Patient Services

Orthognathic Surgery

Who Needs Orthognathic Surgery?

People who can benefit from orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is a gradual process and in some instances, the upper and lower jaws may grow at different rates. The result can be a host of problems that can affect chewing function, speech, long-term oral health and appearance. Injury to the jaw and birth defects can also affect jaw alignment. Orthodontics alone can correct bite problems when only the teeth are involved. Orthognathic surgery may be required for the jaws when repositioning in necessary.

Difficulty in the following areas should be evaluated:

• difficulty in chewing, biting or swallowing
• speech problems
• chronic jaw or TMJ pain
• open bite
• protruding jaw
• breathing problems

Any of these symptoms can exist at birth, be acquired after birth as a result of hereditary or environmental influences or as a result of trauma to the face. Before any treatment begins, a consultation will be held to perform a complete examination with x-rays. During the pre-treatment consultation process, feel free to ask any questions that you have regarding your treatment. When you are fully informed about the aspects of your care, you and your dental team will make the decision to proceed with treatment together.

Orthognathic surgery is just one part of a more comprehensive orthodontic treatment. Therapy often requires treatment with braces up to a year or more prior to surgery and a period of “finishing” orthodontics afterwards. Therefore, close coordination between our office and your orthodontics is imperative

Technology and Orthognathic Surgery

Drs. Englehardt and Vande Berg use modern techniques and three-dimensional models to show you exactly how your surgery will be approached. Using comprehensive facial X-rays and predictive tracings, we can show you how your bite will be improved. This helps you understand the surgical process and the extent of the treatment prescribed. The use of bone plates and screws (rigid fixation) often means that patients do not need to have their jaws wired together after surgery.

We feel that orthognathic surgery is an important treatment consideration for those with significant skeletal discrepancies. Our goal is to educate patients to treatment options so that more informed decisions can be made.

If you are a candidate and desire Corrective Jaw Surgery, Drs. Englehardt and Vande Berg will work closely with your dentist and orthodontist during your treatment. The actual surgery can move your teeth and jaws into a new position that results in a more attractive, functional and healthy dental-facial relationship.

A word regarding orthognathic surgery and insurance coverage:

Unfortunately, medical insurance carriers can sometimes refuse to cover orthognathic surgery. We feel that it is very important to obtain a predetermination prior to initiating orthodontic therapy. We usually file a predetermination after the initial consultation visit. It would be very unfortunate to spend a year or more of pre-operative orthodontics only to find that your policy will not cover the procedure! Please contact our office with any questions.

Orthognathic Surgery Post Operative Instructions

After you have undergone a surgical procedure to reposition your upper jaw, lower jaw, or both, attention must be directed to several aspects of post-operative care to help you make the recovery as quick and easy as possible. Since surgery produces soreness in the muscles and bones of the jaw as well as the lips, nose and other areas of the face, some difficulty is encountered in performing such tasks as eating, drinking, and cleaning your teeth. However, each of these things must be performed continuously and carefully to avoid post-operative problems. This is a list of instructions which should help you in your post-operative recovery.

Medications

You may be given several types of prescriptions following surgery.

1. Pain Medication: should be taken only during the time that you feel significant discomfort. If the pain is severe, the prescription pain medication may be used. However, if pressure or mild discomfort is experienced, attempt using less potent over the counter medications such as Tylenol, Ibuprofen, etc.
2. Antibiotics: You may be given a prescription for an antibiotic such as Amoxicillin, Keflex, etc. These should be taken at the appropriate interval as described on the bottle. Be sure not to miss any doses until the medication is gone. Note: Some types of antibiotics can reduce the effectiveness of birth control pills. Please contact your gynecologist if you have any concerns.
3. Decongestants: Following orthognathic surgery, especially upper jaw surgery, there can be considerable stuffiness of the nose and sinuses. A decongestant such as Dimetapp, Tavist, etc. can be indicated for 7-10 days following surgery if necessary.
4. Nasal Spray: can be used at 4-6 hour intervals to help improve breathing through your nose. In order to prevent overuse of nasal spray, this can be alternated with plain saline nasal spray or mist. These can be purchased from your pharmacy. If you have had upper jaw surgery, do not blow your nose for at least 14 days following surgery.
5. Lip Ointment: you may be given a tube of steroid lip ointment upon discharge. Use this only for the first 2 days after surgery. Keep enough ointment on lips to keep them appearing moist. After 2 days, use only Vaseline or Chap-Stick.

Drinking

Following jaw surgery there is usually some numbness in the upper and or lower lips. When combined with facial swelling and soreness due to the incisions inside the mouth, a task as basic as drinking may seem somewhat difficult. Here are some basic tips which may assist you.

1. Attempt to drink from a cup if possible. While some fluid may spill while drinking in this manner, a cup is the most effective way for obtaining adequate intake. Drinking gets much easier after a little practice and healing.
2. Place a towel under your chin and pour a small amount of liquid into the cup. Tip your head back slightly and attempt to open your mouth a small amount while pouring in the fluid. Pour slowly taking in small amounts until it becomes easier.
3. If necessary, take the cup away from your mouth and use slight finger pressure to place your lips together and swallow. Again, this becomes much easier in a day or two.
4. If a cup is simply not working well, you may try a sports-type squeeze bottle to squirt fluid into your mouth.

Remember: Taking in adequate amounts of fluid is essential following surgery. You will need about 2 quarts per day!

Eating:

Initially, it will be difficult to eat adequate amounts of food in 3 meals a day. Try to eat 5-6 times a day eating smaller portions each time. You may have the opportunity to meet with a dietician during your hospital stay. Use the following guidelines for progressing from a liquid or blenderized diet to firmer foods.

1. For the first 7 days after surgery: During this time the diet should be essentially a liquid diet. This can include soups, any food with baby food consistency, or blenderized foods. You can also eat such foods as mashed potatoes, apple sauce, oatmeal and pudding. Some sort of diet supplement such as Ensure, Sustacal or similar substitute may be used once or twice a day to increase calorie intake. Do not drink milk products for 2 days after surgery.
2. Day 7-14 after surgery: During this period your diet should include foods extremely soft in consistency and require minimal chewing such as pasta, and scrambled eggs.
3. 2 weeks to 5-6 weeks after surgery: At this point softer foods like ground beef crumbled in small pieces, flaky fish, and shredded chicken can be eaten. Remember, the important point is to avoid foods which require significant pressure between your teeth.
4. After 5-6 weeks: At this point the splint has usually been removed and it will be much easier to eat. Remember that it will take a few more weeks for the jaw to completely healed and that it is still better to cut food into pieces during this time. Foods such as pizza, apples, tough meat etc. should be avoided until at least 10 weeks after surgery.

Elastics (Rubber Bands)

Usually some types of elastics (small rubber bands) are used during the time immediately after surgery. These rubber bands are placed around small lugs or hooks on the braces or arch wires. The purpose of these small elastics is to help train your bite into the new jaw position and limit jaw function. This splint has small indentations for each tooth to bite in to. With the elastics in place and your teeth together, your should see that the teeth fit into the grooves in the splint.

1. The elastics should be worn at all times except when eating and brushing unless instructed otherwise. They should be worn in the manner shown at your post-operative visits.
2. The elastics should be changed to new ones at least every day to maintain their elasticity.

Hygiene

It is extremely important for you to keep all areas inside your mouth clean after surgery. You should brush your teeth and rinse your mouth after eating. Since you will most likely be eating five to six times a day you will need to clean your teeth at each of these intervals.

During the first week be careful to keep the bristles of the brush on or very near the teeth. You may have some soreness and difficulty opening your mouth which will prevent you from cleaning the tongue side of your teeth. However, this will improve with time.

1. Each time you brush your teeth place a small amount of toothpaste on the brush and clean all areas of the braces and splint the best you can.
2. Rinse your mouth thoroughly with warm salt water or water mixed with half water and half mouth wash. Do not use a water pik inside your mouth for the first week after surgery.

The importance of cleaning your teeth cannot be overemphasized. This must be done thoroughly, several times each day.

You must not smoke or use other tobacco products for at least 8 weeks after surgery. Tobacco and smoking can cause severe healing problems.

Exercises

In the past, and occasionally at the present time, teeth must be kept together with wires or heavy elastics after surgery. This allows the jaw bones to be held still while healing. Most of the time, however, small bone screws and plates are used to hold the bones together during the healing period. With the use of these screws and plates the jaws can still move slightly during the post-operative period. It must be remembered that the bones are not healed and are simply held together by the screws and plates. Therefore, we encourage a gradual progression of movement and use of the jaws, keeping in mind that complete healing process does not take place for approximately two to three months after surgery.

1. Immediately following surgery: Since surgery causes soreness in the muscles and bones of your jaw, movement will be difficult initially. We do not recommend any specific exercises during the first week to ten day after surgery.
2. 10-14 days following surgery: Stand in front of a mirror and attempt to open and close your mouth. At ten days you should be able to get at least 1 finger between your teeth. This will increase gradually in the next several weeks. Simply move your jaw open and closed then side to side. Moist heat to the side of your face prior to these exercises can be beneficial. Do not use your fingers to force open your jaw.
3. 4-8 weeks after surgery: At this time you should be able to get 2 fingers between your teeth comfortably and can begin using gentle finger pressure to stretch your jaw muscles. By week 8 you should be able to get 3 fingers between your teeth. Again, stretch the muscles open and closed as well as side to side.

As you can see, recovery from surgery requires a lot of patience and effort on your part. We will be happy to answer any questions you may have regarding post-operative care. Remember, the post surgical process is sometimes uncomfortable and may seem to occur slowly. However, with some determination and attention to these instructions, you can maximize the healing process. Our practice will make every effort possible to make your experience a positive one.

Please do not hesitate to contact us if we may provide any assistance.

Drs. Englehardt and Vande Berg

(919) 461-0110