bite will not be absolutely perfect immediately after surgery. In the weeks following surgery your orthodontist will put elastic bands on to your braces to guide your teeth into the best possible positions. Very rarely, a second, small operation may be needed to reposition the fixing plates and screws if your new bite is not quite right.

The stability of the final result depends on the type of operation and an individual’s response to the operation.

Are there any risks?

All operations involve a degree of risk related to the general anaesthetic.

Following your operation you will definitely experience some numbness or tingling near to the operation site (usually of the lips or cheeks). This numbness may last for between 6 weeks and 6 months, but it can be permanent. A minor degree of persistent numbness or tingling is fairly common, but usually only affects a small area of the face.  Most patients get used to this slight change in sensation and are not worried by it.  Movement and appearance of the face are not affected.

Other surgical risks vary depending on the type of operation and any particular risks affecting you will be discussed in detail with your surgeon.

You will be wearing a fixed brace for a long time. Damage may occur if you do not look after your teeth and gums properly during treatment. Your orthodontist will talk to you about the risks associated with wearing braces and how to avoid them.

How long will I have to stay off work/college after my operation?

You will normally be away from work/college for approximately 3-6 weeks. Again, this varies from patient to patient and depends on the type of operation.

What about playing sport after the operation?

You are advised to avoid all contact sports for at least 3 months.

Will I need to see my own dentist during this treatment?

You must continue to see your own dentist during treatment for routine dental care. Keeping your teeth and gums healthy is especially important during treatment.

Do I have to decide whether to go ahead with treatment straight away?

Orthognathic treatment is complex, lengthy and can be quite an emotional treatment to go through. As we have explained, it is not without risk. Success depends a great deal on your enthusiasm and the support of your family and friends.

You should think things over carefully before deciding whether or not to go ahead. There is no hurry, and we would be happy to talk to you again before you make your decision. If you decide to go ahead, please talk to us if you have any further concerns. Don’t worry if you decide not to go ahead. This may be the best choice for you.

We hope this information leaflet has answered many of your questions. Your orthodontist would be happy to discuss details of your orthodontic treatment. You are welcome to speak to your surgeon again if you need more information about your surgery. There is also some very good information on the following website: www.yourjawsurgery.com