Orthognathic Jaw Surgery
Few people have perfectly size matched jaws. People who have an imbalance in jaw size often dislike their facial appearance, feeling that they look chinless or like the comic book character “Desperate Dan”.
Sometimes a facial asymmetry exists too. Alternatively, the patient may have an inability to bite properly or a traumatic bite, causing the gum to be stripped away from the upper or lower front teeth.
For people with a significant mismatch in jaw size, jaw surgery is an opportunity to correct this underlying problem.
Jaw surgery can also be a solution for patients suffering from obstructive sleep apnoea, for whom conservative treatments such as CPAP are not tolerated.
The orthodontist works closely with experienced maxillofacial surgeons to enable patients to achieve the optimal surgical outcome to their problem and provides the brace treatment that is an important part of this patient journey.
This treatment is not radical or pioneering and has been used for many people over several decades to great effect. As an NHS Consultant Orthodontist of many years standing, Dr Claire Nightingale has treated hundreds of patients jointly with several Consultant Maxillofacial Surgeons.
Consultant Orthodontist, Dr Claire Nightingale and Consultant Oral and Maxillofacial Surgeon, Mr Manolis Heliotis explain why they are still passionate about providing orthognathic care for their patients.
Case report 1: Short lower jaw leading to prominent teeth and a traumatic bite
"It has made such a phenomenal difference to my life. Before I was struggling to eat; I had a lot of pain and I was very conscious of what I looked like and I’ve gone home this week and my food tastes different; I look completely different; people don’t recognise me anymore. I feel much more confident in myself and I don’t get the aches and pains that I did before. "
Alex had a short lower jaw, which meant that her upper incisor teeth were pushed forward by the muscle pressure of her lower lip and were prominent (“goofy”) as a result. As they had no contact against her upper teeth, her lower incisor teeth had over erupted into the roof of her mouth (the palate) and had stripped away the gum from behind the upper incisors.
The solution for Alex was to correct the short lower jaw by jaw advancement surgery, which brought the lower incisors forward to meet the upper incisors in an anatomically correct position. She wore braces for about 12 months before the surgery and needed to wear them for a similar period of time afterwards to settle her bite. Overall her treatment time was about 2 years.
As a result of treatment, the gum health of her upper incisors improved dramatically, she could eat properly and the bonus was that she had a great smile too!
Case report 2: Short lower jaw leading to obstructive sleep apnoea
“Since the surgery, I have lots more energy, I can exercise more, I’m more active, I feel fitter and have lost weight, and just altogether feel more energised to enjoy life! And of course I sleep better - and I also hardly ever snore now either!! An added bonus...
My sleep study after surgery showed that the number of apnoea and hypopnoeas had reduced to less than 2 per hour, a big change from before surgery.
And I’ve never since woken up gasping for breath like I used to.”
" The result QGO achieved for me has been genuinely life enhancing. Everyone at QGO is friendly, warm, engaging, and brilliant at what they do - the perfect balance of a warm and engaging practice, delivering excellent patient care, and focused on a great outcome and result. I cannot recommend them highly enough.”
Richard never had an orthodontic assessment as a teenager because his teeth were pretty straight. As a result, his short lower jaw was not recognised to be a problem. When he became older, he developed obstructive sleep apnoea, where he would wake gasping for breath, sometimes frequently. As a consequence, he was listless and exhausted, unable to function properly. The cause of his problem was that his tongue and soft palate were very close to his pharynx (airway) and when he laid down, his airway would “collapse”, blocked by his tongue and soft palate, stopping the air from reaching his lungs. Richard hated wearing a noisy CPAP machine at night, and having had success with a mandibular advancement splint, he looked for a more permanent solution to resolve his problem.
After having braces to straighten his teeth and create some prominence of his upper front teeth to allow the lower jaw to be brought forward, Richard had surgery to both the upper and lower jaws (a bimaxillary osteotomy) which corrected his obstructive sleep apnoea immediately. His overall treatment time was nearly 4 years.
Case report 3: Asymmetrical growth of the lower jaw leading to facial asymmetry and a traumatic bite
" I could not be happier with the results of my orthodontic treatment and surgery. I’ve always been extremely self-conscious of my mouth, often covering it when talking and never smiling with me teeth. I also struggled to eat normally and suffered jaw clicking and pain which was extremely uncomfortable. I’m so glad I sought out treatment to correct this, the 2.5 years of treatment flew by and I’m pleased to say I now cannot stop smiling!”
The right side of Lily’s jaw joint (condyle) had grown more than the left side jaw joint. As a consequence, she had a facial asymmetry with her chin point off to her left side and the upper jaw was tipped down to the right (maxillary occlusal cant). Additionally, she had a crossbite of her teeth on the left side. This is called a hemifacial asymmetry.
After braces to straighten her teeth and move them to allow them to meet ideally post operatively, she had surgery to both jaws to correct the tip on the upper jaw, and bring her chin to the back to the centre of her face. Her overall treatment time was approximately 2.5 years.
Case report 4: Increased growth of the lower jaw leading to an anterior open bite
“I would go through the whole journey again within a heart beat!
I am so pleased with the results and I feel so much more confident.
I couldn’t speak highly enough of Claire and her team. I looked forward to every visit over I made from Manchester as it was one step closer to the end result.
Even though the time period of the whole treatment was over 2 years I felt the time flew.”
Due to the lack of contact between her front teeth, Louise found biting into fine foods difficult. In addition, she disliked her appearance, feeling that the middle of her face was too flat.
Various treatment options were discussed in great detail with Louise, before she decided to have surgery to bring her upper jaw forward. Louise also decided to travel quite some distance to London from Manchester to have treatment with the orthognathic team of her choice. She wore upper and lower braces to straighten her teeth and ensure that her bite was as good as possible once the surgery was completed. Her treatment took about two years. She was thrilled with the result, as she can now bite properly and likes the subtle changes to her facial appearance.
Case report 5: Long lower jaw and short upper jaw, causing an anterior crossbite and flat facial profile
“My life has improved 10 fold. Before the treatment I was conscious of my smile and how I presented myself. The actual procedure made me a lot more confident. I could smile without thinking people were looking at me differently and I wasn’t covering my face during speech. Absolutely fantastic, a remarkable difference. It is quite daunting when you first think about the treatment, but it’s improved my life tremendously and I’m very happy with the results.”
Jonathan had a disproportion in the size of his jaws, in that the upper jaw was slightly too short and the lower was longer than average. The consequence was that his lower teeth jutted out in front of his upper teeth (an anterior crossbite), which made it difficult for him to bite into food properly. Additionally, he didn’t like his smile or his profile, which was a little flat.
Although Jonathan’s teeth were straight, he still needed to have upper and lower braces to move his teeth so that they would fit together ideally after jaw surgery. Thirteen months of braces prepared him for orthognathic (jaw) surgery to the upper and lower jaws, intentionally creating a larger gap between his front teeth, so that the surgery could move the upper jaw forward and the lower jaw back maximally, to give him a better facial profile and a normal bite. The braces stayed on his teeth for the duration of treatment, including the surgery, following which he then had about 9 months of further orthodontic treatment to settle his teeth into maximum contact. His total treatment time was 22 months. He now has a fuller facial profile, with a better curve of his upper and lower lips, plus the benefit of a correct anterior bite, which allows him to eat normally.
Case report 6: Short upper jaw leading to a traumatic crossbite and worn upper incisor teeth
“My two middle teeth, top and bottom, were wearing down because I had a crossbite. My dentist advised that I should have this sorted out as quickly as possible, otherwise I’d end up with crowns and false teeth. The benefits have been that my teeth are now in great shape. Although it’s been a long process, I’m very pleased that I went through it. It’s been a great journey!”
Su had a short upper jaw, causing her upper teeth to be incorrectly positioned behind her lower teeth (anterior crossbite). This meant that the front surfaces of her upper incisors were worn down by the lower teeth and had become in need of restoration. However, it wasn’t possible to restore her upper teeth properly without correcting her bite first. In addition, her back teeth didn’t meet properly either (posterior crossbite). Although Su was essentially happy with the look of her smile and despite having a faulty bite, she could eat what she wanted, nevertheless, she made the decision to go forward with extensive treatment, in order to protect the long term health of her teeth.
After wearing braces to straighten her upper and lower teeth, Su had surgery to the top jaw only, bringing it forward to correct the bite with the lower teeth. Overall, her treatment took a couple of years.
Following treatment, Su’s upper teeth have been protected from any further unwanted wear. She could eat properly and liked the improvement in her profile too.
Case report 7: Deterioration of the bite in midlife resulting in a large anterior open bite
“It’s been a longish journey but I feel amazing, it’s brilliant, it’s like all the Christmases have come early. I couldn’t bite into anything, and I could hardly chew, so my diet was rice and yoghurt at one stage. I had double jaw surgery, and now all my teeth connect. I have a full functioning mouth like anyone else. Just biting into a sandwich, and not feeling embarrassed, not panicking when I’m out is amazing. Now I can just live a normal life like everyone else.”
In her midlife, Zoe experienced a significant deterioration in her bite over a 4 year period. Although the cause remains uncertain, despite thorough investigation, it is most likely due to alteration of her jaw joints. The consequence was that Zoe found it impossible to eat properly and her diet became very limited; likewise her social life became constrained with limitations about which type of restaurants she could go to eat out with friends.
Once the bite alteration had stabilised, Zoe had surgery to both jaws, in conjunction with orthodontic treatment, which successfully closed her bite down to give her contact between her teeth, with minimal change in her facial appearance. Despite the Covid-19 pandemic interrupting her treatment, Dr Nightingale and Mr Heliotis pulled out all the stops to get her surgery completed between the two lockdown periods, so that her treatment was successfully finished within only 20 months.
Once her braces were off, Zoe is now able to complete the dental restorations in her lower jaw, having had implants placed many years before her bite problems began.