Surgical Treatment to Correct the Faulty Jaw: Frequently Asked Questions

[Anonymous]

Can a toothache indicate a problem with the jaw?

A toothache certainly can indicate a problem within the jaw. Whenever a toothache occurs, it should be evaluated to prevent any potential infection from spreading into the jaw or surrounding soft tissues.

Why would you wire the jaw shut — can’t you surgically advance the jaw without wiring?

With most osteotomies or major jaw surgery to move the jaws, it is not necessary to wire the teeth together. Instead, we use titanium plates and screws to secure the jaw into the new position.

Isn’t wiring a jaw shut painful?

The use of wires to close the upper and lower jaws together is not painful because of the use of local anesthetics, conscious sedation, and occasionally general anesthesia

With jaw surgery, are any scars visible?

There are generally not any visible scars when major jaw osteotomies or cuts and movements are accomplished. The majority of incisions are intraoral or inside the mouth. The oral mucosa or tissue has an amazing capacity to heal and even intraoral scarring is minimal.

I have a severe underbite and would like to get it fixed. Should I consult a surgeon like you, or a plastic surgeon?

With respect to a patient with a severe underbite, first and foremost, one should visit an orthodontist. Correction of a malaligned or an underdeveloped jaw requires a combined effort, usually including an orthodontist and an oral and maxillofacial surgeon. Plastic surgeons also do osteotomies. I would recommend relying on your orthodontist for ultimate referral.

What is JRA?

JRA is “juvenile rheumatoid arthritis”. This condition will involve both temporomandibular joints. Fortunately, unlike adult rheumatoid arthritis, this process tends to “burn out” as the child reaches their late teens. The ultimate diagnosis of JRA does not come specifically from the observation of TMJ changes.

There is a new trend for moving facial bones called distraction osteogenesis. This is essentially moving the bone very slowly after making a corticotomy or bone cut, that movement being approximately 1 mm per day. This can be accomplished with an intraoral or extraoral device. Distraction osteogenesis is not a replacement for routine orthognathic or jaw surgery, but has been an exciting addition to our surgical options for treatment of assymetries and the severely underdeveloped jaw.

What kinds of pain medications are normally prescribed to a patient after jaw surgery? Does welling often occur?

Following jaw surgery, we typically prescribe a mild analgesic. It is not usually necessary to give antibiotics beyond the final dose give intravenously in the recovery room. With upper jaw surgery, we often give a nasal decongestant to decrease swelling of the nasal mucosa. Otherwise, no other medications are generally prescribed. With respect to swelling, we utilize peri-operative high-dose steroids. This limits the amount of swelling that occurs from surgery and facilitates patient comfort. Patients are not swollen to a great extent; however, the amount of swelling varies from patient to patient.

what is the percentage of people who will experience an infection after surgery?

The incidence of infection following orthognathic or jaw surgery is very low. In the literature, the incidence is reported to be between 6 and 15 percent. These figures are high, in my opinion. When it occurs, the infection is easily treated with antibiotics and drainage with minimal discomfort and no long-term sequelae.

Is there any long term follow up needed?

Following a jaw osteotomy, we have patients return for numerous postoperative visits. We see patients typically at 1 week, 3 weeks, 6 weeks, and 12 weeks following surgery. We also see the patient back at the 6-month and 12-month intervals. This is to assure that the proper jaw correction has been obtained, is stable, and that there is not an infection or any other postoperative complications.