“Surgery to correct any facial deformity is known as orthognathic surgery. Orthognathic simply means straight jaws and most of the operations that I carry out to help patients with structural facial problems involve surgery to change the way the upper and lower jaws are aligned.“
The surgical techniques that we now have to correct facial deformity have been developed over the last 50 years and are very safe. Although this seems like a major and frightening surgery, the results are highly predictable and many patients say afterwards that they wish they had not been so worried.
The surgical techniques that Mr Hodges uses allows him to reset the jaw so that the position of upper and lower jaws and the chin can all be corrected.
“This type of surgery allows deformity of the face, jaws and bite to be corrected. It improves the way that the teeth and jaws work together for eating and speaking, it boosts the long term health of the teeth and jaw bones and we aim for the best cosmetic appearance possible.”
Types of jaw deformity
The jaws can have several problems and these can affect the entire face and also compromise your speech and ability to eat and drink. Some of the most common deformities that we see are:
Class II skeletal relationship – The lower jaw is smaller or set back in relation to the upper jaw.
Class III skeletal relationship – The lower jaw is larger or further forward compared to the upper jaw. The problem usually arises because the upper jaw is underdeveloped compared to the lower jaw.
Anterior Open Bite (AOB) – This is where there is a space between the upper and lower front teeth when the back teeth are touching. It can be caused by excessive thumb sucking or an overactive tongue.
Vertical Maxillary Excess (VME) – The upper jaw is too prominent in the up/down direction. Patients find that they show too much of their upper incisor teeth and gums and have what is known as a gummy smile.
Asymmetry – Facial asymmetry can have several causes such as overgrowth of the lower jaw at the jaw joint. This can have a major impact on the relative positions of the upper and lower jaws and chin.
What kind of surgery is possible?
Surgery to correct jaw and facial deformity have been perfected over several years and the procedures are well tested. We have a lot of evidence that they are successful as they have been used in so many patients. The surgery is usually performed through the mouth, so there are no scars on the skin of the face at all.
All of the operations summarised below are carried out under general anaesthetic. Patients usually stay in hospital just one night afterwards and can then return home to rest and recover. Careful follow-up will take place after surgery to make sure that the jaws and tissues are healing well.
Adjusting the position of the lower jaw
The most common operation used to reposition the lower jaws is the bilateral sagittal split osteotomy.
This very versatile operation allows the lower jaw to be moved forwards or backwards. The part of the jaw that contains the teeth is separated from the back part that connects with the jaw joint. Once the jaw is in its new position it is fixed with titanium metal plates and screws. Contrary to popular myth, these do not set alarms off in airports! The wounds are then closed with dissolving stitches
Moving the upper jaw
The most common operation to move the upper teeth and jaw is the Le Fort 1 osteotomy.
This is a very safe predictable operation and again, all the incisions are made inside the mouth, so no facial scars.
When the upper jaw and teeth have been separated from the rest of the face it is still attached to the body by the soft tissues of the cheek and palate. This ensures the upper jaw has a good blood supply while it is healing. The upper teeth can then be repositioned as planned and then fixed with titanium metal plates and screws and everything is sewn in place with dissolving stitches.
Surgery to reposition the chin
The operation to reposition or re-shape the chin is called a genioplasty.
This operation allows the chin portion of the lower jaw to be moved into a more cosmetically pleasing position. It is then fixed with titanium metal plates and screws and dissolving stitches are used to close all the incisions.
More complex jaw deformity surgery
If we need to move both your upper and lower jaw and maybe even your chin in the same operation, this is referred to as a bimaxillary osteotomy
The operation involves doing a bilateral sagittal split osteotomy and a Le Fort 1 osteotomy as described above, but at the same time. It is best to do both procedures simultaneously rather than one after the other to allow the facial deformity to be corrected in a safe and predictable way. The end results are much better as the position of the entire jaw can be set to give the best cosmetic outcome.