Orthognathic Surgery (Jaw Surgery)

Mr Heliotis is a private orthognathic surgeon at several private hospitals in London, UK, and has an extensive NHS practice in this field at Northwick Park and St Mark's Hospitals.

Ortho (Greek for 'correct') gnathos (Greek for 'jaw') surgery is corrective surgery of the jaws. Orthognathic surgery is undertaken to correct and enhance the position, aesthetics and function of the jaws, teeth and overlying soft tissues relative to each other and the rest of the face.

We can address many cosmetic and functional issues of the face, jaws and teeth, depending on the underlying problem and what the patient wants. These vary from cosmetic to functional, but there is usually an element of both; aesthetics and function are usually interdependent.

A patient may be unhappy with a large or small lower or upper jaw, their profile, or may wish to enhance or reduce the size of the chin with a genioplasty (chin surgery). It can be used as an adjunct to facial rejuvenation procedures and enhance the effect of face lifts, neck lifts, fillers and facial volume, lip position and fullness, by addressing not only the soft tissue but the supporting facial skeleton and even the underlying dentition. Thus, by addressing all these components together, we can give a more comprehensive treatment. We work with colleagues across specialities to achieve these optimal results.

Most often, people present to dentists and orthodontists with overcrowded and poorly aligned teeth concerned about the cosmetic appearance of their teeth, embarrassed about their smile or reporting functional problems with their bite. Common complaints are protruding 'buck' teeth, an open bite with an inability to bite into food, requiring effort to close the mouth and lips with consequent mouth breathing and challenges to oral hygiene. Conversely, over-biting can cause trauma to the gums and bone with consequent loss of teeth and bone volume with premature ageing of the face. Some of these functional and cosmetic dentistry demands can be addressed with orthodontics alone. However, in many cases, joint orthodontic and surgical treatment is mandatory as the problem may appear as purely dental overcrowding, but the underlying diagnosis is a combination of small/large jaws and dental discrepancies. In these cases a combination of orthodontics (braces) and jaw surgery give an optimal facial and dental balance with an elegant cosmetic and functional result that will greater long term stability.

It is not unusual for many patients who have had orthodontic 'camouflage' treatment of these problems without the input of corrective jaw surgery, to return with relapsed orthodontics (teeth going skew again). Similarly, prior to undertaking orthognathic surgery for most cases, orthodontic intervention is integral to surgical long term success. Hence, we work closely in a multi-disciplinary team with joint orthodontic and surgical input for the more complex cases that require both interventions.

This is a common under-diagnosed problem, which is often neglected because many patients and doctors think nothing can be done, or it's too difficult to correct. The causes are many, but fundamentally related to uneven upper and/or lower jaw and chin growth as well as overactive growth in the Temporomandibular Joint (TMJ).

This can be tackled by correction of the underlying skeletal or soft tissue asymmetry or by camouflage surgery using reduction or augmentation of parts of the face with surgical implants, fillers or botulinum toxin injections, individually or in combination with each other. If there are also underlying malocclusions and overcrowding of teeth these can be simultaneously dealt with in a multidisciplinary team of expert prosthodontic and orthodontic colleagues who routinely deal with these complex cases with us in clinics.

People can present with disproportions in facial growth that result in long, short, broad or narrow faces. The underlying causes are many but in essence they represent too much or too little bone, muscle or skin growth in different parts of the face, lips, nose, eyes, cheeks and jaws.

There are two basic ways we manage these. Surgical correction of these disparate components using ostoetomies to the facial skeleton and jaws and soft tissue plastic surgery or the addition/removal of tissue or placement of implants, prostheses, fillers or botulinum toxin to camouflage and rebalance the different components into an aesthetic whole. We tailor the treatment depending on individual needs.

Post-injury and post-traumatic facial deformities can also be addressed with orthognathic jaw corrective surgery. Often jaws are set in the wrong place with consequent problems with occlusion and teeth meeting properly, biting properly, or cosmetic concerns. In these cases, teeth often go missing from trauma and concomitant osseointergrated dental implants can be placed to restore function and cosmetics.

Sleep apnoea can be helped with jaw surgery. A multi-disciplinary team of respiratory physicians, ENT surgeons, orthodontists and ourselves are involved in treating these patients. In very simple terms, in addition to other therapies and interventions, the jaw relationship is surgically altered to increase the capacity of the airway passage and enhancement of respiration.

There is no conclusive scientific evidence to show that orthognathic surgery and/or orthodontics can correct this problem. One should be guarded about undertaking this surgery purely for the correction of this problem. However, in cases of large anterior open bites, there is some empirical evidence that putting the jaws and teeth in a more functional position may improve on TMJ problems.

There is no set upper age limit for these procedures. Many people are going through this treatment in late adult life as they were discouraged by friends, family and health professionals in the past from addressing their needs. However, not everyone may be suitable for this. We would need to talk and see what you might require and if your needs can be met.

This depends on what is being addressed. Generally however, you would have a consultation with us so as to address your concerns and undergo an examination for a diagnosis. You might, on the other hand, present to the orthodontist, a dentist, general practitioner or a plastic surgeon who might feel that your problem requires our attention and will be referred to us.

If your problem involves a combination of dental malocclusion (a bad bite, poor tooth alignment) and underlying jaw disproportions, we will be working very closely with your orthodontist while he/she gets you to an optimal dental position for an operation to your jaws.

In these cases, the treatment commences with orthodontics, after we and your orthodontist have decided on a treatment plan. Your orthodontist will need to see you every 5-6 weeks to adjust the braces on your teeth. The braces are on the teeth and hardly ever are external headgears required. We will be seeing you once or twice prior to the operation, possibly with the orthodontist. Eighteen months to two years down the line, you will be having the operation. Two weeks prior to the operation, we will see you for the final surgical treatment plan.

You will come in to one of the listed hospitals in North or Central London on the day of the operation and a general anaesthetic is required. The whole of the operation will take place within the mouth for the jaw osteotomies in orthognathic surgery, other than two small cuts on either side of the angle of your jaw (about 3 mm long) which heal with hardly a visible scar. If you're having a genioplasty with the osteotomy, it is also performed intraorally, usually as an osteotomy of the chin bone to reduce or augment (enhance) the chin. However, depending on the circumstance, we may place a prosthetic ('plastic') chin implant from under the skin of the chin.

You will normally go home the next day after the operation or stay one to two nights depending on how you feel. Again, depending on the procedure, you will be swollen to different degrees, but this goes down fast after two weeks. Surprisingly, few people complain of much pain, but rather discomfort. You will have varied degrees of numbness around your lips and face, depending on the procedure. You will feel tired from the operation and worn out for the first week. With osteotomies of the jaws, you will need to be in tight elastics between your top and lower teeth for the first 2-4 weeks and light elastics for 2-4 weeks after that, depending upon the type of operation and your occlusion. For the first 2-4 weeks you will need to be on blended food and nutritional drinks, going on to a soft diet after that. You will need to be seen on a weekly basis for the first 4-6 weeks by the orthodontist or ourselves to ensure all is going well.

Luckily, serious complications are very unusual. You will be swollen to varied degrees after the operation, depending on what you've had. There may be bruising. The swelling is usually gone by 6 weeks. You will probably lose some weight as you will be in elastics as described above with a non-solid diet for several weeks, again depending on what you've had done. You will have some temporary numbness for the first few days or even weeks around the lips and face. Osteotomies involving the lower jaw have a risk of 5-10% of permanent numbness to part, or in some cases the whole of the lower lip. Interestingly, however, most people adapt to this quite well over a period of months and it usually is not a serious issue in their lives.

Very rarely you may need to be put back to sleep a week or two later if the jaws aren't sitting the way they should, to adjust the osteotomy.

Blood transfusions are extremely rare.

Pain in the joints of the jaw following this surgery is unusual, but possible.

It has to be remembered that although we are striving to change your face and teeth in as good and improved a functional cosmetic position, the body has a 'memory', so to speak, of your previous anatomy. This may result in various degrees of what is known as 'relapse', both orthodontically and surgically. In other words, there will always be a tendency for your muscles, skin and tongue to bring your face and teeth to some degree back to their pre-treatment position. The chances of going back to your pre-treatment position are very slim, but there may be some degree of relapse, not usually to any large extent.

It must be appreciated that all the information given above has been provided in good faith and is meant only as a guide. A personal consultation will be needed for a full understanding of what you may need and expect from any treatment described.

If you do not have private medical insurance please contact our secretary and she will be able to give you an indication of the cost associated with orthognathic jaw surgery.