Orthognathic Surgery
(Corrective Jaw Surgery) in Los Angeles, CA
Case Description:
This patient complained that her lower jaw felt receded, she breathed through her mouth and said that she had difficulty closing her lips and when she did it felt strained.
It is possible to reduce the lower facial height and position the jaws proportionally to reduce the lip strain and enhance the esthetics of the face and profile.
Since no two faces are alike, it is impossible to make someone look exactly like another, but it is helpful to use Jacobson 2-D and 3-D templates and 2-D and 3-D imaging available at Jaw Surgery LA to discuss, plan and clarify what may be possible using a combination of orthodontic, surgical and esthetic procedures.
This is an example of a Surgical Treatment Objective using a template to help review the options, alternatives, and also the limitations of the various procedures.
Orthognathic Surgery
Jaw surgery includes surgery of the maxilla (upper jaw), mandible (lower jaw), chin, zygomatic arches (cheeks), and temporo-mandibular joints and teeth to re-align the anatomy to improve a person’s teeth, bite function, aesthetics, airway and health.
“Orthognathic Surgery (Jaw Surgery) can be one of the most rewarding and gratifying elective surgeries for patients, surgeons, orthodontists, and specialists when carefully planned and successfully completed.”
Excerpt from Dr. Jacobson’s lectures, Orthognathic Surgery, State of the Art 2020
Jaw surgery is an art and a science. It is a complex procedure where millimeters can make a big difference. For that reason, jaw surgery is best planned with a team of experienced specialists working together to ensure optimal structure, function, and form.
What does “form follows function” mean? (The shape of a structure, should be based upon its function.)
In architecture, “form follows function” is a principle proposing that the shape of a building or object should primarily relate to its intended function or purpose.
In surgery, it is helpful to consider the “form follows function” principal as well as 11 additional principles and more than 100 parameters including 12 important categories listed below :
1.Teeth:
The size, shape, color, contour, condition, position of the teeth, or the teeth in relation to each other and to the jaws, cranial base and their emergence profile. Also the teeth roots, size, length, shape, proximity to each other, and the size, shape, and health of the pulp, blood supply, and nerve tissue.
2. Periodontium:
The gum tissue, color, thickness, position, health, recession, proximity to the bone, size and depth of the sulcus and bony pocket, the connective tissue, and the underlying alveolar and cortical bone.
3.Maxilla (upper jaw):
The size, shape, cant, width, length, depth, and position relative to the cranium, face, cheeks, lower jaw, and chin.
4.Mandible (lower jaw):
The size, shape, angle, configuration, width, length, depth, and position relative to the cranium, face, cheeks, upper jaw, and chin. Also important is the movements of the lower jaw dynamically.
5.TMJ’s (Temporomandibular Joints):
The size, shape, and position of the heads of the condyles is considered as well as the integrity of the jaw condyles and disc complex assemblies. Particular attention is given to the condition of the ligaments and muscles and any pathology. The functioning of the TMJ’s must be carefully evaluated including static and dynamic movements. The amount of opening and closing of the mouth and the entire range of movements of the mandible is evaluated. The integrity of the discs and their respective positions during complex moments including rotation and translation is evaluated.
6.The Frenum:
There is a small connective tissue attachment on the inside of the upper lip between the front two central teeth called a frenum that must be carefully evaluated. There is also a small connective tissue attachment below the tongue that is important to evaluate and procedures can be included independently or in conjunction with jaw surgery to ensure optimal functioning and stability including normal swallowing and speech.
7.Airway:
The airway including the size, shape, position and internal anatomy of the nose. Mouth breathing must be evaluated and the area of the airway at the back of the palate and behind the tongue is critical to consider. The adenoidal and tonsillar tissue must be evaluated and the dynamic and static swallowing and breathing cycle must be examined and considered. The uvula and soft tissue is evaluated by ENT and sinus specialists at Sinus Center LA en suite our Jaw Surgery LA.
8.Sinus:
The health and normal functioning of the sinuses is critical to our health and wellbeing. Therefore the Maxillary, Sphenoid, Ethmoid, and Frontal sinuses are imaged and evaluated by our on-site ENT’s and the appropriate treatment included in the overall plan. Patients with chronic nasal or sinus congestion will be delighted to know that effective procedures are available to ameliorate these with a relatively minimal recovery. These can be in conjunction with jaw surgery or as in-office procedures.
9.Face:
The human face is fascinating and infinitely complex. For that reason, we have included specialists that are trained and board-certified in Plastic Surgery AND Jaw Surgery (Maxillo-facial Surgery) as well as a specialist in Ears, Nose, Throat and Sinus and specialists in Orthodontics and Dento-facial orthopedics to work together in our multi-disciplinary center in Pacific Palisades.
10. Skin:
The facial skin condition including the age, tonicity, thickness, elasticity, color, and surface condition and any damage including sun damage. Previous and preferred procedures are discussed including non-surgical skin treatments, lasers, stem cell treatments, PRP, Botox, fillers and plastic surgery procedures.
11. Health and Biology:
The general health of each patient is carefully considered and a great deal of emphasis is placed upon attaining optimal health, physiologically, biochemically and functionally. Age, genetics, diet, exercise, sleep, medications, and lifestyle is discussed to help choose the optimal treatment for you.
12. Psychology and motivation:
Each person has preferences and personal factors that are motivating and important to them. Therefore a thorough individual and team collaboration is considered to develop highly individualized, optimal treatment plans.
A multi-disciplinary approach is followed for all patients. The team of specialists at Jaw Surgery LA are highly trained specialists with extensive experience in a wide range of mild, moderate, and severe conditions.
Patients with complex anatomical, biochemical or physiological conditions and patients with psychological and behavioral histories should discuss these in-depth with our team at the initial consultation so we can help appropriately address these.
“The human face is a drama of flesh—
an architectonic structure of skeleton and muscle,
a musical arrangement of ellipsoids and undulating arcs.”
—Maureen Mullarkey
Frequently Asked Questions ABOUT JAW SURGERY
Who is the best Jaw Surgeon in the world?
Unlike sports, there is no quantitative measure of who the best jaw surgeon in the world is.
To find the best jaw surgeon for your needs, look for a team of specialists that includes:
1. An experienced board-certified Maxillofacial surgeon, preferably dual board-certified in Maxillofacial Surgery and in Plastic Surgery and preferably with advanced training in Craniofacial Surgery from one of the top University Medical Centers in the USA.
2. An experienced board-certified Orthodontist with at least 20 years of experience doing orthodontics in preparation specifically for jaw surgery.
3. An experienced Ears, Nose, Throat and Sinus specialist especially for any condition that involves aberrant swallowing, congestion of the nose or sinus, snoring and airway issues including obstructive sleep apnea.
4. An experienced prosthodontist or dentist and any appropriate allied specialists.
Jaw surgery entails the jaws, bite, teeth, TMJ, airway, and face. The advantage of working with a multi-disciplinary team of specialists is found in the diagnostic and treatment planning stage. During the initial stages of treatment, all relevant specialists collaborate and formulate an individualized plan specific for your condition.
How long is the Jaw Surgery?
Jaw surgery can take as little as one hour or as long as 5-6 hours depending upon the complexity of the surgery. Cranio-facial surgery involving complex deformities of the jaw, face and cranium can even take longer.
Do I need my teeth “wired shut” after Jaw Surgery?
Surgeons at Jaw Surgery Los Angeles have rarely needed to ‘wire jaws shut’ for more than 20 years. If patients are referred to Jaw Surgery Los Angeles following an accident or trauma, especially if the jaws are fractured in one or more places, “inter-maxillary fixation” (a form of wiring jaws together) may be needed.
What can I eat following Jaw Surgery?
Following Jaw Surgery at Jaw Surgery Los Angeles, there is a clear protocol of what and how to eat that we will provide for you. This includes a “no chewing” diet for 3 weeks. Since your teeth and jaws are not ‘wired shut” you can blend and eat almost anything. We will provide you with fun and creative ideas and will encourage you to eat and drink as much as you can since healing and recovery occur best when the body is well-nourished .
Does Jaw Surgery hurt?
All surgery causes pain, as does Jaw Surgery. Protocols at Jaw Surgery Los Angeles have been developed over the past 30 years of doing jaw surgery to reduce and even eliminate pain using effective pain management protocols.
Generally, staying “ahead of the pain” and taking your prescribed medication at regularly prescribed intervals, before the pain begins, is recommended.
Many patients report stopping taking their prescription ‘pain killers’ a few days after surgery and progress to ‘over the counter’ pain relievers as soon as possible, taking the prescription medication at night if they feel the need.
Does Jaw Surgery change the way I look?
Jaw Surgery can be individualized to improve the structure, function, and esthetics of the jaw and face.
Some patients do not want to change the way they look. Other patients are very happy to enjoy the subtle changes and improvements to their esthetics in conjunction with jaw surgery. Yet others want to make a significant improvement to their looks.
The advantage of the 3-D imaging of the hard and soft tissues available at Jaw Surgery Los Angeles is the ability to discuss visually your preferred changes that you do or don’t want. Correspondingly, specialists at Jaw Surgery Los Angeles can recommend changes based upon your preference and discuss with you options, alternatives, limitations and ancillary esthetic and cosmetic procedures available.
Do the plates used in Jaw Surgery set off the metal detectors at airports.
No. The small titanium plates and screws used at Jaw Surgery Los Angeles does not set off the metal detectors at airports.
Do the plates used in Jaw Surgery need to be removed.
The small titanium plates and screws used at Jaw Surgery Los Angeles do not need to be removed following surgery.
Generally, small screws and plates are placed to hold the bone segments in place while the bone is healing. The bone remodeling usually occurs within three weeks. At that stage, sufficient bone remodeling has occurred that a relatively normal soft diet can be resumed.
At 6 weeks the bone has remodeled considerably and at 12 weeks bone is considered sufficiently remodeled whereby patients can eat almost anything they prefer. Thus, technically, plates and screws can be removed since the bone is strong enough without the need for the plates and screws.
Most patients do not need or want their plates and screws to be removed since they are internally positioned in the bone and cannot be felt.
Periodically, patients will mention that they feel a screw or rarely, the tissue around a screw or plate gets infected. In that scenario, those screws or plates can be removed. This is usually uneventfully and the surgical procedure is much simpler and shorter than the original jaw surgery.
Does Jaw Surgery cure Obstructive Sleep Apnea?
There are many causes of obstructive sleep apnea and many effective treatments, including CPAP and a variety of comfortable and removable mandibular posturing appliances that are worn at night, made and administered by board-certified orthodontists at Orthodontic Center LA. (See the American Journal of Orthodontics and Dento-facial Orthopedics publication by Richard L Jacobson DMD MS) (Also the AJO publication by Allan Lowe DDS MS).
There are also numerous minimally invasive effective procedures performed and monitored by the board-certified ENT specialists at Sinus Center LA.
However, the MMA (Maxillo-Mandibular Advancement Surgery), when prescribed and performed successfully, is very effective at improving and fully resolving obstructive sleep apnea. (See the American Journal of Oral and Maxillo-facial Surgery publication by Powell, Schendel, and Jacobson).
Multiple factors determine the efficacy and appropriateness of this procedure for each individual. These will be discussed in great detail at your consultation with specialists at Jaw Surgery Los Angeles, Sinus Center LA, and Orthodontic Center LA.
What are the risks of Jaw Surgery?
There are many risks of Jaw Surgery that you should fully appreciate prior to proceeding. These include infection, bleeding, scar tissue, nerve damage, teeth damage, mal-union or incomplete and fibrous healing, the need for additional surgeries, and death from anesthesia. Fortunately, most risks can be greatly reduced and very well managed. The risk of nerve damage during surgery can also be reduced but can occur, especially with surgery of the lower jaw, and will be discussed in detail prior to proceeding. Below is a short description:
Temporary numbness of the area where surgery is performed always occurs following surgery. This numbness can be permanent. If lower jaw surgery is performed, the numbness can be in the gum and teeth area, but also in the chin area. Since the numbness is sensory, not motor, you can eat, talk, kiss and open and close your mouth normally, but patients report a feeling of numbness in the chin area of the face and/or lower lip area. Some patients report a feeling of tingling. The incidence of permanent numbness or tingling reported in the literature ranges from 1-5% with some reports in the literature of more than 50%. With the advent of 3-D imaging, surgeons can visualize the position of the nerve in the cbct scan prior to surgery, greatly reducing these risks. The older a patient and the greater the movement of the lower jaw surgery, the greater the risk of numbness. Patients that do experience sensory numbness in the lower chin and/or lip area generally say that they get used to it. One patient commented that even though it does not bother him, and he is fully used to the partial sensory numb sensation in the chin area, once in a while, a small piece of food gets inadvertently on his chin while eating and his wife beckons to him to wipe it off.
The American Association of Oral and Maxillofacial Surgeons and the American Association of Plastic Surgeons have Informed Consent forms that describe these and other risks of surgery. These should be studied in detail. However, specialists at Jaw Surgery Los Angeles will supplement your written informed consent with extensive in-person consultations specific to your condition prior to surgery and will discuss the risks and options and alternatives to surgery and the possible limitations as well as the possible benefits. You should not proceed with jaw surgery or any surgery, or any procedure for that matter if you do not fully understand the risks.
Patient satisfaction following jaw surgery is generally very high.