Surgical Treatment to Correct the Faulty Jaw: Frequently Asked Questions

[Anonymous]

What can be done to prevent infection?

During jaw surgery, we utilize high-dose perioperative intravenous antibiotics for prophylaxis to prevent infection. Meticulous surgical technique and accomplishing the surgery in an efficient manner will also reduce infection rates. Occasionally, if bone graft is utilized during osteotomy, we will continue the antibiotic therapy for 7-10 days orally after discharge.

Like the Ilizarov leg lengthening procedure?

Jaw distraction osteogenesis is based on the Ilizarov leg lengthening procedure. In many ways, it is more successful and reliable in the head and neck region versus the extremities because of the ample blood supply found in the head and neck.

How often is this jaw distraction performed?

The distraction osteogenesis procedures are somewhat new, and are being utilized for the more severe deformities. It is also being utilized very early in life to advance the lower jaw and prevent the need for a tracheostomy in children with microgenia or micrognathia.

I have two bumps on my lip. How do I get rid of them?

With regard to bumps on the lip, I would advise seeking the opinion of a physician or dentist. Many bumps on the lip can be related to the minor salivary glands. There are, of course, many other causes.

Over what period of time is the distraction completed, and what kind of followup?

Let’s look specifically at mandibular or lower jaw distraction osteogenesis: once the bony corticotomy or cut is made, and the distraction device is placed, the distraction rate is approximately 1 mm per day. Thus it is possible to advance the lower jaw approximately 14 mm in 2 weeks’ time. This obviously is a large advancement. Once the jaw has been advanced, it is necessary to “lock up” the distraction device with the jaw in the advanced position. This allows the newly formed bone to calcify and heal. One other advantage of distraction osteogenesis is that the soft tissue envelope meaning muscle and skin readily, follow the bone.

What is the likelihood that you would lose sensation in your mouth after surgery?

Following orthognathic or upper/lower jaw surgery, there will be neurosensory changes. The nerves involved with jaw surgery are not motor, meaning surgery will not affect how your face looks or moves. In the lower jaw, the numbness will include the lower lip, chin and gum tissue, and in general, this should resolve in about 3 months. Sometimes neurosensory changes take up to 18 months in an adult to resolve. Occasionally, minor neurosensory changes of the lower lip and chin can be permanent. Permanent numbness following an upper jaw (maxilla) procedure is less common.

Is there a great chance of infection at the pin sites?

These pin sites are remarkably free of infection; however, one complication with the pin sites is stretching of the skin and scarring. Thus, there is a great push to develop smaller and more efficient intraoral distraction devices to eliminate this problem.

How is it locked up?

When one is using distraction osteogenesis, it is the patient’s caregiver or the parent who will activate the appliance either once or twice per day. The device specifically clicks, indicating a 1-mm advancement, and after achieving the desired movement, there is a locking mechanism to keep the device in its final position during healing. Some devices have different measurements; meaning 1 click might equal 0.5 mm.

Is it dangerous to nerves in jaw?

Distraction osteogenesis can also affect the sensory nerves within the bone; however, patients are generally young and neurosensory recovery is good. The distraction device is usually left in place for approximately 6 weeks following the last distraction movement or after it is “locked up.” If the device is an extraoral appliance, it is usually quite easy to remove the pins and often does not require a general anesthetic.