November 23, 2023 Author : João Ferreira de Barros Orthognathic surgery is the area of maxillofacial surgery that aims to correct bone deformities in the face and jaw , with aesthetic and functional benefits. It improves bite function, breathing and quality of life. The idea of having facial surgery almost always brings fear associated with it. However, in orthognathic surgery, as in others medical subjects, the evolution of medicine and technology has brought knowledge and tools that currently allow to transform many people lives. Indications for orthognathic surgery This type of surgery may be indicated in patients with: Dentofacial deformities; Bite disorders; Facial dysmorphia; Treatment of obstructive sleep apnea syndrome (OSAS). Misaligned bite : When the upper and lower jaw do not fit correctly due to skeletal problems (poor relative position of the jaws) and not just to dentoalveolar problems (misaligned teeth), it leads to problems with chewing and speaking and correction is essential. Facial dysmorphia : Deformities of the facial bone bases are corrected, such as a recessed jaw, a retracted or very prominent chin, lateral deviations with asymmetries, among others. Breathing problems : Improving the permeability of the airway, particularly the nasal cavities (nasal septum, inferior nasal turbinates, pyriform orifice, among others), can be essential when there are breathing difficulties. Obstructive sleep apnea syndrome (OSAS) : It involves the treatment of cases of sleep apnea related to dentofacial deformities that favor the fall of soft tissues in the upper airways during sleep when there is greater relaxation. Orthognathic surgery in the treatment of OSAS Obstructive sleep apnea syndrome (OSAS) is a serious disorder that affects the quality of life and health of many people. By definition, in OSAS the upper airway becomes obstructed during sleep , resulting in repeated pauses in breathing. One of the possible causes of this obstruction is the presence of dentofacial deformities, such as mandibular retrognathism, that is, when the mandible (lower jaw) and chin are too far back. Orthognathic surgery plays a fundamental role in the treatment of OSAS related to these deformities. Through maxillomandibular advancement, the maxillofacial surgeon is able to reposition the mandible and jaw, creating space in the posterior airway and allowing easier ventilation during sleep. Many people who suffer from severe apnea improve significantly after the procedure: Reducing dependence on CPAP equipment (continuous positive airway pressure); Reducing the risk of cardiovascular diseases and excessive daytime sleepiness. Preparing for orthognathic surgery Before undergoing orthognathic surgery, a period of preparation is necessary, which involves the evaluation and collaboration of an experienced orthodontist dedicated to this area. Based on the initial assessment, the orthodontist works together with the maxillofacial surgeon to define the preparation and treatment plan. Dental device It is necessary to use orthodontic braces before and after surgery to prepare the teeth and align the bite. The orthodontist will work closely with the surgeon to ensure that the teeth are in the proper position for the procedure. The objectives of preparation devices for orthognathic surgery and devices for conventional orthodontic camouflage are different, and it is necessary to commit to the treatment plan outlined from the beginning: the idea of “using the device to improve and then seeing if it is necessary to operate or not ” is wrong. Dental decompensation Orthognathic surgery is often performed to correct significant jaw deformities. During preparation, the teeth will be moved according to this misalignment, which is essential for the success of the surgery. Wisdom teeth extraction If there are impacted wisdom teeth (or other teeth) that could interfere with the surgery, the surgeon may recommend its prior extraction. This helps to avoid complications during surgery and facilitates the recovery process. Surgery and post-surgery Edema and pain : It is common to experience facial swelling and discomfort after surgery. Medication during hospitalization and at home, in addition cold pads and elevating the head of the bed, will help control pain and edema. Speech recovery : You will be able to speak surgery, although the swelling and the new position of the jaws may appear strange at first. This will resolve as recovery progresses. Nerve sensitivity of the face : Loss of sensitivity or temporary numbness may occur in the face, especially in the lower lip, which usually improves over time and as the sensory nerves recover. Bite : The bite will be somewhat out of alignment immediately after surgery, but this is part of the process. With time and orthodontic monitoring, this will be corrected and refined. Mouth opening : During the first few days or weeks after surgery, it is normal to experience a decreased range of motion of the jaw. Physiotherapy and mouth-opening exercises play a crucial role in recovery. To improve jaw range of motion, relieve muscle stiffness, and help restore function, it is important to perform gentle mouth-opening exercises. As recovery progresses, the ability to open and close your mouth will gradually increase. Oral hygiene and diet : It is essential to maintain good oral hygiene to avoid infections. A liquid or soft diet is essential in the first month, avoiding hard foods. Gradually as the bone consolidates food consistency may be increased. Return to work and sport : Physical activity should be limited during the first stages of recovery. Time required to return to work varies. Lighter activities may be resumed sooner, but it will generally take a few weeks before it is possible to return to intense physical exertion and contact sporting activities. And patience! Full recovery may take some time. It is important to be patient and follow the prescribed precautions to optimize results. By following the guidance of healthcare professionals, you will help ensure a successful recovery. The points mentioned are just some general indications. Your surgeon and orthodontist will provide specific and personalized guidance, according to individual evolution. It is important to follow all instructions carefully to ensure the success of orthognathic surgery and a favorable and smooth recovery . Meet the maxillofacial surgery clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
