Corrective jaw (orthognathic) surgery
Orthognathic surgery repositions the upper jaw, lower jaw or chin so that the teeth meet properly and the face is better balanced. Will leads the orthognathic service at Homerton, where surgery is planned and carried out jointly with a consultant orthodontist.
Who it may help
- Difficulty biting or chewing because the jaws do not meet
- An open bite, or a lower or upper jaw that sits well forward or back
- Problems closing the lips, or some cases of obstructive sleep apnoea
- Facial asymmetry from uneven jaw growth, once growth has finished
Recovery
Swelling peaks at two to three days and most of it settles over two to three weeks. You will be on a soft diet for about six weeks and most people take two to three weeks off work or study. The final result is seen after several months.
What is involved
You will usually wear fixed braces for 12–18 months before surgery to line the teeth up for their new position. Your jaws are then planned in 3D on computer from scans, and custom guides or wafers are made for theatre. The operation is under general anaesthetic and is carried out from inside the mouth, so there are normally no visible scars. The bone is divided and moved, then held with small titanium plates and screws. Most people stay in hospital for one or two nights, and the braces stay on for several months afterwards to fine-tune the bite.
Types of jaw surgery
Your plan may combine more than one of these:
- Upper jaw surgery (Le Fort I osteotomy) to move the upper jaw forwards, backwards, up or down
- Lower jaw surgery (bilateral sagittal split osteotomy) to move the lower jaw forwards or back
- Both jaws together (bimaxillary surgery) for larger or more complex discrepancies
- Genioplasty to reshape the chin, either with jaw surgery or on its own – see Chin & jaw contouring
Risks and side effects
All surgery carries some risk. The main ones for this treatment are listed below; your own risk depends on your health and the details of your operation.
- Numbness of the lower lip and chin after lower jaw surgery – common at first, and persistent in a minority of patients
- Swelling, bruising, bleeding or infection
- Plates or screws needing removal later
- Changes in the bite, or the jaws moving back slightly over time (relapse), sometimes needing further treatment
- Jaw joint discomfort or stiffness
- Changes to the shape of the nose after upper jaw surgery
Alternatives
Braces alone can sometimes disguise a mild jaw discrepancy (orthodontic camouflage), though they cannot change the jaw position. You can also choose to accept your bite as it is. Will and your orthodontist will discuss which options are realistic for you.
Guidance and standards
GIRFT recommends that corrective jaw surgery is delivered within networked services with a joint surgeon–orthodontist clinic. NHS treatment is available when the bite problem meets national clinical criteria; it is not offered for cosmetic reasons alone.
Questions worth asking at your appointment
- Benefits – what will this treatment do for me?
- Risks – what could go wrong, and how likely is it for me?
- Alternatives – what other options are there?
- Nothing – what happens if I wait, or decide not to have treatment?
Based on the Choosing Wisely UK BRAN questions.