Ortho means straighten and gnathia means jaw, and hence, Orthognathic Surgery means surgical straighting of the jaw(s). The main objective of Orthognathic Surgery is the correction of a wide range of minor and major facial and skeletal (jaw) irregularities. The shape of the face depends on the architectural framework of the facial skeleton. Through an Orthognathic Surgery in UAE, the Oral & Maxillofacial Surgeon could reposition the bones of the face and the jaw to a more aesthetically acceptable position while improving the bite and function
Orthognathic surgery is generally performed to correct malocclusion (bad bite) in cases where routine orthodontic treatment has not or will not be effective.
There are several classifications of malocclusion (the improper coming together of teeth) which may require orthognathic surgery:
This malocclusion means that the lower anterior incisors sit directly behind the upper anterior incisors when the patient bites down. This is considered less destructive than Class II and Class III malocclusions.
This is identified when the lower anterior incisors lie significantly behind the upper anterior incisors during the biting process; in some cases hitting the soft tissue behind the upper incisors. This is commonly referred to as an overbite and can cause discomfort, bone damage, excessive wear of the front teeth, and tooth loss.
This is commonly known as an under-bite and occurs when the lower anterior incisors and lower jaw are positioned beyond the upper teeth, making the lower jaw much more prominent than the upper jaw.
Jaw growth is a gradual process in accordance with the growth of a person. In some instances the upper and lower jaw or one side of the jaw to the other may grow at different rates. This may cause many functional and aesthetic problems. Injuries to the jaws at a young age or birth defects may affect the normal growth of the jaws. While Orthodontic treatment (braces) can correct many problems if only the teeth are involved, Orthognathic Surgery in UAE maybe required if the jaws (bone) also need correction.
1-Improve Masticatory Function
2-Improve Facial Cosmesis
3-Treat or Prevent Joint Problems
5-Treat Obstructive Sleep Apnea Syndrome
The malocclusion of the teeth can create greatly destructive forces among the five powerful muscles that control the closing and opening of the jaw. These muscles generate a tremendous force when clenching, grinding or chewing. Misalignment can seriously damage the function and aesthetic appearance of the teeth in many ways if left untreated, such as:
In the case of an overbite, the pressure and wear on the teeth is not spread evenly. This can also lead to TMJ, migraine headaches, and tooth loss.
Chronic Jaw, Muscle Pain & Headache – The misalignment of the teeth alters the way the facial muscles interact. In some cases, the meniscus cartilage which acts as a buffer between the jawbones can be painfully damaged.
When uneven pressure is continually exerted in unintended places or soft tissue is damaged by an overbite, adjacent teeth may become loose in their sockets which causes pain and reduces proper function.
Each can be associated with muscle pain and/or poor alignment of the upper and lower jaws.
It can be treated better once the jaws and bite is normally placed
Maxillomandibular advancement is carried out in cases of OSA which has not responded to other conventional medical and surgicl management or in cases where jaw deformity is contributing to OSA
a. Difficulty with biting and chewing
b. Inability to make teeth meet together
c. Discomfort due to the malocclusion
d. Palatal or gingival soft tissue trauma (e.g. deep overbite)
c. Speech difficulties / sleep disorders
d. Temporo-mandibular joint pain and discomfort.
e. Wishes to have teeth replaced /told jaws are not aligned
a. Facial appearance – Protruding /retruding Jaw / Chin
b. Smile – gummy smile / lack of teeth show / want better smile
c. Deviation of the jaw / change in bite
The common Dentofacial deformities and their clinical appearances are the following:
The upper jaw is protruded beyond the normal limits along with the teeth. The person cannot close the lips (lip incompetence) without effort. The teeth are often visible at rest and in most cases there is excessive visibility of the gum (gummy smile). A gummy smile is mainly due to the vertical excess of the maxilla although it can be due to short lip also .The common procedures done on the maxilla are Lefort 1 Osteotomy and anterior Maxillary Osteotomy
This deformity is due to under development of the upper jaw . These patients usually have a concave facial profile , with very little if any of upper teeth being seen.
It is also in people who have cleft lip or palate. After the surgical correction of the cleft lip and palate at a young age the growth of the maxilla is retarded along with mal alignment of teeth. This results in a dish shaped face with a hooked or flaring nose and irregularly aligned, rotated or missing teeth.
In some people there will be extra growth of the lower jaw resulting in long jaw. The face is very long with protrusion of the lower jaw with thick lips. Normally on biting the lower teeth will be inside the upper teeth while in people with long jaws often the lower teeth will be outside the upper arch. The common procedure done on the mandible are Sagittal Split Osteotomy done on the Ramus, Body Osteotomy, Genioplasty etc.
In some people due to developmental deformity or due to hereditary factors the lower jaw is very small and or placed in backward position. There may be no proper development of the chin. Mandible and chin can be advanced by surgery.
Sometimes a part of the face maybe overdeveloped or underdeveloped causing one part of the face to be small or large. One side of the face is not in symmetry with the other side giving an unaesthetic appearance. In these cases a single jaw surgery or sometimes two jaw surgery is required to correct the asymmetry.
Occasionally, a narrow upper or lower jaw can be present. In an adult ,surgical procedures in the maxilla (SARPE- surgically assisted rapid palatal expansion) is the most common surgery done to expand the narrow upper jaw with orthodontics and surgery. Very less frequently a similar procedure is done in the mandible also to achieve expansion
A detailed aesthetic facial, radiologic and dental examination is the first step. A multidisciplinary treatment plan must be formulated from all the findings along with an orthodontist and when possible patient is evaluated along with the orthodontist in joint clinical session. The Oral & Maxillofacial Surgeon and the Orthodontist will work closely together during the treatment. Choosing this type of treatment requires a considerable commitment from you because the alteration of the positions of both your jaw and teeth is not a speedy process.
Orthodontic treatment is started before surgery. The teeth are moved and re positioned into proper alignment before surgery. This pre-surgical phase can take any where between 6 months to 1 and half years . This may also involve removal of your some premolar teeth and during this phase the facial appearance and bite may appear to get worse and will get better only after surgery and post surgical orthodontic phase.
Having a strong positive attitude towards the surgical procedure and outcome will serve to make the whole experience a more positive one. If you are feeling negative or very skeptical about things, DO NOT have the procedure performed. Arrange for family or friends to be with you during the first two or three days. Their support is important.
For several weeks before your surgery, avoid substances to which you are allergic. Try to get some physical exercise, sleep well and allow yourself to rest. Our bodies heal while we sleep and rest.
Smoking is discouraged the week before surgery and 2-4 weeks after the surgery.
Stopping smoking before surgery will help your body cope better with the anesthesia. Smoking following surgery can interfere with the tissue healing and cause wound breakdown.
Taking Vitamin C, 1000mg. 1-2 times daily. It will strengthen your immune system, promote healing and lessen pain. However, do not take it the night before surgery as Vitamin C can lessen the effects of anesthesia. Resume taking it after surgery as soon as approved by your surgeon. Vitamin E is also an important supplement. It functions as the most important antioxidant found in the body. Recommended doses of Vitamin E are 400 to 800 IU daily. Always begin Vitamin E supplements in small amounts. Stop Vitamin E two days before surgery and do not take it for five to six days afterward. High amounts of Vitamin E could potentially contribute to excessive bleeding. Multivitamins with iron are also necessary to replace any blood loss and should be taken starting at least two months before surgery.
A thorough examination with facial measurements, photographs, x-rays is done when the orthodontic preparation is completed. Prior to scheduling your operation, the surgeon will carefully review your medical history. It is most important that you advise him of any past and present medical problems, illnesses, operations, medications you are currently taking (both prescription and over-the-counter), allergies, and any adverse reactions to medications or to a previous general anesthetic.
A complete medical examination along with blood tests is done to rule out any health problems that would interfere with the surgery or the administration of General Anesthesia. The patient is admitted to hospital on the same day as surgery.
This is the surgical procedure done on the maxilla (upper jaw) to shorten or lengthen the maxilla to correct maxillary protrusion,vertical excess or retrution. The upper jaw is cut and repositioned to correct the deformity.
This is used to correct the protrusion of the maxilla. This procedure is often combined with LeFort 1 osteotomy or independently as per the requirement
This procedure is done on the mandible (lower jaw) to shorten or lengthen the mandible to correct long jaw or retruded jaw respectively. After putting an intraoral incision a split is made at the ramus of the mandible. The jaw is repositioned and the jawbones are held together with the help of screws and bone plates.
This is used to correct the defects of the chin. Chin can be moved in all the three dimensions by surgery. Chin can be augmented, reduced, moved to the sides etc.
This is the surgery done to assist in the expansion of the maxilla(upper jaw) by orthodontic appliances.
Joint Commission International (JCI) works to improve patient safety and quality of health care in the international community by offering education, publications, advisory services, and international accreditation and certification. It is the recognized global leader in healthcare accreditation with the highest standards built on maximum safety and minimum risk.
There are a couple of hospital options that I affiliated with, which accredited by JCI. I will perform your surgery at either one of the distinguished, cutting edge hospitals in Dubai. You may opt for one during the consultation.
When you wake up from your anaesthetic, you will feel sleepy, swollen and sore around the mouth and face. During the surgery, we take great care to protect the nerves that run through the jaws, however, immediately after your surgery some areas of your face might feel numb.
When you first wake up, you will not be able to open your mouth as some gentle elastic bands are used with the braces on the upper and lower teeth, to guide your teeth into position. Patients will wake up to find a bandage wrapped around their jaw. Chin and nose This is a pressure dressing to reduce swelling and is usually removed 48 to 72 hours after surgery.
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