All about Jaw Surgery

Jaw Surgery is not just a Cosmetic Surgery – Know the “What”, “How” and most importantly “Why” of Jaw Surgery.

The WHAT

Orthognathic Surgery is the surgical repositioning of jaws, which is done to restore the balance of the facial structure. The upper and lower jaw is fractured and then fixed in an ideal and pre-planned position. One may fear that everyone undergoing Orthognathic Surgery shall bear a similar resemblance because of the same process employed. However, let me bust this myth for you! As surgeons, we don’t stick to a set measurement or a mould where we try to make everyone look alike; instead, our goals are to achieve what is practical, achievable, and sustainable in terms of the Surgery.

The idea is not to make everyone look alike as film stars. The goal is to give a harmonious, balanced, naturally pleasing, and attractive appearance. The law of nature has designed man to have the upper jaw a few millimetres ahead of the lower jaw. It is the distinction of the upper jaw, which is also responsible for cheek prominence and nose projection. On the other hand, the lower jaw forms the chin and the jawline. Of course, we also recognize the natural differences between male and female jawlines, and Orthognathic Surgery takes it all into account!

When planned carefully, the Surgery perfectly corrects what is less or more, such as a backwards-placed or small lower jaw, a retruded upper jaw, a small chin, a broad chin, or facial asymmetry. All these deformities affect your face shape and function.

The HOW

A patient seeking jaw surgery may first consult with either: a Dentist, Orthodontist, or Maxillofacial Surgeon. The General complaints are inability to bite and talk and Jaw joint [TMJ] pain. Additional complaints received are about facial appearance, sunken cheeks, a gummy smile, or a broad chin. A cursory clinical examination tells us the problem, post which we record x-rays and complete the dental exam. A team approach is necessary between the Orthodontist and the Surgeon to plan the timeline of Surgery and Braces.

Proper and repeated counselling is pivotal in making the patient comfortable for Surgery. Preparation for Surgery includes adequate psychological evaluation and counselling of the parents: to prepare them for what to expect from the Surgery. The Surgery essentially involves fracturing the jaws and fixing them in a new position. The entire surgical procedure is done from inside the mouth, leaving no outside scars. The Surgery can last for 2-3 hours. It also results in postoperative swelling and pain lasting for 2-3 days. The pain settles down in a week, but the results may take up to 3 months to show.

Now let us come to the crux: “Why Jaw Surgery”?

The WHY

In medicine, there is a cardinal saying that form affects function, and vice versa. Even when the child is growing, right in the womb, a slight change in position can affect the shape. Children are born with cleft lip and palate or a difficult airway. Monitoring your child's growth over the years is equally imperative. It decides how the child's final facial structure is going to be.

1. Our faces result from our growth and childhood habits. Thumb sucking affects the upper jaw and teeth, as the thumb is against the palate. Due to adenoids, and enlarged lymph tonsils, the child develops the habit of mouth breathing.

2. This habit of mouth breathing leads to a narrow upper jaw [maxilla], and a downward and backward lower jaw resulting in a convex facial profile, also called a bird-like face. This deformity remains unrealized till the child reaches adolescence and adulthood. This deformity is explained by a pinched nose appearance, a gummy smile, a poorly developed lower jaw, and an excessively developed upper jaw.

These are examples to explain how function affects form.

A child who has had trauma to the chin and jaw joint in childhood might be unable to open their mouth and may suffer from micrognathia, a small jaw, and a small chin. Due to the trauma, the child never develops a full mouth-opening function.

Similarly, obstructive sleep apnoea is a disorder where a patient has trouble breathing due to an obstruction anywhere in the upper airway, such as a deviated septum, a large turbinate, a large uvula, a small jaw, or a large tongue. Here, advancing the jaw helps improve the airways, and the bonus is it also gives a good appearance.

Moreover, a patient with excessive bruxism and teeth grinding suffers from a reduced facial height, a square jaw, and a chubby face due to hypertrophy of the masseter muscle. Muscle bulking needs debulking to prevent TMJ disorder and the problem of reduced facial height.

Thus, surgery is needed to correct the deformity and restore function.

These girls and boys come to us as adults. It is that age when facial appearance is attached to their confidence, and any abnormality seen in that face has a negative psychological impact. It is thus imperative to perform jaw surgery/orthognathic surgery, and it should not be considered otherwise as a justification for cosmetic reasons.