Orthognathic surgery is an unfamiliar term to most people. The purpose of orthognathic surgery is to correct functional and aesthetic problems that are due to underlying skeletal deformities.

Orthognathic surgery is often the treatment solution in cases where the bite problem is so severe that braces alone aren't enough to correct the problem, or where orthodontics alone would compromise your facial appearance.

There are 3 main types of orthognathic surgery utilized in our cases:

Things to know:

1. Sagittal Split Ostoetomy:

This operation is performed on the lower jaw {mandible} to move it forward {in the case of a deficient lower jaw}, or backward {in the case of a large lower jaw}. Its performed behind the back teeth {not in the joint} and the jaw is sectioned in such a way that bony contact is always maintained. There are no gaps in the bone that have to be filled in, and it is not necessary to wire your teeth together during the post-operative healing period. Rigid fixation is now commonly used for the post-operative healing period, and this surgical technique eliminates the need to wire teeth together.

The Surgery

Please note, that the information provided by us is a rough outline to help prepare you for the big day! Ultimately each surgeon has a different approach and any questions or queries should be directed to the specialist performing your surgery!

2. Le FORTE I OSTEOTOMY

This operation involves the upper jaw {maxilla} and the movement of it in various directions. This procedure is used in the treatment of: 

3. GENIOPLASTY

This operation involves the movement of the chin, which may be moved forward, back, or upward to shorten it, or downward to lengthen it. The choice depends almost entirely on how it might affect your ability to let your lips relax together and on how it affects your facial appearance.

ORTHODONTIC APPLIANCES

The purpose of the presurgical phase of orthodontics is to align the teeth so the bite is correct when the surgery is complete. At the time of surgery, we will place surgical pins which are threaded through a special slot in your orthodontic brackets. These serve as an attachment during the surgery for the surgeon to be able to secure the teeth. The braces are not removed before your surgery.

SEQUENCE OF TREATMENT EVENTS:

• Diagnostic records and analysis as a New Patient
• Insurance (medical aid) predetermination and treatment plan confirmation
• Consultation with oral and maxillofacial surgeon
• Presurgical phase of orthodontics
• Presurgical work-up (Surgical Records) and analysis
• Collection of Surgical Records to give to Surgeon
• Appointment with surgeon to select surgical date
• Surgery
• Postoperative rehabilitation
• Finishing touches of orthodontics
• Removal of braces, placement of retainers
• Final dental equilibration, restoration, and cosmetic finishing

To achieve maximum results, we pride ourselves in the collaboration and co-operation between Dr. E Ghabrial, your Orthodontist specialist and Oral & Maxillofacial surgeon. This approach is more than "just teeth," it is a comprehensive approach to treatment to capture the result desired by you! The Patient!

Surgery Day

THE SURGERY

Please note, that the information provided by us is a rough outline o help prepare you for the big day! Ultimately each surgeon has a different approach and any questions or queries should be directed to the specialist performing your surgery!

DAY OF SURGERY

Generally, you will be admitted to the hospital the morning of your scheduled surgery. The length of your surgery depends on the procedure being performed. The length of your hospital stay also varies according to your procedure. Your surgeon should discuss with you all these necessary details prior to your surgery.

GENERAL ANESTHESIA

There are many side effects to general anesthesia that you may possibly experience after surgery. These include some weakness, dizziness, and nausea. Drugs are generally administered during and after your surgery to prevent nausea. We must emphasize that this side effect is very rare, and is generally controlled with medicine. We would also like to point out that after general anesthesia is administered, there may be a feeling of depression several weeks later. Please be aware that this may happen and do not be alarmed. Make sure your family is aware of this as well.

INTUBATION

Your anesthesia will be administered through nasal intubations. In other words, a tube is passed through your nose to the lungs to administer the anaesthetic agent. A tube is also passed to the stomach in order to keep the stomach empty before, during, and after surgery to help control nausea. You should expect to have a sore throat for 1-2 days following your procedure due to the intubations.

INTRAORAL INCISION

Incisions are made on the inside of your mouth for access during the surgical procedure. As a result, there is no external scarring. These incisions are typically located in the folds of tissue and are not usually visible after your surgery. The sutures used on the incisions either dissolve or are removed after 5-7 days.

INTRAVENOUS FLUIDS (I.V)

Intravenous fluids are administered at the time of surgery. The I.V. is used during surgery to maintain adequate fluid levels and is used after surgery to administer pain medication, antibiotics, etc. It is generally removed the day after surgery.

 Your Maxillo Facial Surgeon & Anaesthetist will discuss each of these with you in more detail.

AFTER SURGERY

We do everything we can to make your surgical experience as comfortable as possible. There are several things you can do to help. Here are also things you should expect.

SWELLING

The amount of postoperative swelling which occurs varies from person to person. It appears to be greater in the second or third day after surgery and tends to decrease thereafter. Swelling may be present up to 6 months after your surgery, but generally is only noticeable up to 6 weeks. In order to minimize swelling, we suggest:

1. Ice compresses - It is most important that ice compresses be in place the first 12 hours after surgery. Place ice around the operative site several times a day to reduce the amount of swelling which occurs in the first week.

2. Elevation of head ~ {the first 2 weeks after surgery} the head should be placed at a 30-45 degree angle while sleeping. This will reduce the amount of fluid accumulation in the jaws at night.

3. Steroids - Your surgeon may recommend the administration of steroids to reduce the amount of swelling, which also reduces discomfort.

4. Increasing activities - Walking and "getting back to normal" increases blood flow, which helps to disperse swelling. We encourage all patients to begin normal walking and other activities which would increase their blood flow. However, do not resume vigorous activities such as jogging, working out or other sports until your surgeon gives you approval.

It is not uncommon for you to experience a brief period of "the blues" several weeks after your procedure. This mild depression may be due not only to the general anesthesia, but to changes in diet as well. Another factor may be the response from your friends and relatives. Your friends and relatives should be aware that there is going to be a change in your appearance and that gradual adaptation to the surgery will occur. Please caution your friends and family that final judgments of the end result should not be made for many months. Also in advance, you should inform them of what should be expected with your procedure.

POST-OP GUIDELINES

RESUMING NORMAL ACTIVITIES

Most patients return to work or school one week after their procedure. Physical activities such as jogging, working out, etc. should not be resumed for approximately 3 months. Walking and other more moderate activities are certainly encouraged in order to increase your blood flow to reduce swelling.

ORAL HYGIENE

Strict oral hygiene maintenance is essential. If you do not keep your mouth clean after your surgical procedure, you greatly increase the chance of an infection occurring. Use a soft bristle brush, preferably with a very small head {child's toothbrush}, and clean above the brackets and around the orthodontic arch wires as effectively as possible. Please take great care not to hit the incisions.

Please download our Post Surgery Instructions Brochure or the Surgical Brochure and ask for one at our practice so that you have the information close by!