Some jaw deformities may be congenital, while others may develop during bone development or as a result of trauma. Orthognathic surgery is performed to position the jaws and facial bones in relation to each other and aims to improve the chewing function of the jaw. It is important to note that surgery is only one component of the overall treatment process. In many cases, orthodontic treatment involving the movement and correction of the teeth may also be required. Usually, this orthodontic intervention can take place before or after the surgical procedure.
The Role of the Patient in the Treatment Process
The preparation of patients planned for orthognathic surgery for surgery, the surgical stage and the processes afterwards require a certain amount of time. It is important to stick to this process before starting the whole treatment period. Know each stage of your treatment plan and understand what to expect at all stages. Take time to understand the benefits and risks. You also need to actively participate in the process by asking questions and getting the necessary information.
Your Orthognathic Treatment Team
- Oral and Maxillofacial Surgeon: This specialist performs surgical procedures on the jaw and facial bones.
- Orthodontist: In close co-operation with the surgeon, this dental specialist focuses on moving the teeth to improve their function and appearance, as well as their harmony with the jaws.
- General dentist and additional dental specialists: A general dentist deals with various dental problems and you can consult dental specialists if you need them. For example, a periodontist deals with gum disease, while a prosthodontist can provide crowns, bridges or implants if necessary.
- Other professionals: Depending on your needs, a speech therapist, physiotherapist or other healthcare providers can contribute to optimising your treatment.
Common Problems in the Jaws
Below are some common jaw problems. It is possible to have more than one problem at the same time.
-Class II (retrognathia)
Positioning the lower jaw too far back (retrognathia) can make biting difficult and make the jaw appear weak or retracted.
-Open-bite
In cases where the back molars touch each other but the front teeth do not close, it may become difficult to close the lips. This may occur because the upper jaw is too long or the lower jaw is too short.
- Class III (prognathia):
If the lower jaw protrudes too far forward (prognathia), the jaw protrudes forward and the lower teeth can overlap or cover the upper teeth.
- Asymmetry:
The upper jaw and/or lower jaw not being in the same plane on the right and left sides causes facial asymmetry.
What Causes the Problem of Closing the Jaws?
- Difficulties with chewing: Difficulty holding food in the mouth when biting or chewing. This may be accompanied by pain in one or both temporomandibular joints (TMJ).
- Speech difficulties: Difficulties making certain sounds or speaking clearly.
- Respiratory problems: A narrowed or blocked airway can lead to noisy or difficult breathing, which can cause sleep apnoea (breathing interruptions during sleep).
- Aesthetic problems: Jaw incompatibilities can cause the individual to be dissatisfied with their own appearance.
Examination and Treatment Records
Your surgeon and orthodontist will carry out comprehensive examinations and keep detailed records. These records include photographs, CT scans and digital models showing the current position of the teeth and jaws. Some records can be taken more than once.
Examinations and records may include:
- Medical history: Questioning about past surgeries, injuries, general health and dental health. It is important to mention any dental or facial aesthetic procedures planned for the future.
- Physical examination: Assessing how the jaws and teeth work together, checking the health of the gums and teeth and assessing the size of the tongue and airway.
- Photos and videos: Taking photographs of the jaws, teeth and face, recording videos of laughter or speech.
- CT Scans: Using cone beam computed tomography (CBCT) scans to create 3D images of the head and jaws.
- Models: Plastic, plaster or 3D digital models created through digital scans or physical moulds of teeth. These show the alignment and movement of the teeth and jaws during chewing.
- Other evaluations: In certain cases, a sleep study, speech test, psychological examination or other assessments may be required.
Preparation for Surgery and Operation Day
Preparation for Surgery
There are several steps you can take to facilitate your treatment and recovery:
- Stop smoking: If you are currently a smoker, it is recommended that you stop smoking or using other tobacco products, which can increase the risk of complications during surgery, hinder the healing process and lead to or worsen gum disease.
- Plan for the recovery period: Arrange time off from work or school before the operation and discuss the expected duration of the recovery period at home with your surgeon.
- Adjust the medication according to the instructions: Inform your surgeon about any prescription or non-prescription medicines, supplements or herbal remedies you are using. Depending on your condition, you may need to stop some or all of these before surgery.
Surgical Experience
Preoperative Preparations
- The surgery usually takes a few hours and you can return home the same day after surgery or stay in hospital for one or more nights until you have recovered sufficiently.
- Before the operation, you should have liquid foods that require little chewing. These include full nutritional drinks, soup and milk. Foods that can be easily liquefied, such as bananas, are also recommended.
- Arrange for an adult family member or friend to drive you home and stay with you after the operation.
- Avoid eating or drinking for the specified time before surgery, (usually about 8 hours) Talk to your surgeon about whether you can take your regular medicines during surgery and if you can, take them in small sips with water.
Operation Day
- When you arrive at the hospital, the staff will help prepare you for the operation. During this process, they may ask your name and the type of surgery you will have several times for safety reasons.
- An intravenous (IV) line will be set up to administer fluids and medication.
- General anaesthesia will be administered to ensure that you are in a painless, deep sleep-like state during the operation.
- Towards the end of the surgery, a plastic splint may be placed between the chewing surfaces of your teeth. In some cases, it may be attached to wires or elastics to keep the jaws closed. Alternatively, more loosely guiding tyres can be used. In certain cases, wires or elastics may not be needed
Postoperative Period
First Postoperative Period
After the operation, cold packs will be applied for swelling on your face. It is normal for your face to still be numb from the surgery. If you have any pain, you will be given painkillers. The nurses will closely monitor your recovery before transferring you to a normal hospital room.
Hospital Recovery Phase
Shortly after surgery, you will be helped to walk to prevent complications and speed up recovery. Fluids will be started early to maintain hydration. Nausea is a common condition after surgery. If you have any concerns, discuss them with your surgeon beforehand.
Homecoming
The hospital stay is usually 1 or 2 days. Before discharge, you will receive comprehensive self-care instructions about pain management, swelling and necessary medications.
Home Recovery
When you return home, prioritise actions that will help your body's recovery process. Make sure you eat enough calories and protein. Maintaining the cleanliness of your mouth and teeth is very important for the wound sites to heal.
Swelling and Pain Management
In the first few days, you may experience increased swelling of the face and neck and possible skin discolouration. To alleviate these symptoms:
- When lying down, keep your head and shoulders higher than your heart.
- Apply the cold pack wrapped in a thin cloth to your face for 10 minutes, with a break of at least 5 minutes between them.
- Take prescribed pain medication as prescribed and do not wait to take it before the pain gets worse.
Nutrition and Fluids
After surgery, it may be difficult to consume solid foods due to swelling. This period can last for days and all food must be consumed in liquid form. This can make it difficult to meet the daily nutritional needs of an adult patient. As fluids are the most important nutrient, special attention should be paid to drinking 6 to 8 glasses of fluids a day. It can also be difficult to meet calorific needs at this stage. Many liquid nutritional supplements are available for this purpose. Thanks to their high calorie content and balance of protein, calories and vitamins, they make it easier to reach your goals. These drinks can be enriched with smoothies or iced fruit drinks containing fruit, protein powders or other ingredients. To determine whether you are reaching your nutritional goals, it can be helpful to keep a diet diary in which you record the amount of fluids and calories you consume. After this short period of fluid dependence, a diet of semi-solid "non-chewy" foods that do not require biting or chewing may be recommended. This diet can be consumed in a consistency that does not require biting or chewing. You can eat many of the foods you normally eat, such as soft-cooked eggs, soft pancakes, well-cooked pasta, fish fillets, etc. It is very important to avoid forcing your surgical sites until the healing progresses.
Oral Hygiene
Ensure the cleanliness of your mouth and teeth with the following steps:
- If your mouth opening is limited, use a baby toothbrush to reach difficult places.
- Follow the prescribed instructions for fluoride toothpaste or mouthwash.
- Return to your normal brushing and flossing routines as early as possible.
Bathroom
There is no harm in bathing after oral operations. However, postoperative fatigue and exhaustion may cause dizziness and fainting during bathing. You should leave your bathroom door unlocked and ensure that there is someone at home who can reach you quickly while you are bathing. If you have a wound on the outside of your mouth, it is important to keep it dry when bathing, especially for the first 2 days after surgery. You should follow your doctor's advice for these situations.
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