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What is Orthognathic Surgery?
Ortho (Greek for 'correct'); gnathos (Greek for 'jaw') is, literally from the Greek translation, corrective surgery of the jaws. In practice it is a sub-specialised field of surgery involving correction of dental, jaw and facial cosmetic and functional problems.
What does this type of surgery address?
Jaw surgery aims to correct functional and cosmetic discrepancies in the face. Depending on the type and extent of the surgery, it aims at its most fundamental level to improve the relationship of the teeth and jaws to each other together with optimising and harmonising facial appearance. At its more complex, it may improve speech, breathing, chewing, while simultaneously balancing the different parts of the face, teeth, lips, nose and chin into an aesthetic harmonious unit. As a consequence it has been shown to improve Quality of Life as a result of better function, increased self-esteem and confidence. It is one of the few interventions in surgery where aesthetic enhancement and functional improvement are interdependent.
A patient may be unhappy with a large, small or asymmetrical lower (mandible) or upper jaw (maxilla), their profile, or may wish to enhance or reduce the size of the chin with a genioplasty (chin surgery). It can be used as an adjunct to facial rejuvenation procedures and enhance the effect of face lifts, neck lifts, fillers and facial volume, lip position and fullness, by addressing not only the soft tissue but the supporting facial skeleton and even the underlying dentition. Thus, by addressing all these components together, we can give a more comprehensive treatment. We work with colleagues across specialities to achieve these optimal results.
Dental Cosmetics, Malocclusion and Function
Most often, people present to dentists and orthodontists with overcrowded and poorly aligned teeth concerned about the cosmetic appearance of their teeth, embarrassed about their smile or reporting functional problems with their bite. Common complaints are protruding 'buck teeth', an open bite with an inability to bite into food, requiring effort to close the mouth and lips with consequent mouth breathing and challenges to oral hygiene. Conversely, over-biting can cause trauma to the gums and bone with consequent loss of teeth and bone volume leading to premature ageing of the face. Some of these functional and cosmetic dentistry demands can be addressed with orthodontics alone. However, in many cases, joint orthodontic and surgical treatment is mandatory as the problem may appear as purely dental overcrowding, but the underlying diagnosis is a combination of small or large jaws and dental discrepancies. In these cases a combination of orthodontics (braces) and jaw surgery give an optimal facial and dental balance with an elegant cosmetic and functional result that will improve long term stability.
It is not unusual for many patients who have had 'orthodontic camouflage treatment' of these problems without the input of corrective jaw surgery, to return with relapsed orthodontics (teeth going skew again). Similarly, prior to undertaking surgery for most cases, orthodontic intervention is integral to surgical long term success. Hence, we work closely in a multi-disciplinary team with joint orthodontic and surgical input for the more complex cases that require both interventions.
Facial Asymmetry / skew face / asymmetric jawline
This is a common under-diagnosed problem, which is often neglected because many patients and doctors think nothing can be done, or it is too difficult to correct. The causes are many, but fundamentally related to uneven upper and / or lower jaw and chin growth as well as overactive growth in the Temporomandibular Joint (TMJ).
This can be tackled by correction of the underlying soft tissue or jaw asymmetry or by camouflage surgery using reduction or augmentation of parts of the face with surgical implants, fillers or botulinum toxin injections, individually or in combination with each other. If there are also underlying malocclusions and overcrowding of teeth these can be simultaneously dealt with in a multidisciplinary team of expert prosthodontic and orthodontic colleagues who routinely deal with these complex cases with us in clinics.
Short, Long, Broad or Narrow Face
People can present with disproportions in facial growth that result in long, short, broad or narrow faces. The underlying causes are many but in essence they represent too much or too little bone, muscle or skin growth in different parts of the face, lips, nose, eyes, cheeks and jaws.
There are two basic ways we manage these. Surgical correction of these disparate components using ostoetomies to the facial skeleton and jaws and soft tissue plastic surgery or the addition or removal of tissue or placement of implants, prostheses, fillers or botulinum toxin (botox) to camouflage and rebalance the different components into an aesthetic whole. We tailor the treatment depending on individual needs.
Post-injury and post-traumatic facial deformities can also be addressed with corrective jaw surgery. Often jaws are set in the wrong place with consequent problems with occlusion and teeth meeting properly, biting properly, or cosmetic concerns. In these cases, teeth often go missing from trauma and concomitant osseointergrated dental implants can be placed to restore function and cosmetics.
Sleep apnoea can be helped with surgery of the jaws. A multi-disciplinary team of respiratory physicians, ENT surgeons, orthodontists and ourselves are involved in treating these patients. In very simple terms, in addition to other therapies and interventions, the jaw relationship is surgically altered to increase the capacity of the airway passage and enhancement of respiration.
Temporomandibular Joint (TMJ) Pain and Myofacial Dysfuntion
There is no conclusive scientific evidence to show that jaw surgery and/or orthodontics can correct this problem. One should be guarded about undertaking this surgery purely for the correction of this problem. However, in cases of large anterior open bites, there is some empirical evidence that putting the jaws and teeth in a more functional position may improve on TMJ problems.
Do I need jaw surgery?
Nobody needs orthognathic jaw surgery per se. However, there are many circumstances where if it is not carried out, there may be long-term detrimental effects on the teeth, gums and jaws that may cause substantial disability in your overall health and quality of life later on. Your consultant will advise you on all options, but the final decision is always yours.
We offer this service to you if you want an improvement in your appearance in terms of your teeth, your bite, your smile, chewing function, and in some circumstances speech and breathing can be improved as well. We also offer it if your bite and appearance are felt to be out of the normal as a result of growth problems resulting in disproportions between the jaws, facial asymmetries, skew or long/short faces, gummy appearance and also following injuries which have resulted in a distorted bite or altered appearance from the normal. Increasingly, it is used to address sleep apnoea in patients that want a more permanent solution to removable oral devices during sleep or those that cannot comply with oral mandibular advancement splints of various types.
Who are the people that will be treating me?
Mr Heliotis is a private orthognathic surgeon at several private hospitals in London, UK, and has an extensive NHS practice in this field at Northwick Park and St Mark's Hospitals. If you see him privately your operation will be done by him, but naturally he has assistants for the operation and an experienced surgical nursing team. He has a dedicated sub-specialist interest in this field and carries out a high volume of these procedures.