Orthognathic surgery is the name of the combined procedure in which the jaws are brought to their correct positions by surgery in addition to orthodontic treatment, in cases of skeletal disorders where only orthodontic treatment is not sufficient to create a more aesthetic appearance on the face.

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In cases where dental disorders are accompanied by jaw disorders, braces treatment alone is not sufficient; jaw surgery may also be required. Lower or upper jaw surgery planned by the orthodontist should only be performed by oral, dental and maxillofacial surgeons and plastic surgeons who specialize in this field. 

Orthognathic surgical treatment is a surgical treatment for patients who are not satisfied with their facial appearance. In adult patients whose growth and development period has ended, incorrect jaw positions cannot be corrected only by orthodontic treatment (braces). The patient requires surgical intervention along with brace treatment. Thanks to public awareness on this issue and technological advances, orthognathic surgical treatment is becoming increasingly common.

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Proper alignment of teeth can be achieved with orthodontic or orthopedic treatment. Interjaw relationships can also be corrected to a limit. However, in some cases orthodontic treatment is inadequate. In such cases, a maxillofacial surgeon can work with an orthodontist to surgically correct a severe anomaly.

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Nowadays, with increasing aesthetic concerns, orthognathic surgical treatment is becoming increasingly common.

 

The treatment protocol applied in orthognathic surgery cases is as follows:

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1. The decision for orthognathic surgery is made based on the clinical examination of the patient, a number of x-rays (Cephalometric, PA, OPTG) taken from the patient and the results of the drawings made on these x-rays.

2. The patient's measurements, photographic records, and medical history are taken.

3. By looking at the orthodontic models obtained from the measurements, it is decided whether upper jaw expansion is required. If necessary, this usually requires surgical intervention called corticotomy (after the age of 15, maxillary expansion is not possible without surgical support called corticotomy). The device that will expand the upper jaw is glued to the mouth and a corticotomy is performed on the patient by the surgeon. Chin expansion takes an average of 15 days. Afterwards, the expander device is kept passively in the mouth for 3 months (for reinforcement purposes). At the end of 3 months, the expansion appliance is removed from the mouth. Classic wires are attached.

4. If jaw expansion is not required, direct wires are placed and orthognathic surgery preparation begins. Since the treatment is performed according to the 'post-operative position' in cases preparing for orthognathic surgery, measurements are taken from the patient at certain periods (every 3-4 months), the need for treatment is determined and the treatment is directed accordingly.

5. By the way, if the patient's wisdom teeth are in the mouth - especially the lower wisdom teeth - these teeth should be extracted at least 6 months before the surgery, as they will remain in the incision line during the surgery.

6. The duration of treatment varies depending on the severity of the case. After approximately 12-18 days, the patient is ready for surgery.

7. The patient receives an appointment for surgery from the surgeon.

8. The orthodontist takes a new Cephalometric, PA and OPTG from the patient 10 days before surgery. The patient's final measurements and photographic records are taken. In the light of all these records, the Orthodontist (with the opinion of the Surgeon) plans the surgery.

9. The orthodontist prepares the splints to be used during surgery in accordance with the surgery planning and tries these splints in the patient's mouth a few days before the surgery. He attaches surgical hooks to the patient.

10. The patient goes to the surgeon with these splints and has the surgery. The orthodontist also participates in the surgery - unless there is a significant obstacle. The operation takes an average of 4-5 hours (varies depending on the case).

11. During the surgery, the upper jaw and lower jaw are fixed in their ideal positions. On the first day, the patient's mouth is left open (to avoid the risk of vomiting). On the 2nd day, the splint is placed back in the mouth and the mouth is closed with elastics attached between the lower wires and the upper wires. The patient can no longer open his mouth. The patient's mouth remains closed for 3-4 days (sometimes 1 week). The patient is discharged 2-3 days after the surgery (at the surgeon's discretion). Meanwhile, the patient is fed through a straw because he cannot open his mouth.

12. At the end of a week, the patient comes to the Orthodontist and the mouth is opened. The splint is attached only to the upper jaw, leaving the patient's mouth open. However, we are taught how to remount tires. Thus, the patient takes off the elastics and opens his mouth while eating (in the meantime, he can start eating soft foods), and puts them back on after eating. 

13. At the end of two weeks, the splint is removed. After this stage, the Orthodontist continues the treatment to ensure the ideal relationship between the lower jaw and the upper jaw. This period varies between 3-6 months.

14. After the ideal relationship between the lower jaw and upper jaw is established, the treatment is terminated by removing the wires and installing reinforcement devices.