Orthognathic surgery

Jaw surgery

It is not possible to solve all orthodontic problems only by braces. In case that wrong bite is caused by a bad growth of the jaws during the puberty, braces themselves won't often do and it is necessary to undergo a jaw surgery to achieve an uncompromising result.

If it is possible to improve an operation defect without an operation, we create an operation plan as well as the other one, without an operation, so called compromising (the occlusion won't be perfect, the face doesn't have to look as nice as after surgery, etc.). A patient makes his choice. Only extreme defects require solely ortho-surgical intervention.

During consultations in our office we are most often asked the following questions:

 What defects are solved by jaw surgery?

• The chin is too small - the upper front teeth stick out over the lower front teeth

• The chin is too big – reversed bite

• Significant facial distortion, a crooked chin - often a crossbite

• Open bite - no vertical contact between the front incisors, a patient bites only on the posterior teeth

• Gummy smile - a smile that shows an excessive amount of gum above upper incisors

• Narrow upper jaw, crossbite in adult patients - only extreme cases. A treatment without a surgery is often possible.

before surgery	after surgery

At what age is surgery performed?

Not before the age of 18. In women, who started menstruating very early (at the age of 11), surgery is possible at the age of 17. To perform surgery is is necessary the growth of the face has been finished.

Does it hurt?

A patient is put into a deep sleep under general anesthesia. Patients usually don't complain about pain after surgery. They stay in hospital for 5-7 days after surgery, that's when unpleasant healing is going on and painkillers ease the pain. Patients suffer more from facial swelling than pain, which can last up to 6 weeks.

Another oddness is that just as during fracture healing (eg. an arm) it is necesarry to immobilize the bones for 6 weeks. Immobilizing jaws is secured by a higher number of elastics between upper and lower braces which keep upper and lower teeth together. Elastics are removed only for brushing the teeth. A patient can consume only liquid diet three weeks after surgery. It is possible to gently bite between 3rd and 6th week. The side effect of jaw operation is losing a bit of weight which is appreciated by most of the patients. Pronunciation with elastics isn't usually a big problem. Patients learn quickly to talk with their teeth together. After 6 weeks, swelling disappears, elastics are worn only occasionally, a patient can normally bite and pronounce.

Is there any risk?

Risk is very low in healthy people without high blood pressure and other serious diseases.

The most common problems:

• Numbness of the lower lip - the lower lip is numb after surgery. Neither mobility of the lip or its look changes, it is only numb when touched. Numbness should disappear after a few weeks or months.  It rarely lasts longer. The same problem can occur after extracting the wisdom tooth, a patient isn't usually informed about it before extraction though.
• Bad bone healing - if a patient follows doctor´s instructions, especially liquid diet and wearing elastics which hold upper and lower teeth together, this complication is very rare.
• Relapse - the teeth and jaws return to their original alignment. We use all means to prevent the relapse. It always happens in a small way though. Only a significant relapse is a problem. In such a case a reoperation is necessary (it hasn't happened in our office yet).

Is it necessary to have braces for surgery?

Braces always have to be worn for surgery (bonded fixed braces or removable aligners Invisalign on both jaws). Sometimes we use procedure called „surgery first“, where braces or Invisalign starts after surgery.

 How much does jaw surgery cost?

It costs about 120-270 000 Kč and it is fully funded by Czech health insurance (if patient has one).

Unfortunately, health insurance companies don't have enough money and they limit a number of patients going to surgery every year. It means that there is a rapidly growing list at dental clinics and the waiting time can be up to four years. It is possible to pay privately for the surgery though and then the waiting list won't relate to a patient.

 Surgery options:

• Surgery first - surgery is performed at the beginning of the orthodontic treatment

• Surgery early - surgery is performed after six months

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  Traditional preparation - teeth are completely straightened before surgery (1-1.5 year of treatment). Surgery is followed by a short 3-6 months lasting after-treatment.

Where is surgery performed?

At specialized dental surgery clinics all over the Czech Republic, where they do jaw surgery. The best experience we have with VFN in Prague (prof. Foltán) and  FN in Brno (MUDr. Liberda).