Ortho means straighten and gnathia means jaw and hence, Orthognathic Surgery means straightening of the jaw(s) by surgery. An Oral & Maxillofacial Surgeon carries this out. It is a cosmetic surgery and the surgeon envisages changing the face of a person from distortion to proportion. Orthognathic Surgery is sometimes called “Surgical Orthodontics” because just as an orthodontist repositions the teeth with the help of braces within the oral cavity, the Oral & Maxillofacial Surgeon repositions one or more jaws (skeletal bones) through surgical procedures to produce a much more pleasing appearance and also improved ability to chew, speak and breathe.
The main objective of Orthognathic Surgery is the correction of a wide range of minor and major facial and skeletal (jaw) irregularities. The shape of the face depends on the architectural framework of the facial skeleton. Through Orthognathic Surgery the Surgeon could reposition the bones of the face and the jaw to a more aesthetically acceptable position.The common maxillofacial deformities and their clinical appearances are the following:
1. Protruded Maxilla (upper jaw):
The upper jaw is protruded beyond the normal limits along with the teeth. The person cannot close his lips (lip incompetence) without effort. The teeth are always visible and in most cases the whole of the gums are visible on smiling (gummy smile). A gummy smile is mainly due to the vertical excess of the maxilla.
2. Retruded Maxilla:
This deformity is due to under development of the upper jaw mainly seen in people who have cleft lip or palate. After the surgical correction of the cleft lip or palate at a young age the growth of the maxilla is retarded along with displacement or destruction of the tooth bud. This result in a dish shaped face with a hooked or flaring nose and irregularly aligned rotated or missing teeth.
3. Protruded Mandible (lower jaw):
In some people there will be extra growth of the lower jaw resulting in long jaw. Their faces are very long with protrusion of the lower teeth and thick lips. Normally on biting the lower teeth will be inside the upper teeth while in people with long jaws usually the lower teeth will be outside the upper arch.
4. Retruded Mandible:
In some people due to developmental deformity or due to hereditary factors the lower jaw is very small resulting in a “bird face”. There is no proper development of the chin.
5. Facial Asymmetry:
Sometimes a part of the face maybe overdeveloped or underdeveloped causing one part of the face to be small or large. One side of the face is not in symmetry with the other side giving an unaesthetic appearance.
6. Ankylosis of Tempromandibular Joint (TMJ):
Injury during birth or trauma or infection at a young age to the tempromandibular joint will result in restricted mouth opening and reduced growth of the mandible.
7. Nasal Deformity:
Nasal deformities are often seen along with deformities of the jaw. Some common deformities of the nose are: deviated nasal septum flared or constricted ala of the nose, saddle nose, hooked nose, asymmetrical nose, etc. The ideal age for Orthognathic Surgery is after the growth period has been completed, that is after 18 years for girls and 20 years for boys.