What Is Orthognathic Surgery
Orthognathic surgery is a procedure that moves the bones of the upper jaw (maxilla), lower jaw (mandible), or both into a better position. The goal is to correct a skeletal discrepancy, meaning the jaws themselves are not aligned properly, rather than just the teeth. Braces and aligners can move teeth within the bone, but they cannot move the bone itself. When the jaw bones are significantly misaligned, surgery is the only way to achieve a stable, functional bite.
The term orthognathic comes from the Greek words for straight (ortho) and jaw (gnathic). The surgery is sometimes referred to as orthodontic surgery because it is almost always performed as part of a combined orthodontic and surgical treatment plan. An oral and maxillofacial surgeon performs the surgery, while an orthodontist manages the braces or aligners that align the teeth before and after the procedure.
Orthognathic surgery is not cosmetic surgery, though it often improves facial appearance as a secondary benefit. The primary purpose is to correct functional problems: difficulty chewing, chronic jaw pain, breathing obstruction, speech problems, and excessive tooth wear caused by a severely misaligned bite.
When Orthognathic Surgery Is Needed
Not every bite problem requires surgery. Most malocclusions (misaligned bites) can be corrected with orthodontics alone. Orthognathic surgery is recommended when the discrepancy between the upper and lower jaws is too large for tooth movement to compensate.
Common Reasons for Orthognathic Surgery
- Severe underbite (mandibular prognathism): The lower jaw extends significantly forward of the upper jaw, making it difficult to bite into food and causing excessive wear on the back teeth.
- Severe overbite (mandibular retrognathism): The lower jaw is set too far back, creating a large gap between the upper and lower front teeth and potentially contributing to obstructive sleep apnea.
- Open bite: The upper and lower front teeth do not meet when the mouth is closed, making it impossible to bite through food with the front teeth.
- Facial asymmetry: One side of the jaw is longer or positioned differently than the other, causing the chin to deviate to one side and uneven tooth contact.
- Jaw growth abnormality: Conditions where one or both jaws have grown excessively or insufficiently, creating functional and sometimes airway problems.
- Obstructive sleep apnea: In some patients, advancing the upper and lower jaws forward can open the airway and reduce or eliminate sleep apnea.
Age and Timing Considerations
Orthognathic surgery is typically performed after jaw growth is complete. For most females, this is around age 16 to 17. For most males, this is around age 18 to 21. Operating before growth is complete risks relapse as the jaw continues to grow after surgery.
There is no upper age limit for orthognathic surgery as long as the patient is in good general health. Adults in their 30s, 40s, and beyond undergo the procedure when they have lived with a dysfunctional bite and decide to correct it.
Types of Orthognathic Surgery
The specific procedure depends on which jaw needs to be moved and in which direction. Some patients need surgery on one jaw only. Others need both jaws repositioned in the same operation (bimaxillary surgery).
Le Fort Osteotomy (Upper Jaw Surgery)
A Le Fort I osteotomy repositions the entire upper jaw (maxilla). The surgeon makes cuts in the bone above the roots of the upper teeth, separates the maxilla from the skull base, and moves it forward, backward, up, or down as needed. The jaw is then fixed in its new position with titanium plates and screws.
This procedure corrects problems such as an upper jaw that is too far back (contributing to an underbite appearance), a vertically excessive maxilla (gummy smile), or an open bite caused by the upper jaw growing unevenly.
Bilateral Sagittal Split Osteotomy (Lower Jaw Surgery)
A bilateral sagittal split osteotomy (BSSO) is the most common procedure for repositioning the lower jaw. The surgeon splits the mandible on both sides behind the molars and moves the tooth-bearing segment forward or backward. Titanium plates and screws hold the jaw in its new position.
BSSO corrects underbites (by moving the lower jaw back), some overbites (by moving the lower jaw forward), and asymmetry (by moving one side more than the other).
Genioplasty (Chin Surgery)
A genioplasty repositions the chin bone independently of the rest of the lower jaw. The surgeon cuts the chin segment and moves it forward, backward, up, or down. This procedure is often combined with upper or lower jaw surgery to achieve balanced facial proportions.
Genioplasty is sometimes performed on its own when the bite is acceptable but the chin position creates a functional or aesthetic concern.
Bimaxillary Surgery (Both Jaws)
When both jaws are misaligned, the surgeon may perform a Le Fort osteotomy and BSSO in the same operation. This is called bimaxillary surgery. It allows the surgeon to position both jaws relative to each other and to the skull base, producing the most stable and balanced result. Bimaxillary surgery is common in cases of severe facial asymmetry or when the bite discrepancy involves both jaws.
The Combined Orthodontics and Surgery Timeline
Orthognathic surgery is not a standalone procedure. It is part of a coordinated treatment plan that includes pre-surgical orthodontics, the surgery itself, and post-surgical orthodontics. The full process typically takes 18 to 30 months from start to finish.
During the pre-surgical phase, which lasts 12 to 18 months, the orthodontist aligns the teeth within each jaw so they will fit together correctly after the jaws are repositioned. This sometimes means the bite temporarily gets worse before surgery. The orthodontist and surgeon collaborate on the treatment plan using 3D imaging and computer-aided surgical planning.
After surgery, the orthodontist continues treatment for 6 to 12 months to fine-tune the bite and achieve the final tooth positions. Braces or aligners are then removed and retainers are placed to maintain the result.
What to Expect: Before, During, and After Surgery
Orthognathic surgery is performed under general anesthesia in a hospital or surgical center. The procedure typically takes two to four hours depending on whether one or both jaws are being repositioned.
Before Surgery
In the weeks before surgery, you will have final imaging and surgical planning appointments. Your surgeon will use 3D models and computer software to plan the exact movements. You will receive instructions on pre-operative preparation, including fasting, medication adjustments, and arranging time off work or school.
During Surgery
All incisions are made inside the mouth, which means there are no visible scars on the face in most cases. The surgeon cuts the bone, repositions the jaw segments according to the surgical plan, and secures them with titanium plates and screws. These plates are small and typically remain permanently. In rare cases they are removed later if they cause irritation.
Recovery Timeline
Most patients stay in the hospital for one to two nights after surgery. Swelling peaks around day three to four and gradually subsides over the following two to four weeks. The jaws are not wired shut in most modern cases, though some surgeons use elastic bands to guide the bite during early healing.
You will follow a liquid diet for the first one to two weeks, then transition to soft foods for four to six weeks. Most patients return to work or school within two to four weeks. Full bone healing takes approximately 9 to 12 months, during which you should avoid contact sports and activities that risk jaw impact.
Numbness in the lower lip and chin is common after lower jaw surgery and typically improves gradually over several months. In a small percentage of patients, some numbness persists long-term.
Orthognathic Surgery Cost and Insurance Coverage
The total cost of orthognathic surgery varies depending on the type of procedure, the surgeon, the hospital, and your geographic location. Surgery on one jaw typically costs $20,000 to $40,000 when you include the surgeon's fee, anesthesia, and hospital facility charges. Bimaxillary surgery costs more. These figures do not include the cost of orthodontic treatment, which is a separate expense.
The important distinction with orthognathic surgery is that it is often covered by medical insurance, not dental insurance. Because the surgery corrects a functional skeletal problem, many medical insurance plans classify it as a medically necessary procedure. Coverage varies by plan, and pre-authorization is almost always required. Your surgeon's office typically handles the insurance submission process.
If your insurance does not cover the procedure or covers only a portion, many oral surgery practices offer payment plans or can help you apply for medical financing. Ask your surgeon's financial coordinator about options before committing to treatment.
When to See an Oral and Maxillofacial Surgeon
If your orthodontist has told you that your bite problem involves the jaw bones and not just the teeth, the next step is a consultation with an oral and maxillofacial surgeon. An OMS is a dentist who has completed four to six years of surgical residency training, including training in hospital-based surgery under general anesthesia.
You should also see an oral surgeon if you have chronic jaw pain or TMJ symptoms that may be related to jaw misalignment, if you have sleep apnea that might respond to jaw advancement surgery, or if you are an adult who was told as a teenager that you needed jaw surgery but did not have it at the time.
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