Orthognathic surgery to treat dentofacial (jaw) deformity is coordinated with your orthodontist’s treatment (braces) & carried out to straighten and align the teeth in order to improve the occlusion (bite), speech articulation, breathing and overall facial appearance.
The first phase of treatment consists of pre-surgical orthodontics to move your teeth into their most healthy and stable position. This allows your teeth to fit together properly when the jaws are surgically repositioned. During this time you will meet with your orthodontist on a regular basis.
Orthodontics in preparation for jaw surgery corrects malposition of teeth that occurs naturally to compensate for the abnormal jaw relationship. The approach to orthodontic treatment used to prepare for orthognathic surgery is different from that which would be done to “camouflage” a skeletal deformity with orthodontics alone.
The majority of the orthodontic work is carried out prior to the surgical procedure with final orthodontic detailing completed after the operation. Braces remain on the teeth during the entire process which from start to finish requires approximately one to three years.
Dr. Fantuzzo will work closely with your orthodontist to design an effective plan that meets your objectives.
As the pre-surgical phase of orthodontic treatment nears completion, additional records will be taken that may include: new imaging, current dental models, facial photographs and a bite registration.
After completion of pre-surgical orthodontics a final “surgical” stabilizing orthodontic wire will be placed.
An appointment will need to be scheduled 4-6 weeks prior to your date of surgery. At this time, Dr. Fantuzzo will perform a more detailed facial and oral exam and take “final records.” A Cone Beam CT scan and/or updated articulated dental models will be used to “simulate” the planned surgery providing information that will be used to more precisely achieve an ideal occlusion & facial appearance. Acrylic “splints” will be made to serve as a guide for alignment of the jaws into the hoped for position in the operating room.
The surgery is performed in the hospital operating room under general anesthesia. During the month prior to your surgery, make arrangements for a general physical exam and routine laboratory work, with your family physician.
No smoking 6-8 weeks prior to surgery and for at least two weeks after surgery. Smoking jeopardizes wound healing and makes your airway more reactive compromising lung and overall health.
You may not have anything to eat or drink after midnight the night before surgery. Ask me about medications that you may be taking as they relate to your surgical procedure. All of this is to ensure your safety.
You will check in to the hospital on the morning of surgery. There you will meet with the anesthesiologist. The operation will generally take from one to four hours depending on surgical details. The length of hospital stay is generally one to two nights. Once you have gained enough strength and are able to walk (ambulate) without assistance, and drink enough fluids, you will return home to the care of your family.
During the initial recovery period you should expect temporary swelling of the lips and cheeks, bruising, nasal congestion, a sore throat and a variable degree of nausea. Swelling generally progresses for the first 48-72 hours. Ice is helpful as directed during the first 24-36 hours after surgery, to limit swelling.
The newly positioned facial bones are held together (while they heal) with small metal (titanium) plates and screws placed across the osteotomy (bone cut) sites at the time of the operation. The use of small plates and screws limits the need for wiring the jaws together. For a time, orthodontic (elastic) rubber bands will be used to guide your bite and allow the jaws to comfortably rest after surgery.
After leaving the hospital it is recommended that you remain basically at home during the initial two weeks. Prescriptions will be given for pain medication and antibiotics.
A high-calorie, high protein, blenderized diet is important and should be supplemented with liquid vitamins. The blenderized diet will be continued for five weeks after surgery before you gradually return to regular food. Nutrition will be taken through a syringe until a cup and/ or spoon can be used effectively.
You will begin brushing the teeth using a prescribed antimicrobial rinse on a soft toothbrush starting the day after surgery. You may shower and wash your face and hair on the day after surgery. Sleep with your head elevated (on two or three pillows) for the first five days after surgery to help with drainage of fluid and decrease swelling. Nasal congestion is expected during the first 3 to 5 days after surgery. Saline nasal spray may be helpful during this time. Do not blow the nose during the first two weeks after surgery as doing so may increase the risk of bleeding.
Walking is encouraged as well as reading and desk type work as you wish. In general you may return to office or school work after two weeks, but should refrain from (sports related) physical activities for six to eight weeks or until permission is given. Initial healing takes four to six weeks but complete healing will take six to twelve months.
Four to six weeks after surgery you will return to the orthodontist for “finishing” post-surgical orthodontics. During this time your orthodontist will “fine tune” your bite. In the majority of patients, braces are removed four months to a year after surgery.
As in any operation, complications are possible and may include anesthesia related problems, pain, swelling, infection, bleeding, temporary or permanent alteration of facial sensation, injuries to adjacent teeth or bone, relapse of the new jaw position with malocclusion, limited range of lower jaw mobility, (TMJ) jaw joint pain and dissatisfaction with facial appearance. Fortunately most of these are rare. The risks and benefits of orthognathic surgery will be discussed with you in detail at each visit.
Orthognathic surgery when combined with orthodontics will move your teeth and jaws into a new position designed to provide better facial balance, function and health. In general your facial appearance will be enhanced with the potential for positive effects on your self-esteem.
Our office looks forward to providing high quality medical, dental and facial surgical care for you. Please call Fantuzzo - Oral, Maxillofacial & Dental Implant Surgery, P.L.L.C. Phone Number 585-737-6973, if we can answer any questions or concerns that you may have.