FACIAL DEFORMITY AND ORTHOGNATHIC (JAW) SURGERY
Orthognathic surgery corrects the position of the jaws.
The Face, Airway and Bite are the three key factors that determine how and why jaw surgery may be indicated.
In general, surgery is undertaken at the same time as orthodontic treatment (braces) to correct the position of the teeth. Orthognathic surgery not only corrects the alignment of the jaws, but also ensures that the teeth meet correctly.This can improve the function of the jaw, a patient’s dental health, the airway and a person’s facial appearance.
While for many people jaw surgery is an elective surgical procedure, there are some individuals when jaw surgery may be necessary.
Are braces or aligners (Orthodontics) required for jaw surgery?
Having well aligned teeth to assist with a stable bite is necessary for long term surgical stability. The upper and lower teeth and the jaws work together to achieve this. The majority of jaw surgery patients need some form of orthodontics to achieve a stable bite to assist the accuracy of surgery outcomes. Due to the complexity of this treatment, only qualified specialist orthodontists should be undertaking orthodontics (braces) for jaw surgery.
If you haven’t already seen an orthodontist, your individual presentation will be assessed and you will be guided on whether an orthodontic assessment is needed.
When is orthognathic surgery indicated?
When there is jaw discrepancy, eg large or small lower jaw, or small upper jaw
The patient has a ‘long face’ which may present with a gummy smile
The patient has a ‘short face’ which may present with no teeth showing or with a deep bite which may cause trauma to the gums and teeth
The patient has an asymmetrical face and jaw
The patient has an ‘open bite’ where the front teeth of the upper and lower jaws don’t meet.
The patient’s chin is too small, too large or asymmetric (Genioplasty)
Obstructive Sleep Apnoea (Maxillo-Mandibular Advancement) for the management of severe airway collapse and snoring
Post traumatic facial deformity after an injury to the bones of the face.
The treatment and planning for Orthognathic Surgery is usually carried out using a multidisciplinary patient centred approach with an Orthodontist and your general dentist. Sometimes, to optimise outcomes, we work with a specialist sleep physician, sleep psychologist or psychologist who manages body awareness.
Dr Madden employs the most contemporary 3D computer aided planning, patient specific personalised titanium plates and 3D intra-oral scans to ensure the most accurate and stable results.
Orthognathic surgery may involve surgery on either the top jaw, lower jaw, chin(genioplasty) or a combination of both jaws (Bimaxillary Osteotomy).
Sometimes surgical widening of a narrow upper jaw (SARPE/MARPE) is necessary at the very start of treatment even before orthodontics starts.
How long does jaw surgery treatment last and what is my recovery after jaw surgery?
Most cases start with the orthodontic treatment (pre-surgical orthodontics) followed by surgery 12-18 months later with the braces still on the teeth.
Surgery is carried out under general anaesthetic in a major private hospital setting and requires a hospital stay of 1-3 nights. Pain is well controlled in hospital and after discharge home based pain relief is provided to keep you comfortable. Most people need about 2 weeks off work, school or university. Patients require a modified diet after surgery, initially puree the transitioning to soft chew diet for 6-8weeks after surgery. Dr Madden will provide guidance and you are normally seen by a dietician in hospital who can provide contemporary information prior to discharge.
Bones have usually fully healed 6-8 weeks after surgery.
Most people can return to contact sport 10-12 weeks after surgery.
In general, 6 -9 months of Orthodontics is required after jaw surgery to help fine tune the final position of the teeth and bite.
The total treatment time for jaw surgery is approximately 1.5-2.5 years and includes both orthodontic (braces) time and surgery time.
Will I look different after jaw surgery?
Yes, it will change your facial profile and facial balance, which is often a primary goal for patients. Re-positioning the upper jaw, lower jaw, or chin can significantly improve facial symmetry, correct a receding chin, reduce a "gummy" smile, and change the appearance of your lips and nose.
Is jaw surgery painful?
During surgery, a very long acting local anaesthetic keeps you comfortable. Whilst in hospital you are provided with a strict post surgical pain regime (The Analgesic Ladder) and you are given medication to keep you comfortable when you return home. All surgery causes some form of swelling and pain, this is a normal response, and it typically peaks between day 2-5 after your surgery. Each person responds differently. For the majority of people, jaw surgery is well tolerated with the pain relief provided by the surgeon, simple regular ice packs for 3-4 days then regular heats packs after 7 days and keeping yourself in an elevated position with an extra pillow or two at home when sleeping. Most Swelling settles quickly over 14 days. While diffuse muscle stiffness and puffiness for some, can last 3-6 months. Patients will need to pay close attention to oral hygiene for 5-6 weeks after surgery.
Will I be numb after jaw surgery?
Temporary numbness or a "tingling" sensation in the lower lip, chin, cheeks, and gums is extremely common because the nerves running through the jaw are stretched or manipulated during the bone movement. For most patients, this resolves gradually over 3 to 6 months. However, there is a small, permanent risk of residual numbness in a small patches of the lips, gums, face, tongue or chin, though this does not affect your ability to move your face or smile.
What are the costs of jaw surgery?
Dr Madden’s practice is private practice only. The costs of jaw surgery can be quite significant, so top level private hospital health insurance is necessary to cover the cost of your hospital admission. Hospital fees can make up 2/3 of the total cost of surgery. In addition, there are surgeon fees, anaesthetist fees and where necessary surgical assistant fees and planning fees.
Surgeon Fees: Depending on the scope and complexity of surgery, surgeon fees in Sydney for jaw surgery may range from $6000 to >$20,000. Private health insurance makes a contribution to this but will not cover the full out of pocket costs.
Medicare only provides rebates if the surgery is deemed medically necessary to correct functional issues like severe malocclusion (misalignment), sleep apnoea, or developmental growth abnormalities. It will not cover surgery done strictly for cosmetic facial contouring. Private health insurance can cover a substantial portion of the private hospital accommodation and theatre fees, provided you have top-tier hospital cover and have served the necessary waiting periods (on average a 12 month waiting period applies for new insurance or when moving to a higher level of cover )
At the time of your appointment, Dr Madden’s team will provide you a letter with a guide to current fees, timing of fee payments and other contacts and appropriate medicare item codes to ensure you are able to arrange the correct level of private health insurance in time for your surgery. In general, we do not recommend a particular insurer as each one changes its policies regularly.
Who does Dr Madden work with and how do I arrange a jaw surgery appointment?
Dr Madden works closely with a number of Sydney’s leading Specialist orthodontists and orthodontic practices to provide corrective jaw surgery and maxilla-mandibular advancement for sleep apnoea.
Should you wish to enquire about jaw surgery please ask your orthodontist, dentist or family doctor to refer you for a consultation - we require a new OPG xray and Lateral Cephalogram Xray and preferably new study models/moulds of you teeth. If you are enquiring about jaw surgery for sleep apnoea, a recent sleep study with review by a specialist sleep physician helps to guide the advice you are provided with.
If you don’t have an orthodontist or sleep physician, Dr Madden would be happy to recommend one in your area. We recommend seeing an orthodontist close to home or to work as it may involve regular 6 weekly visits to manage changes in your bite.
With our very easy transport links on major rail, metro, bus and our close relationship with a wide range of specialists and many years of experience, if you need jaw surgery in the Sutherland Shire, or jaw surgery in Sydney, jaw surgery in the Eastern Suburbs or Lower North Shore, jaw surgery in the Hills District or Inner West then please contact our rooms to make an appointment to see Dr Madden, we would be delighted to welcome you to our practice.