Short answer: Orthognathic surgery is a planned jaw operation performed to correct discrepancies in the position and size of the upper and lower jaws relative to each other or to the rest of the face. It is used for skeletal problems that cannot be solved by tooth movement alone, usually after growth is complete, and is planned jointly by an orthodontist and a jaw surgeon. Orthodontic treatment before and after surgery is part of the process.
Some bite problems are caused not by how the teeth are arranged but by the size and position of the jaws themselves. In situations such as a markedly protruding lower jaw, a retruded upper jaw or jaw asymmetry, moving the teeth alone may not give a sufficient result either functionally or aesthetically. Orthognathic surgery is a jaw surgery method planned together with orthodontics to correct these kinds of skeletal discrepancies. In this article we cover who needs it, the stages of treatment, the recovery process and realistic expectations.
What is orthognathic surgery?
Orthognathic surgery is an operation in which the upper jaw, the lower jaw or both are cut in a controlled way, moved to a new position and fixed there with small plates and screws. The aim is to improve functions such as chewing, biting, speaking and breathing, and also to achieve a more balanced facial profile.
The operation is performed under general anesthesia by an oral and maxillofacial surgeon in a hospital setting. Because most of the incisions are made inside the mouth, in most cases no external scar is left on the face. The technique used varies with the type of problem: procedures on the upper jaw, procedures on the lower jaw and, if necessary, procedures that adjust the position of the chin can be planned alone or in combination.
Which jaw problems require it?
Orthognathic surgery is considered for skeletal discrepancies so pronounced that they cannot be compensated for with tooth movement. The most common situations are:
- Protruding lower jaw or retruded upper jaw: Skeletal Class III cases, in which the front teeth bite in reverse and the lower jaw looks markedly forward.
- Retruded lower jaw: Skeletal Class II cases, in which the jaw sits back, with a markedly convex profile and a deep bite.
- Open bite: Cases of skeletal origin in which the front teeth do not touch while the back teeth are in contact.
- Facial and jaw asymmetry: Cases in which the jaw is shifted to one side and the facial midline is disrupted.
- Vertical problems: Conditions such as vertical excess of the upper jaw, which causes too much gum to show when smiling.
In some cases of obstructive sleep apnea, moving the jaws forward may also be considered among the treatment options; this decision is made together with a sleep physician. Not every skeletal difference requires surgery. Mild and moderate discrepancies can often be brought to an acceptable bite with orthodontic treatment alone by adjusting the position of the teeth within the bone. If you are curious about the effect of clear aligners on jaw structure, our article do clear aligners correct jaw structure explains this distinction in detail.
The right age for surgery
Orthognathic surgery is usually planned after facial and jaw growth is complete. When growth ends varies from person to person; it is usually completed earlier in girls and somewhat later in boys. The dentist assesses whether growth has stopped with a hand-wrist X-ray, serial cephalometric measurements and clinical follow-up. If surgery is done while growth is ongoing, continued growth of the jaw may change the result.
Why is orthodontic treatment needed before and after surgery?
Orthognathic surgery is not a treatment on its own; it is part of a process carried out together with orthodontic treatment. Before surgery, the teeth are aligned so that they will bite together correctly once the jaws are moved to their new positions.
In people with a skeletal discrepancy, the teeth may have tipped over the years to adapt to the situation; this is called dental compensation. An important aim of pre-surgical orthodontics is to remove these tilts (decompensation). For this reason, in the period before surgery the bite and appearance may temporarily show a more pronounced discrepancy; this is an expected part of the plan. In most cases this phase may last a year or somewhat longer.
After surgery, orthodontic treatment also continues for a while for the final adjustments of the teeth. At the end of treatment, a retainer is needed to maintain the new position of the teeth. In suitable cases, depending on the orthodontist's assessment, orthodontic preparation can also be done with clear aligners instead of fixed braces; at our clinic, clear aligner treatment is provided with Invisalign. Some centers shorten pre-surgical orthodontics with a "surgery-first" approach; this option is not suitable for every case.
How is planning done?
In the planning phase, facial photographs, intraoral scans or impressions, cephalometric X-rays and often three-dimensional CT are taken. Using these records, the orthodontist and jaw surgeon jointly determine how many millimeters and in which direction the jaws will move. Today, virtual surgical planning can be done with digital software, and the surgical splints used during the operation can be produced according to this plan.
What are surgery and recovery like?
The operation is performed under general anesthesia and often requires a hospital stay of one to several days. Depending on the scope of the procedure, surgery may take several hours.
The main things to expect during recovery are:
- Swelling and bruising: These become more noticeable in the first days and then subside over weeks. Cold compresses and the care recommended by the surgeon make this period easier.
- Eating: A liquid diet followed by soft foods is recommended in the first weeks; the transition to a normal diet is gradual and planned according to the surgeon's instructions.
- Sensory changes: Numbness in the lower lip and chin area is common, especially after lower jaw surgery. In most cases it improves within months, but in some people it may be partly permanent.
- Returning to daily life: Returning to desk work is usually possible within a few weeks; returning to contact sports takes longer.
It takes a few months for the bones to heal in their new position. During this period, regular check-ups with the surgeon and orthodontist and careful oral hygiene are important.
What are the risks and expectations?
Although orthognathic surgery is an operation frequently performed by experienced teams, like any surgical procedure it carries some risks. These include infection, bleeding, loss of sensation due to nerve involvement, jaw joint complaints, partial reversal of the result over time (relapse) and, rarely, the need for additional surgery. The risks should be explained in detail by the surgeon according to the person's general health and the scope of the planned procedure.
Realistic expectations are at least as important as technical planning. The main aim of surgery is a functional bite and a balanced facial structure; the degree of change in the face varies from person to person. Discussing possible outcomes with digital simulations before deciding on surgery, and understanding why surgery is recommended and what the alternatives are, makes for a sound decision-making process.
When should you seek help if you suspect a jaw discrepancy?
If you notice that your front teeth bite in reverse, that you have difficulty chewing, that your jaw has a noticeable asymmetry or that you cannot close your lips without strain, an orthodontic assessment first will point you in the right direction. At our clinic in Çankaya, Ankara, the examination and records are used to assess whether the problem is dental or skeletal; in cases where surgery may be needed, planning is carried out together with a jaw surgeon.
Frequently asked questions
At what age is orthognathic surgery performed?
It is usually performed after facial and jaw growth is complete. When growth ends varies from person to person, and the dentist assesses this with X-rays and clinical follow-up. If surgery is done while growth is ongoing, the result may change.
Does jaw surgery leave a scar on the face?
Because most of the incisions are made inside the mouth, in most cases no visible scar is left on the face. Some special techniques may require small external incisions; the surgeon explains this during the planning phase.
Is treatment possible with orthodontics alone, without orthognathic surgery?
Mild and moderate skeletal discrepancies can often be brought to an acceptable bite with orthodontic treatment alone. In pronounced discrepancies, however, moving the teeth alone may not be enough for function and facial balance. Which approach is suitable is determined by examining the records.
How long do you need to eat soft foods after surgery?
A diet of liquid and soft foods is recommended in the first weeks, followed by a gradual return to a normal diet. The duration is determined by the surgeon according to the scope of the procedure and the course of healing.
