Corrective or reconstructive jaw surgery refers to surgical procedures directed at optimizing jaw form and function. The term “orthognathic surgery” is synonymous with corrective or reconstructive jaw surgery. The need for reconstructive jaw surgery can arise from abnormal jaw growth during facial skeletal development or from jaw deformity due to trauma or disease.
Additionally, reconstructive jaw surgery is sometimes indicated in patients with obstructive sleep apnea, to improve the patient’s airway during sleep. Regardless of the cause of the jaw deformity, because the jaws contain teeth that must function together, reconstructive jaw surgery is usually coupled with orthodontic treatment to idealize dental function, once the jaws are reconstructed.
Reconstructive jaw surgery is undertaken when jaw injury or disease is stable or resolved, or when facial skeletal growth is complete. Completion of facial growth usually occurs at age 16-17 in females and 18-19 in males, with some exceptions. In obstructive sleep apnea patients, jaw surgery is considered when the sleep apnea is severe, or when other less invasive measures have failed.
Common jaw conditions treated by reconstructive surgery are a lack in jaw volume and proper shape, marked discrepancy between the positions of the upper and lower jaw, an upper or lower jaw that is too large, too small, too tall or too short, and severe dental malocclusions. A severe dental malocclusion is a condition in which the upper and lower teeth do not touch and function normally, beyond what can be corrected by orthodontic treatment alone.
Typically, a reconstructive jaw surgery patient will start preparation for surgery with orthodontic treatment. The goal of the orthodontic treatment is to level and align the upper and lower teeth such that when the surgery is completed, the teeth touch and function properly. This period of preparation takes several months, varies with each patient, and is under the direction of the orthodontist. When the orthodontic preparation is complete, the patient’s face and jaws are scanned in a 3–D format. A digital surgical treatment planning session is then carried out to reposition the jaws in 3-D surgical planning software. The resulting treatment plan is then presented to the patient for approval. The 3-D surgical modeling allows for fabrication of computer generated surgical guides and fixation devices that produce a high degree of precision in executing the surgery.
Reconstructive jaw surgery can be safely performed in a medically healthy patient, and usually falls under medical insurance coverage, if there is a reconstructive jaw surgery benefit. If there is no medical insurance, often the surgery can still be performed competitively and efficiently on an outpatient/cash basis. The most ideal timing for reconstructive jaw surgery is in the late teens or early twenties, but patients of all ages can be good candidates for reconstructive jaw surgery.