Double jaw surgery, technically known as bimaxillary osteotomy, is a corrective procedure designed to address significant skeletal discrepancies between the upper jaw (maxilla) and the lower jaw (mandible). This surgery is performed when malocclusion (a misaligned bite) or related facial imbalances are too severe to be corrected by orthodontics alone. The process involves repositioning both jaw bones to achieve proper alignment, which improves functional elements like chewing and speaking, and enhances facial harmony. While the operation itself has a defined time frame, the total commitment from a patient encompasses a much longer, multi-phase treatment arc.
The Duration of the Operation
The time a patient spends under general anesthesia for double jaw surgery typically ranges from three to six hours. This window accounts only for the surgical procedure itself, excluding the time required for pre-operative preparation and post-operative recovery within the operating suite. The goal is to perform a coordinated adjustment to both the upper and lower facial skeletons.
The procedure combines a Le Fort I osteotomy on the upper jaw and a Bilateral Sagittal Split Osteotomy (BSSO) on the lower jaw. The Le Fort I technique involves making precise cuts above the teeth to separate the maxilla, allowing the surgeon to move it in three dimensions—up, down, forward, or backward. Following this, the BSSO technique is performed on the mandible, which involves splitting the bone near the back of the jaw to enable forward or backward repositioning.
All bone cuts and repositioning maneuvers are performed through incisions made inside the mouth, which eliminates visible external scarring. Once the jaws are in their planned new positions, they are secured using miniature titanium plates and screws, a process called rigid fixation. The surgical team then closes the internal incisions with dissolving sutures before the patient is moved to the recovery area.
Factors That Influence Surgical Length
The variation in surgical time is dictated by factors entirely contained within the operating room. The complexity of the skeletal movement is a primary determinant; cases requiring large-magnitude movements or significant rotation of the jaw segments take longer to execute precisely than simpler advancements or setbacks. The difficulty of the bone cuts and the need for meticulous fixation of the new position directly extend the duration of the procedure.
The necessity of performing ancillary procedures simultaneously can also add significant time to the operation. Many patients receive a genioplasty, a procedure to reposition the chin bone, performed immediately after the jaw adjustments are finalized. Genioplasty, or other supplemental procedures like septoplasty to improve nasal breathing, are integrated into the main surgery to complete the desired functional and aesthetic changes in a single session.
Another variable is the use of segmental osteotomies, where the tooth-bearing arch of the jaw is divided into multiple pieces, which is required for certain complex dental alignments. Dividing the jaw into three or more segments requires additional time for precise cutting and stabilization. Finally, the experience level of the surgical team and the efficiency of the operating room staff contribute to the overall time, with highly specialized teams often completing the procedures closer to the shorter end of the time range.
Immediate Post-Surgical Timeline
Immediately following the procedure, the patient is transferred to the Post-Anesthesia Care Unit (PACU) for close monitoring, a period that typically lasts for one to two hours. During this time, medical staff ensure the patient is safely waking up from general anesthesia and that initial pain and swelling are managed effectively. The patient is then moved to a regular hospital room for observation.
The standard hospital stay for double jaw surgery ranges from one to three nights, depending on the complexity of the case and the patient’s individual recovery progress. Discharge criteria generally require the patient to be able to manage their pain with oral medication, demonstrate adequate fluid intake, and be able to walk without assistance. Swelling peaks dramatically around the second or third day post-surgery, which is often managed with cold compresses and head elevation.
The first two weeks following discharge constitute the acute healing phase, where the most noticeable changes occur. Patients are restricted to a liquid or blenderized diet for this initial period to prevent any stress on the newly positioned bones. During this time, the jaws are stabilized using guiding elastics worn on the orthodontic braces, which help the muscles adapt to the new bite position.
The Comprehensive Treatment Arc
The surgery itself is a single event that occurs within a much longer, multi-phase treatment process. The entire comprehensive treatment arc, from the initial consultation to the final removal of orthodontic appliances, can span between one and three years. This timeline is heavily influenced by the extent of pre- and post-surgical orthodontic work required.
The preparatory phase begins with pre-surgical orthodontics, which typically lasts from nine to eighteen months. During this period, the orthodontist uses braces to align the teeth within each jaw so they will fit together perfectly once the jaws are surgically repositioned. This phase is counter-intuitive for some patients, as the bite may temporarily appear worse before the surgery can correct the skeletal problem.
Following the surgery, the patient enters the post-surgical orthodontic phase, which focuses on fine-tuning the bite. This final alignment usually takes an additional six to twelve months, after which the braces are removed. The recovery of functional activities, such as returning to a regular diet and strenuous physical activity, generally progresses over a period of six to twelve weeks.
The final phase of the treatment arc is the retention phase, which begins once the braces are removed. Patients must wear retainers indefinitely to prevent the teeth and jaws from shifting away from their corrected positions. While the bones achieve their initial stability within a few weeks, complete bone consolidation and final soft tissue settling take up to a full year.