The shape of the face is largely determined by the structure of the upper and lower jaws. There are many congenital and acquired problems that can distort the appearance of a person. There is a too narrow or wide upper jaw, too long or short, protruding forward. To correct these flaws and give a person the desired appearance, an operation of an osteotomy of the upper jaw is performed.
Operation in brief
Osteotomy is a type of surgical intervention performed by a dentist. Most often, it is prescribed for serious bite pathologies, congenital disorders of the jaw formation, after an unfavorable correction of a cleft palate ("cleft palate"). Osteotomy of both the upper and lower jaws is possible. Operation on the lower jaw is often performed after a traumatic fracture.
Types of interventions on the upper jaw
There are two main types of osteotomy: general andsegmental.
General, in turn, is divided into three more subtypes. They got their name from the name of the author who invented them: osteotomy of the upper jaw according to Le Fort 1, 2, 3.
Three subtypes of segment operations are distinguished separately:
- Premaxillary osteotomy.
- Posterior maxillary osteotomy.
- Surgery on the lower labial segment.
Each type of segmental osteotomy of the upper jaw has its own characteristics. The first type is to move the incisor bone, the second method is to change the placement of the posterior alveolar segments, and the operation on the lower segment is to reposition the lower anterior teeth.
Indications for surgery
Osteotomy of the upper jaw is performed in the following cases:
- with severe malocclusion and non-closure of the dentition, which is not eliminated by wearing braces or other orthodontic methods;
- pathological growth of the bones of the upper jaw;
- a strongly pronounced violation of the proportions of the face, which gives a person inconvenience from the aesthetic side.
But the operation is carried out not only to make the face more beautiful. Sometimes these defects can contribute to the development of severe life-threatening conditions:
- impaired breathing;
- diseases of the jaw joints;
- inflammatory processes in the gastrointestinal tract.
Osteotomy can prevent the development of these consequences and even save the life of the patient.
Contraindications for surgery
Sometimes the patient's desire alone is not enough to carry out an intervention. The presence of certain conditions completely excludes the possibility of osteotomy of the upper jaw:
- minority, as children and adolescents continue to form bone tissue;
- periodontal disease in the active stage or running chronic course;
- bleeding disorder;
- systemic connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis and others);
- presence of diabetes;
- unprepared dentition.
Preparation for surgery
If the doctor decides to make the patient an osteotomy of the upper jaw, first of all, he prescribes an x-ray examination of the dentition. The discussion of the surgical intervention should be carried out in a complex maxillofacial surgeon and orthodontist. They analyze the x-ray in detail and make the final decision about the operation.
Osteotomy alone is not able to change the misalignment of the teeth. It only corrects the deformation of the bone tissue. Therefore, often before surgery, the patient needs to undergo orthodontic treatment - wearing braces. Sometimes they resort to the help of surgical dentistry: installing dentures, removing teeth.
Before the operation, the patient visits the orthodontist again. If braces were prescribed, the doctor will change their location so that an osteotomy can be done.
Only after alignment of the dentition andconsultation with an orthodontist, the patient goes to the maxillofacial surgeon again. If the alignment results are satisfactory, the surgeon will discuss the maxillary osteotomy plan with the patient.
Progress of operation
Osteotomy is performed under general anesthesia. The anesthetic is injected through a tube into the trachea. The patient falls into a deep sleep and feels absolutely nothing. All stages of the operation are done on the inside of the face, so no defects will remain on the skin.
First, the gingival mucosa and periosteum are cut above the place of attachment of the upper teeth. This gives the surgeon access to the bone.
The bones are marked on both sides for cuts. A special surgical saw cuts the bone of the upper jaw. Most often, cuts are made according to the method of osteotomy of the upper jaw according to Le Fort.
The resulting fragment is moved to a new location. It is fixed with screws and plates. All fasteners are made of titanium, which is completely safe for the body.
Sometimes patients need a bone graft. Usually take a section of the femur. This is done at the same time as the jaw surgery while the patient is under general anesthesia.
Sometimes there is a need for splinting. This procedure is the union of several teeth. This method helps to fix the dentition with the help of special equipment. This is a temporary procedure. After a certain time after the operation, the threads are removed.
The duration of the operation is about two hours.
Complications
Most often, osteotomy of the upper jaw goes well, without any adverse reactions. But sometimes they do occur, so both the patient and the doctor should be aware of possible complications. Key concerns include:
- Nosebleed. Slight bleeding from the nose is normal and does not need additional measures. But if there is a large amount of blood during and after the operation, it is necessary to clamp the nasal passages for at least 10 minutes.
- Numbness of upper lip after surgery. This is more likely not a complication, but an adverse reaction to anesthesia. The discomfort can last for weeks.
- Penetration of microorganisms. Occurs when there is a violation of the sterilization of screws and plates, insufficient processing of the surgical field.
- Exacerbations of chronic lung diseases. It occurs in patients with bronchial asthma and long-term smokers.
- Incorrect bite. Change of bite is possible after the operation. Sometimes it becomes necessary to repeat orthodontic treatment.
- Bone healing too slow.
Rehabilitation period
During the operation, the patient does not feel anything. But after surgery, he may be disturbed by minor pain in the upper jaw. So the doctor prescribes pain medication for him.
While the patient is in the hospital, he is given intravenous antibiotics. This isa necessary measure for the prevention of infectious complications.
After the operation, the patient will face some inconvenience:
- impaired nasal breathing, causing him to breathe through his mouth;
- discomfort due to swelling;
- difficulty opening the mouth due to bruising over the lip;
- sore throat and trouble swallowing due to anesthesia tube.
Facial swelling is reduced with cold compresses and an elevated head position during sleep.
The first two days after surgery, the patient can eat only liquid food. After a few days, the diet expands to a meal of soft consistency. Only after a few weeks is it possible to eat normally.
Full performance returns to the person three to four weeks after surgery.
In the first month, the patient will have to face some difficulties, however, it's all worth it. Osteotomy of the upper jaw gives excellent results. It really changes people's lives. Changes in the photo before and after osteotomy of the upper jaw are visible to the naked eye.
Operation reviews
Osteotomy has a fairly high cost. The price depends on the qualifications of the doctor, the status of the medical institution, the method of surgical intervention. The cost starts from 80 - 100 thousand rubles and reaches 300 thousand or more.
But despite the high prices, most reviews of maxillary osteotomy are positive. However, patients are concerned about strongswelling after surgery. Many do not look in the mirror until a month after the intervention.
Patients claim that their attitude to the operation and their appearance is largely determined by the speed of wound healing and edema subsidence. The more positive the attitude, the faster the recovery.
But the end result amazes almost everyone. Those who have gone through a maxillary osteotomy say that all these inconveniences are definitely worth it.
