Orthognathic Surgery

 

688. <Orthognathic Surgery>
Orthognathic surgery, or double jaw surgery, involves cutting and repositioning the upper (maxilla) and lower jaw (mandible) to correct misalignment. Ideally, the jaws align in a perfect bite, but varying degrees of discrepancy can require surgery.

The most common method for repositioning the upper jaw is the Le Fort I osteotomy. If the upper jaw is retruded (flat face), it's moved forward; for protruding mouths, it is set back. In long midface cases, especially when gums show while smiling, the maxilla is reduced to balance the distance between the eyes and teeth.

Those who chew hard food often have overgrown back maxillae, flattening the occlusal plane. By reducing the posterior part and rotating the jaw clockwise, volume in the midface increases, creating a youthful appearance and a natural smile arc.

When the lower jaw is overly developed (prognathism), it’s often due to genetics or strong chewing habits. The Sagittal Split Ramal Osteotomy (SSRO) is the typical method to reposition the mandible, while the Intraoral Vertical Ramus Osteotomy (IVRO) separates the jaw vertically.

SSRO offers wide bone contact for stable healing but carries a higher risk of inferior alveolar nerve damage, depending on nerve canal anatomy. IVRO minimizes nerve risk and is often used for TMJ disorders or severe facial asymmetry, though it may require non-fixed healing, causing patient discomfort.

In cases with a narrow airway or asymmetry, lower jaw surgery alone isn't enough—both jaws must be addressed. Severe bimaxillary protrusion may also require an Anterior Segmental Osteotomy to reduce the premolar region.

Orthognathic surgery can correct underbites, protrusions, asymmetry, long face, and sleep apnea by restoring jaw harmony. Braces may be needed before (pre-surgical orthodontics) or after surgery (surgery-first approach), so dental evaluation is essential.

[Orthognathic surgery harmonizes upper and lower jaw imbalance]
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