Jaw surgery is a procedure undertaken to correct significant functional and aesthetic issues related to the alignment of the jaws and teeth. This intervention is generally reserved for cases where the skeletal structure of the face is misaligned, a problem that cannot be fully resolved through non-surgical methods like orthodontics alone. This specific type of correction, known as orthognathic surgery, aims to improve a patient’s ability to chew, speak, and breathe while also enhancing overall facial balance.
Defining Orthognathic Surgery
Orthognathic surgery is the specialized term for corrective jaw surgery, which involves surgically repositioning the bones of the face. The goal is to achieve harmony between the upper jaw, known as the maxilla, and the lower jaw, or mandible. This procedure is distinct from simple dental extractions or common treatments for temporomandibular joint disorders (TMJ) because it directly alters the skeletal foundation. The surgery is performed by an Oral and Maxillofacial Surgeon (OMS) who works in close collaboration with an orthodontist.
Prevalence and Incidence Rates
Orthognathic surgery is considered a specialized and low-volume procedure compared to general dental or many cosmetic surgeries. Precise, nationally representative incidence rates are often difficult to calculate due to variations in data collection across different countries and health systems. However, available data provides a clear context for its frequency.
In the United States, estimates from national hospitalization data suggest that the procedure is performed on roughly 10,000 to 12,000 patients annually. Patients undergoing the procedure are typically young adults, with an average age around 26 to 28 years, and a slight majority are female.
In Germany, the incidence rate is reported to be around 11.1 procedures per 100,000 person-years. This rate illustrates that for every 100,000 people, only about a dozen undergo orthognathic surgery in a given year. The procedure is reserved for a small segment of the population that requires skeletal correction beyond the scope of traditional orthodontic treatment.
Conditions Requiring Jaw Surgery
The necessity for orthognathic surgery is primarily driven by functional impairments caused by dentofacial deformities. These conditions arise when the upper and lower jaws grow at different rates or in incorrect directions, leading to a skeletal discrepancy. The most common indication is a severe malocclusion, or “bad bite,” such as a significant overbite (Class II) or an underbite (Class III) that cannot be corrected by moving the teeth alone.
Skeletal discrepancies also manifest as facial asymmetry, where the jaw is visibly unbalanced, or an open bite, where the back teeth touch but the front teeth do not. These issues often lead to difficulty in chewing food, impaired speech, and excessive wear on the teeth.
Jaw repositioning is also an established treatment for severe Obstructive Sleep Apnea (OSA) when the airway is restricted due to a retruded, or set-back, jaw structure. By surgically moving the upper and lower jaws forward, the surgeon expands the airway in the back of the throat. This skeletal movement can physically open the collapsed tissue, offering a viable option for patients who cannot tolerate continuous positive airway pressure (CPAP) therapy.
The Surgical Process Overview
The treatment for orthognathic surgery is a long-term commitment that follows a predictable sequence of three main phases. The process begins with a period of pre-surgical orthodontics, typically lasting between 9 and 18 months. During this time, the orthodontist uses braces to align the teeth within each jaw, effectively preparing the dental arches for the new skeletal position.
The second phase is the surgery itself, which is performed in a hospital setting under general anesthesia. The OMS makes precise surgical cuts, called osteotomies, in the jaw bones to move them into the planned position. Titanium plates and screws are then used to secure the bones in their new alignment. Patients usually remain in the hospital for one to two nights for observation and initial recovery.
Following the operation, the third phase involves a period of post-surgical recovery and final orthodontic detailing. The initial healing period lasts several weeks, during which the patient is restricted to a liquid or soft diet. Once the jaws are stable, the orthodontist continues to use the braces for several months to refine the final bite relationship. The entire treatment process often spans 18 months to three years.