Orthognathic surgery

Indications:

Dento-skeletal malformations. Method: Intraoral incisions

Anesthesia:

General

Surgical time:

1 hour / 6 hours

Postoperative clinical checks at:

3 gg oral hygiene check, elastic change and discharge
10gg elastic control and oral hygiene
1month hygiene check and elastic and photos, from here it is sunny with protective cream
6 months and 1year check and photos.

Orthognathic surgery
Orthognathic surgery is a branch of maxillofacial surgery that deals with the repositioning of the facial bones (maxillary and jaw. As orthodontics means “straight teeth”, orthognathic means “straight bones”. In most cases, orthognathic surgery is performed after an orthodontic treatment as the movement of the bones follows a correct alignment of the teeth. The result to which it tends is the gradual improvement of the chewing, of the phonation and of the respiratory functions many times combined with an improving aesthetic result.

To whom it is addressed

People who can potentially benefit from orthognathic surgery are those who suffer from malocclusion and those whose jaws are in the wrong position. The growth of jaws is a slow and gradual process, and in some cases, jaw and maxilla can grow to a different extent. The result can induce a series of problems that may involve chewing, phonation, oral hygiene and also the appearance. Jaw injuries or congenital defects can affect the position of facial bones.
Conditions that may indicate the need for orthognathic surgery:
• Difficulty of chewing
• Difficulty of phonation
• Difficulty to yawn
• Chronic pain in the jaws
• Open bite
• Asymmetric appearance of the face
• Results of trauma or congenital defects
• Receding chin
• Difficulty of tightening the lips effortlessly
• Oral breathing with dry mouth
• Sleep apnea (breathing problems during sleep, apneas or snoring).

Unbalanced growth of the jaws, traumas or birth defects can produce a series of problems and symptoms that require the work of a team comprising the maxillo-facial surgeon, the orthodontist and the dentist. A thorough and multidisciplinary preliminary visit is necessary for a correct assessment of your situation and deciding whether to face the intervention.

Pre-surgical evaluation
A correct surgical-orthodontic diagnosis requires a synergistic work of the maxillofacial surgeon and the orthodontist. The orthodontist’s function is to align the teeth so that they match after the surgical procedure (treatment can last up to 2 years), while that of the maxillofacial surgeon is to ensure that the skeletal bases are in the correct ratios. The dentist ensures that the hygiene of the mouth is sufficient for the duration of the treatment. Following the initial consultation, information on the patient’s status is collected, such as photographs, pictures, dental arches, facial arches, as well as an accurate medical history to ensure that there are no problems that could interfere with the surgical procedure and / or with anesthesia.

Presurgical orthodontics
At this stage orthodontics will move the teeth in such a way that they can be in maximum occlusion at the time of surgery. The pre-surgical period lasts from 6 to 18 months, during which the patient undergoes regular visits for the continuous correction of the dental device that moves the teeth. It is easy to think that during the pre-surgical phase the occlusion gets worse, in reality they move towards the ideal occlusion from an incorrect position, taken to compensate for a skeletal defect. After surgery, an additional period of orthodontics (6 months) is usually necessary to consolidate the movements performed and eventually to fine-tune the occlusion. It is possible that the patient is subjected to dental extractions if he suffers from dental overcrowding or if he still has the wisdom teeth, to have the necessary space for the movement of the teeth. As the end of orthodontic treatment approaches, the maxillofacial surgeon will perform the last pre-surgical preparations. In fact, new impressions of the dental arches will be taken. The surgeon could use new radiological investigations and plaster models to perform the model surgery that serves to finalize the movements of the jaws and to foresee with a certain margin the final result. From these studies a bite is realized that serves as a guide for the correct realignment of the skeletal bases.

Surgical act
The orthognathic surgeon is performed in hospital or in a clinic under general anesthesia. Orthognathic surgery can last from a minimum of one hour to a few hours of surgery, and depends on the type of surgery that must be performed. In most cases the incisions are made inside the mouth, if you have to associate an extraoral approach you will pay close attention to the suture phase to avoid annoying scars

Immediate postoperative
The hospital stay usually lasts a few days, depending on the medical indications. A post-operative swelling is predictable and absolutely normal, especially in the area of ​​the lips and cheeks, and sometimes a burning sensation as an answer to the operation. This symptomatology is destined to disappear from the first days. In the early days you may experience a sore throat or nasal congestion, this is due to intubation for anesthesia. Postoperative pain is usually reduced and easily controlled with the help of drugs.

During healing
A return to normal activities is expected within a couple of weeks.
It is foreseeable a surprise reaction from the patient and his neighbors in seeing the surgical result, however, it will be easy to get used to the new situation.
The patient will be subjected to follow-up visits by both the surgeon and the orthodontist and, if necessary, the removal of the synthesis plates will be planned, after about one year from the intervention. The first phase of healing runs out in about 6 weeks, but the final results can only be appreciated after 9-12 months.
It is very important that during the first phase an extreme cleaning of the mouth is maintained, to avoid the risk of a possible infection. The orthodontist begins the last orthodontic phase at about 4-8 weeks after surgery, in most cases the device is removed a period ranging from 6 to 12 months.

Risks and complications
1) Swelling: is a normal reaction to surgery that occurs in the first 24-48 hours and depends on the surgical action and individual response.
Swelling reduction can be helped awith moist warm compresses from 4 days post-op.
2) Nausea and Vomiting: these are infrequent complications of general anesthesia, if they can be controlled with drugs.
3) Pain: generally is very well tolerated, if necessary controllable co with drugs.
4) Bleeding: it is normal and possible that there is a minimum bleeding in the first postoperative days, and if a surgery of the upper jaw has also been performed, moderate bleeding from the nose is possible. In the rare case of profuse bleeding after returning home, it is necessary to inform the surgeon immediately.
5) Loss or Alteration of Sensitivity: or a reduction in sensitivity or a feeling of “pins” in the face may be present in the postoperative.
This is due to an action of stretching of the involved nerves, it is infrequent that these disorders remain for more than 6 months.
6) Infection: it is a potential risk of each operation, if it happens it is treated with the administration of antibiotic. If fever, pain or pus develops in the postoperative period, the surgeon should be contacted immediately.
7) Sinusitis: pain and infection of the maxillary sinuses are a rare complication, should you have symptoms of sinusitis you should immediately contact the surgeon.
8) Accidental damage to dental elements or prosthetic products: they are possible and must be repaired postoperatively.
9) Recurrence of the Basic Pathology: the relapse of the underlying pathology or an incorrect positioning of the skeletal bases is a very rare occurrence that requires a new treatment.
10) Limited Mouth Opening: it is possible to establish a limited opening that is corrected with specific exercises.
11) Pain in the atm: or its improper functioning are very rare complications, surgery could worsen an initial situation not perfect, if the conditions persist, a second treatment may be necessary.
12) Prolonged hospitalization: these are extremely rare events, but they are related to the risk of general anesthesia. Orthognathic surgery moves teeth and bones into a new, more balanced, healthy and functional position, allowing the patient not only to eat better but also to improve breathing, phonation and physical appearance.

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Orthognathic surgery

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