Assessment, planning and discussion
Your orthodontists and maxillofacial surgeons will discuss your concerns and the long-term aim of your treatment.
Presurgical orthodontics (The Orthodontic Team)
Fixed braces will move your teeth in each arch into better positions in preparation for surgery to one or both jaws. The teeth will then fit and function better. This stage usually takes between one and two years.
Orthognathic surgery (The Surgical Team)
You will be admitted to the ward the day before the operation. Jaw surgery is carried out while you are asleep under a general anaesthetic. You can expect to spend from three to seven days in hospital, where you will recover after the operation with expert supervision before being allowed home. You are advised to arrange a month off work or school/college, during which time you will be reviewed weekly to monitor and assess your progress, extending to monthly reviews after this period.
All the surgery is performed within the mouth: cuts made along the gum allow the bones of the jaw to be moved into the correct position. They are fixed with small metal plates and screws which usually remain in the bone. They may sometimes need to be removed at a later date. The correct jaw position is achieved using a thin, clear plastic splint or 'wafer', which sometimes remains secured to the lower teeth for some weeks. Dissolving stitches neatly close the gum. When you wake from you anaesthetic you can open your mouth, but gentle elastic bands are used the next day, using the braces on the upper and lower teeth, to guide your teeth into position. These elastics are replaced with fresh ones, by the medicl staff initially, and by you later at home.
Great care is taken to protect the nerves that run through the jaws at the time of surgery, but you may experience areas of facial numbness immediately post-operatively. If the upper jaw is moved, the numb feeling is limited to the cheeks and upper lip; if the lower jaw is moved, it is limited to the lower lip and chin, and possibly the tongue. This reduced sensation or 'paraesthesia' will return to normal over the ensuing weeks or months. Very rarely, an area of permanently dulled or altered sensation remains. Appearance and movement of the face is not affected, as the nerves to the facial muscles are not involved in the area of the operation.
Specialist assistance is provided by:
The Dental Hygienist or Dental Health Educator to help you keep your mouth and braces clean. The Dietitian will advise on nutritious soft and liquid diets essential for good healing and recovery. You will need a blender at home for frequent, smaller meals, as your intake will be limited initially.
You should be up and about within a day or two and back to a completely normal routine within a month. You will appreciate the improvement in your face as the swelling resolves completely. The jaw bones are completely healed after two to three months.
Postsurgical orthodontics (The Orthodontic Team)
A period of further orthodontic treatment is usually required to 'fine-tune' tooth alignment and obtain the best fit of the upper and lower teeth in the new position of the jaws. This may take three to twelve months, after which the fixed braces are removed. A period of settling of the teeth takes place and retainers are needed to control unwanted tooth movement. A removable type retainer is used in the upper jaw and can be removed for cleaning. In the lower jaw, a discrete fixed retainer glued behind the lower front teeth may be used for up to a year.
These notes are aimed as an introduction. If you have any further questions please contact your consultant Maxillofacial surgeon.
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