About Jaw Surgery and Orthodontic Treatment

Who may benefit?

In order to correct the position of the teeth and provide a functioning bite, the supporting bones of the jaws need to be in the correct position. We offer jaw surgery with orthodontic treatment to people whose jaws are too long or too short or not symmetrical, as braces alone cannot make the bite right if the jaws are not. Sometimes this surgery is indicated when a broken jaw has healed in an incorrect position.

The jaw surgery is usually done anytime after the person has stopped growing; the orthodontic treatment can be started a year or two earlier. This is a standard form of treatment which is available in many NHS hospitals. The main benefits are:

• improved facial appearance
• straight teeth
• better fit of the upper and lower teeth

Do I have to have it done?

No. The whole process is entirely optional and should be what you want to have done. We are very happy to undertake treatment for anyone who may benefit and who feels that it is right for them to go ahead once they understand what is involved.

Why do I need a brace as well?

The teeth need to be moved so that the top and bottom teeth will meet properly when the jaws are put into the correct position. The brace used is a fixed brace (train tracks) as this can position the teeth most accurately. If jaw surgery is undertaken without orthodontic treatment, the result may be compromised, and can be unstable.

How long does it all take?

The whole process usually takes two to three years and involves:

1. Detailed assessment of the problem with models of the teeth, X-Rays, photographs, and occasionally special scans.
2. Meeting with Consultants in Maxillofacial Surgery and Orthodontics to discuss what is involved, the risks and benefits, and the other options.
3. Decision by the patient (and his or her family).
4. Orthodontic treatment with fixed braces (and extractions of some teeth if necessary).
5. Removal of wisdom teeth (if necessary). This may be required, ideally six months before jaw surgery to the lower jaw, as the lower wisdom teeth sit in the line where the jaw division is to take place. Healing is much better after jaw surgery if the wisdom teeth have been previously removed and the sockets have had time to fill with new bone. Some people do not grow wisdom teeth or do not need to have them removed.
6. Jaw surgery, usually in one operation.
7. Further orthodontic treatment.
8. Retention with removable braces and follow up.

Orthodontic treatment with fixed braces for up to eighteen months is needed to straighten the teeth and put them in the right positions for jaw surgery. This may make the problem look worse but is necessary so the jaws can be fully corrected. The fixed braces stay in place during and after the operation.

After the operation the orthodontic treatment is usually continued for another few months. The fixed appliances are then removed and removable retainers are fitted. These are worn initially full time and indefinitely at night.

How will the operation be done?

The operation is done under a general anaesthetic in hospital. It involves dividing one (or both) jaws and resetting it (or them) in new pre-planned positions with screws and/or small metal plates on the surface of the bones. This is all usually done from inside the mouth with only two small puncture wounds in the skin at the side of the face for placing some screws. The screws and metal plates normally do not need removal (they do not activate airport alarms!) and the stitches dissolve.

What happens afterwards?

After waking up in recovery, the patient goes back to the surgical ward. The jaws are not usually wired together but may be guided into their new position by elastic bands stretched between the upper and lower orthodontic braces. There is sometimes considerable swelling with bruising of the face and mouth at this stage, with discomfort rather than pain, and limited mouth opening. Medication is given to make the patient as comfortable as possible and to reduce the risk of infection.

Liquids, medication and rarely blood are given by a 'drip'. The patient then moves onto a liquid diet and usually stays in hospital for only a couple of days. The swelling often persists for two weeks and the patient is usually fit to go back to work or college about the same time. Weekly visits to out-patients are needed for a month and contact sports must not be played for at least six weeks. Orthodontic visits then continue as required and the braces are removed when the time is right.

We continue to review you after surgery.

How will I eat?

You will be on liquid food initially and it is a good idea to make sure you will be able to use a liquidiser or food processor after the operation. You will need to eat several meals a day to keep your intake up. Normal food liquidised with milk is good, as are high protein soups. After a couple of weeks you will be able to manage scrambled egg, mashed potato or soft pasta type foods, and it will take up to six weeks before anything should be chewed. Further information can be found on our Post-Surgery Modified Diet page.

What are the risks?

All operations carry general risks. These can be reduced by making sure you are in the best condition for an operation, such as:

• Giving up smoking at least six weeks before surgery.
• Not being significantly overweight.
• Talking to the doctor for advice if you take the oral contraceptive pill.

The particular risks with jaw surgery are:

• Numbness of the lips (and sometimes tongue)—
  usually DOES occur but is usually temporary and may take several months to come back to normal. It is occasionally permanent.
• It does not affect movements of the lips, just the feeling.
• Unexpected changes in facial appearance.
• Relapse: improvement not maintained.
• Rarely, plates need to be removed, if they cause problems.

We make every effort to minimise these risks and most patients are pleased with the result and think the treatment has been worthwhile.

How do I decide if it is for me?

Talk to us as many times as you feel you need to and ask your friends and family for advice if you wish. We hope this information will help you to understand the treatment we are offering you. We will be happy to discuss your particular problems in more detail. It is important that you understand what is involved before you decide to go ahead.

Please contact us if you have questions or would like to ask us about arranging for surgery.