Correction of pathologies of occlusion and dentition is one of the most important areas in modern dentistry. One of the most popular methods in orthodontics to correct these problems is considered to be surgical intervention. In some cases, jaw surgery is the only way to achieve any noticeable and significant positive changes.
Orthognathic Surgery
Usually, this concept means a number of specific operations that are designed to correct the external symmetry of the face and malocclusion. When performing an osteotomy, the soft tissues are transformed, which allows the external features of the face to become more aesthetically attractive. Changes in the bone structures make it possible to perform some manipulations, for example, lengthen or shorten the jaws, correct the size of the chin, and also move the jaws to the most suitable position.
Such changes cannot be achieved with braces, plates or other special devices. ExceptIn addition, there is often a need for surgery on a broken jaw if the damage is severe enough. Osteotomy requires clear indications and has a number of limitations, mainly related to the patient's physical he alth.
General indications for surgery
The doctor may recommend surgery for second and third grade skeletal deformities of the jaw, which are characterized by visually distinguishable abnormal sizes of the chin and jaws. Jaw surgery to correct an overbite is usually performed only after unsatisfactory results of treatment with other methods.
Pre-treatment is carried out with the help of orthopedic structures like crowns and veneers, as well as with the use of braces. If the desired effect after treatment could not be achieved, or if it only leads to a deterioration in the patient's well-being, then the doctor decides to perform the appropriate operation.
Sufficiently serious anomalies in the structure of the jaws are not corrected by braces. A protruding chin or a gingival smile can only be corrected surgically. In favor of the operation is also the fact that the correction of skeletal deformities by conventional methods of orthodontic treatment can often provoke pathologies of the TMJ (temporomandibular joint) or dislocation of the teeth. In turn, some of the pathologies of the TMJ cause severe pain in the back and head, problems with the functioning of the gastrointestinal tract, as well asaccompanied by other complications.
Contraindications for surgery
Among the contraindications, the most important is considered to be the age of the patient. Such an operation is not performed for minors, because at the age of 18 years, the processes of bone tissue formation are actively going on. Problems and visual defects associated with the jaw apparatus can correct themselves by the time the bite is finally formed and the process of jaw growth is completed. Other reasons for possible denial of jaw surgery to correct deformities and anomalies include:
- HIV and TB;
- presence of diabetes;
- any infectious diseases;
- blood clotting problems or oncology;
- diseases of the endocrine, immune and cardiovascular systems;
- mental abnormalities and disturbances in the work of the central nervous system;
- incomplete and slow healing of bone tissue, the presence of associated pathologies;
- Rows of teeth unprepared for surgery.
The last point is most often a temporary problem, to eliminate which braces are used. If simple alignment of the dentition with braces is not enough, then doctors prescribe the extraction and prosthetics of the teeth, as well as plastic correction of the lateral strands.
The process of preparing for surgery
After the appointment of a surgical intervention, the process of determining the necessary parameters of the bones of the jaw and face begins, whichwill combine the possibility of high-quality synchronization of the work of the entire temporomandibular joint, the correct adjoining of teeth to each other and a harmonious facial expression from an aesthetic point of view.
Special software will build a three-dimensional model of the future corrected jaw. This model is guided by doctors directly during the operation on the jaw. The use of modern technologies makes it possible to reproduce previously made calculations with an accuracy of up to 99 percent.
The plan drawn up and the model built is just the first stage in the preparation process. This is followed by the second and longest step, which is required in almost every case. The doctor proceeds to the preliminary alignment of the dentition with the help of braces and other necessary tools. The duration of preparation for the operation takes from 2 to 18 months.
Consequences of refusing the operation
According to statistics, most of the patients who refused the surgery recommended by dentists on the jaw to correct the bite, sooner or later face additional complications that aggravate the pathology. The list of complications includes the following:
- Gum disease. Destruction and loss of some teeth.
- Disturbances in the digestive tract due to improper chewing of food.
- Frequent pains around the ears, temples and jaws. Toothache.
- The appearance of problems with speech. Violations of pronunciation and diction.
Surgery techniques and the latest equipment allow you to quickly andit is safe to perform surgery, so the patient's refusal without contraindications is a highly dubious step.
Complications during and after surgery
Since orthognathic surgery is considered the only predictable surgery among all other types, the risks of any complications are naturally reduced to an acceptable minimum. During the work of surgeons, the patient is under general anesthesia. Only certain cases of light intervention in the bone structure allow the use of local anesthesia.
Some patients noted that after the operation there was a temporary numbness of the upper and lower lips. Doctors call this effect absolutely safe and in some ways even useful: the lack of sensitivity after the operation on the bite of the jaw quite logically leads to the absence of pain at first. By the time the sensitivity is restored, as a rule, the pain either recedes completely or is not so pronounced.
It is worth noting that when changing the size of the jaw during surgery, the recovery process will always take longer, as doctors are forced to damage the integrity of the bone and soft tissues.
Jaw fracture surgery
Assign an operation only in a situation where all orthopedic methods do not bring a positive result or are not applicable. With multiple injuries and severe fractures of the jaw, surgery is a necessary measure. Under this classificationthe following cases fall:
- bone defects;
- not enough teeth to fit a splint;
- Unreducible compound fracture.
Four basic surgical techniques are used:
- Fastening the jaw with a steel needle or a rod through the bone.
- Bone sutures with nylon or polyamide thread.
- Attachment to the bone and subsequent fixation with metal plates or splints.
- Osteal fixation with Vernadsky, Uvarov, Rudko and other similar devices.
Surgery to remove the cyst
There are two actual methods for performing such an operation: cystotomy and cystectomy. In the presence of extensive cysts that are prone to degeneration and recurrence, doctors mainly use a two-stage operation to remove the jaw cyst. This method includes both of the above at once, it is saving and non-traumatic. Intervention is acceptable on an outpatient basis. The result of a successful operation is the complete recovery of the patient with the preservation of the visual contours and dimensions of the jaw.
The first stage of the operation is decompression - the creation of a message with the oral cavity according to the cystotomy type. However, unlike the cystotomy method, the channel is made of a smaller diameter, which will be sufficient for outflow from the cyst cavity for a long time. The second stage is a standard cystectomy. A time interval of about 12-18 months is maintained between the stages.
Osteotomy of the upper jaw
An operation is performed on the jaw in this case if one of the following indications is present:
- too small or, conversely, an intensely developed jaw;
- upper jaw protruding;
- has an open bite.
The doctor cuts the oral mucosa slightly above the transitional fold, pushes the edges of the incision apart and cuts the front wall of the jaw. After separating the previously sawn off fragment, the doctor fixes the new position of the jaw and fastens it with titanium plates. Usually, surgery on the upper jaw is prescribed as one of the stages in complex orthodontic treatment.
Osteotomy of the lower jaw
Intervention is recommended for severe deformation of the lower jaw and significant malocclusion. In some cases, doctors put a splint between the jaws to fix them. There is only one minus in such a manipulation after jaw surgery - the inability to fully open the mouth and the need for about two weeks to eat exclusively liquid food.
The technique is generally similar to the osteotomy of the upper jaw. The surgeon cuts the periosteum and mucous membrane, thereby gaining direct access to the jaw. Then cuts are made in predetermined places, excess bone fragments are separated, the jaw is set in a new position and fastened with titanium plates. If necessary, the doctor may additionally prescribe in combination with osteotomy and plastic surgery on the jaw.
Post-opperiod
After the osteotomy, the patient must be kept in a hospital for three days. Complications can extend this period up to 10 days. Doctors will judge the final success of the operation only six months after the operation.
On the first day, doctors will fix the jaw with a pressure bandage and remove it after 24 hours. During rehabilitation, the patient will be prescribed antibiotics to avoid infectious diseases. At the same time, special elastic bands will be placed between the teeth for better fastening of the jaws. Postoperative sutures are removed after 14 days, and fastening screws - only after three months.
Tissue edema will persist for one month, and chin sensitivity disturbance will be present for four months from the date of jaw surgery. These symptoms are not complications and will gradually disappear as you recover.
At the moment, jaw surgery is recognized as one of the safest for patients, and the positive effects after the necessary operation are very noticeable both in terms of life comfort and aesthetics.
