Upper jaw osteotomy: whom it will help, and how to prepare for surgery



The upper and lower jaws define the structure of a large part of the face. Due to a congenital or acquired problem with the jaws, the face may seem too flat and the chin too large. Also, due to maxillary disorders, difficulties with chewing, speaking, and the general appearance of the face may deteriorate.

The upper jaw may be too narrow, too wide, too short or too far forward or backward to fit the mandible properly.

Surgery on the upper jaw (osteotomy of the upper jaw) is the only way to correct these pathologies. The asymmetry between the different sides of the face can also be corrected by changing the upper jaw.



An indication for osteotomy is the defect of the alveolar process of the upper jaw due to congenital cleft.

A surgical osteotomy procedure can also be performed on the lower jaw, in case of its deformity and when significant occlusion is impaired.

For most people, orthognathic surgery is a personal choice. Since the osteotomy of the upper jaw requires a long recovery period, it is necessary to carefully weigh all the benefits and burdens of the operation. For those few people who also have serious functional problems, such as problems with chewing or closing the mouth, orthognathic surgery may be necessary.

Numerous risk factors can change the treatment plan or completely eliminate surgery.

These factors include:



• active or late stage of periodontal disease;
• blood dyscrasia - pathological changes in blood cells or blood clotting elements;
• systemic disease;
• local factors that may affect normal wound healing;
• children and adolescents. The child's jaws have not yet formed.



Preparation for surgery

When a dentist identifies a patient as a candidate for orthognathic surgery, he assigns a complete radiographic analysis. A maxillofacial surgeon and an orthodontist will work together and consider how corrective surgery will affect the functioning of the jaw and the aesthetic appearance of the patient’s face.

Quite often, before the osteotomy of the upper jaw, the patient has to undergo orthodontic treatment to level the teeth. This can be of great benefit to bite and overall human health.

The patient may need to wear braces for about 8-16 months. Brackets are needed to align teeth sufficiently, in preparation for leveling the jaw. When visiting an orthodontist before the operation begins, the braces will be modified so that they can be used during the osteotomy of the upper jaw.

After leveling the patient's teeth will be sent for consultation with the maxillofacial surgeon. He will evaluate the achieved result of treatment and discuss the plan of surgical and postoperative treatment with the patient.

How jaw asymmetry is eliminated and what to expect after surgery

Surgery called osteomy helps to change the position of the upper jaw in relation to the lower jaw and correct problems such as bite pathology, abnormal development of the jaws and the consequences of unsuccessful surgery of the congenital palatal cavities. The operation will take place under general anesthesia: that is, the patient will be immersed in a deep sleep.

Osteotomy

The operation is performed from the inside of the mouth, so no visible scars will remain on the skin of the face. The surgeon will make an incision through the gums above the patient’s upper teeth to access the jawbone.

Then he will cut the upper jaw with a small saw and move the sawed-off fragment to a new position. It will be held in place by small metal plates and screws. They are made of titanium, which is a very inert metal and is safe for use in the body.

Where there was asymmetry of the jaw, soluble sutures will remain in place of the incision, which will disappear in two weeks or a little more.

Patients who undergo an osteotomy may need a bone graft. Part of the bone is usually taken from the hip to set the upper jaw in its new position. This procedure occurs during surgery on the jaw.

The whole operation takes about 2 hours. In this case, the patient is under combined (endotracheal) anesthesia, that is, the anesthesia will flow into the blood and into the respiratory tract.

Rehabilitation period

The operation is not particularly painful, but during the first few days in the postoperative period painkillers may be prescribed to the patient. In addition, the doctor will need to make sure that the area heals without any infection and therefore the patient will be injected antibiotics through a vein on his arm while he is in the hospital.

Immediately after surgery, the face will be swollen, there may be hematomas in the area of ​​the mouth, and the mouth itself will not open wide. In the first 1-2 weeks after the jaw asymmetry has been eliminated, the nose may not breathe and the patient may have to breathe through the mouth. It will be difficult to swallow, and the throat can ache - this is a consequence of anesthesia.

Swelling can be reduced by using cold compresses and the vertical position of the pillow during sleep. The edema usually disappears after two weeks, but sometimes it lasts for several months.

After the asymmetry of the jaw is eliminated in the first two days, the patient can only eat liquid, but he will quickly be able to switch to soft food, and in a few weeks he will return to his usual diet.

The length of stay in the hospital depends on the age and state of health of the person, but most patients spend one or sometimes two nights in the hospital after surgery.

The position of the jaw will be checked using X-rays before the doctor allows the patient to return home.

Most people return to work three weeks after surgery. It is important to remember that you cannot control the mechanisms for 48 hours after general anesthesia.

Elimination of jaw asymmetry has a number of potential complications, as is the case with any surgical procedure. Fortunately, with this type of surgery complications are rare. Nevertheless, it is important to be aware of them and to have the opportunity to discuss them with the surgeon.

• Bleeding. Slight bleeding from incisions inside the mouth is normal and should be expected. You can often notice a slight bleeding from the nose, usually it passes a week after the operation. However, severe bleeding from the nose is very unusual, but if it does occur, help is to apply pressure to the nose for at least 10 minutes.
• Numbness The upper lip will be numb and it will feel tingling after surgery. Similar sensations occur after an injection at the dentist. Numbness may last for several weeks.
• Infection. Small plates and screws that hold the jaw in a new position, as a rule, remain in place permanently. Sometimes they can be infected and should be removed, but if this happens, then a few months after the operation. Metal detectors at airports and other establishments do not react to titanium, from which plates and screws are made.
• Complications of the lungs. Asthmatics or smokers have an increased risk of lung complications. Therefore, it is highly recommended to quit smoking before surgery. This can be difficult and may require the use of a nicotine patch or a special chewing gum. Physical therapy may be required to stimulate lung function in the immediate postoperative phase.
• Change the bite. Within a few weeks after surgery, it is often necessary to put elastic bands on orthodontic braces in order to change the bite to a new position. Rarely, a second small operation may be required to move the fixing plates and screws if the new bite is not quite anatomically correct.

Often, after surgery, patients feel sad and depressed. This feeling, as a rule, disappears after the patients recover and return to their usual activities.

According to reviews, the osteotomy of the upper jaw gives excellent results. The difference in the photo is visible to the naked eye.

The price of such an operation ranges from 130 thousand rubles and higher, depending on the complexity and the chosen methodology. For example, the Bezrukov operation in some clinics costs 240 thousand rubles.