Orthognathic Surgery: Types of Surgery, Recovery & Costs

What is Orthognathic (Jaw) Surgery?

Your jaw has two parts, including the maxilla (upper jaw) and mandible (lower jaw). In some cases, the two jaws may be misaligned. Jaw irregularities are usually genetic but can also be influenced by long-term childhood habits (e.g. thumb sucking or mouth breathing).

If your upper jaw severely protrudes over the lower jaw, you have an “overbite.” Or, if your lower jaw protrudes too far forward, you have an “underbite.” Orthognathic surgery, also called jaw surgery, may be necessary if your jaws do not align correctly.

Developing children with severe misalignment often receive jaw treatment early. For example, orthodontists typically recommend jaw repositioning appliances, braces, headgear, and other devices.

If severe malocclusion is left untreated, serious dental issues may arise. Untreated overbites, underbites, and other forms of malocclusion (misalignment) can cause:

• Temporomandibular Joint Dysfunction (TMD)
• An Increased Risk for Tooth Decay
• An Increased Risk for Gum Disease
• Difficulties Chewing & Swallowing
• Speaking Difficulties (Lisp and/or Slurred Speech)
• Severe Headaches & Discomfort
• Crooked and/or Crowded Teeth
• Structural Mouth Changes
• Bad Breath and/or Dry Mouth

Types of Jaw Surgeries

There are a few different types of orthognathic surgeries available, depending on the severity of misalignment and your jaw positioning.

Maxillary Osteotomy (Upper Jaw)

Maxillary osteotomy surgery corrects a severely receded upper jaw. During the procedure, an oral surgeon makes an incision in the gum above the teeth in the upper jaw. Then they cut, break, and move the upper jaw into the correct position. Lastly, the surgeon attaches a small plastic wafer to the teeth to help align the upper jaw. The jaw is fixed in place with titanium screws and metal plates. Upper jaw surgery can correct an overbite, crossbite, and open bite in adults.

Mandibular Osteotomy (Lower Jaw)

Mandibular osteotomy surgery corrects a severely receded lower jaw. During the procedure, an oral surgeon moves the lower jawbone forward or backward, depending on the patient’s bite alignment. Lower jaw surgery commonly treats underbites.

Genioplasty (Chin Surgery)

Similar to mandibular osteotomies, genioplasties also correct severely receded lower jaws. During this procedure, an oral surgeon restructures the jaw and chin. Often times, an oral surgeon combines lower jaw surgery and chin surgery into the same operation.

Temporomandibular Joint Dysfunction Surgeries

Temporomandibular joint dysfunction (TMD) causes severe pain in the jaw and muscles that control jaw movement. An arthroplasty or arthrocentesis surgery may be used to correct TMD:

Arthroplasty

The most common operation to correct temporomandibular joint dysfunction is an open-joint arthroplasty (keyhole surgery). During the procedure, an arthroscope (small camera) is inserted into a small incision the surgeon makes in front of the ear. Then the surgeon removes any scar tissue surrounding the joint to relieve pain.

Arthrocentesis

Arthrocentesis uses sterile fluid to wash out the TMJ (temporomandibular joint). During the procedure, an oral surgeon repositions the patient’s jaw, realigns the cartilage disc, and then administers a steroid drug into the joint. In essence, the goal of the surgery is to return the cartilage disc to its correct location and remove any debris inside the joint.

Recovery

After orthognathic surgery, most patients can return home the following day. Although, it takes about six to eight weeks for the bones to fully heal. During this time period, it is important to take it easy and not disrupt the healing. For most jaw surgeries, recovery includes:

• Before the procedure, general anesthesia is administered. This ensures you will not feel anything during the operation. You cannot drive a car for 48 hours post-op.
• When you wake up, the upper lip, gums, and jaw will be numb for a few hours. Although, some people experience numbness for months following surgery. This is because an oral surgeon cuts the nerves during the procedure, which require time to re-grow.
• For the first two to three weeks after surgery, you may feel some discomfort and soreness, which is normal.
• The swelling should diminish after about three weeks. In some cases, swelling doesn’t disappear for several months.
• Your surgeon may prescribe you simple painkillers and antibiotics after you leave the hospital.
• For the first six to eight weeks after surgery, your diet should consist of liquids only. After this time period, normal eating patterns can return.

How Much is Orthognathic Surgery?

If you have health insurance, orthognathic surgery may be covered in some cases. For example, some insurance companies (e.g. Aetna) consider jaw surgeries to be “medically necessary” if the skeletal irregularities cause sleep apnea disorder, breathing issues, and/or severe speech impediments. On the other hand, orthognathic surgery is “cosmetic” if the procedure is elective and only improves your facial appearance.