Orthognathic Surgery (Jaw Surgery): A Comprehensive Treatment Guide from a Physician’s Perspective

One of the biggest misconceptions I frequently encounter in my clinical practice is the belief that crowded teeth and jaw bite disorders can only be resolved with braces. Yet if the problem is not only the alignment of the teeth but also the skeletal position of the jawbones that support them, orthodontics alone is not enough. This is where orthognathic surgery, commonly known as jaw surgery, comes into play.

As a jaw surgeon, I should emphasize that orthognathic surgery is far more than improving the aesthetic proportions of the face; it is a vital intervention that restores the patient’s chewing, speaking, and breathing functions. In short, this procedure is the art of moving the lower and upper jaws into their ideal anatomical positions relative to the skull base and to each other.

In Which Cases Is Jaw Surgery Necessary?

Skeletal jaw anomalies are usually genetic, or they may arise as a result of trauma during growth and development, or bad habits such as prolonged thumb sucking. In children identified during the growth period, bone development can be guided with special appliances. However, in adult patients over 18 who have completed bone development, skeletal correction is possible only through surgery.

Patients with the following clinical conditions are ideal and necessary candidates for orthognathic surgery:

• Lower Jaw Protrusion (Prognathia) or Retrusion (Retrognathia): The lower jaw being positioned significantly ahead of or behind the upper jaw.

• Skeletal Asymmetry: The chin being noticeably shifted to the right or left.

• Open Bite: When the back teeth are in contact, the front teeth do not touch each other and a gap remains between them.

• Gummy Smile: Excessive gum show when smiling due to the upper jaw growing more than normal in the vertical direction.

• Sleep Apnea (OSAS): Serious breathing pauses caused by the base of the tongue blocking the airway, especially in patients with a retruded lower jaw.

Step-by-Step Treatment Protocol: How Does the Process Work?

Orthognathic surgery is a long-term team effort carried out not by a single doctor, but by an “Orthodontist” and a “Jaw Surgeon” working side by side. We divide the treatment process into three main phases, from the patient’s chair to the operating table:

1. Orthodontic Preparation Phase (Pre-Surgical Braces Treatment)

Many of my patients ask, “Can’t I just have the surgery right away and get it over with?” In general, that is not possible. While the jaws are mismatched, the teeth erupt at incorrect angles to compensate for this mismatch (natural camouflage). When we position the jaws correctly during surgery, in order for the teeth to fit together perfectly, your orthodontist first brings your teeth to the correct angles relative to the jawbone with 1 to 1.5 years of braces (or clear aligner) treatment.

2. Surgical Planning and the Day of Surgery

Once the teeth have reached the desired position, surgical planning begins. Three-dimensional dental tomographies are taken, millimetric measurements are made, and the surgery is simulated in a virtual environment. The operation is performed under general anesthesia in a fully equipped hospital. Depending on the case, only the lower jaw (single-jaw surgery) or both the lower and upper jaws (double-jaw surgery - bimaxillary surgery) may be moved.

I would like to emphasize that the surgery is performed entirely through the inside of the mouth. There are no visible incisions or suture marks on your face, cheeks, or under the chin. After the jaws are moved to their new positions, they are secured with tissue-friendly titanium plates and screws. These plates can remain in your body for life and do not need to be removed later.

3. Post-Surgical Orthodontics

Approximately 4-6 weeks after the surgery, the jawbones are largely healed. At this stage, your orthodontist takes over to make fine adjustments, and your braces treatment continues for an average of 6 more months to achieve a perfect bite.

Recovery After Surgery and Doctor’s Recommendations

It must be accepted that orthognathic surgery is a major operation. Following successful surgery, the patience you show during your recovery period at home is our greatest help in reaching the final result.

• Edema and Swelling: It is completely normal and expected for noticeable facial swelling to occur after the operation. Swelling peaks within 48-72 hours and then begins to subside rapidly. Ice compresses and keeping the head elevated help control edema.

• Liquid Diet Period: To avoid risking the bone healing process, your jaws are usually fixed together with elastic bands after surgery. Therefore, during the first 3-4 weeks, it is essential that you follow a diet consisting entirely of liquids and smooth blended foods (protein-enriched soups, fruit juices, nutritional solutions).

• Oral Hygiene: Since there are incisions inside the mouth, there is a risk of infection. During the first few days when brushing your teeth is difficult, it is critically important for wound healing that you use the antiseptic mouthwashes prescribed by your doctor regularly and without interruption.

• Loss of Sensation (Numbness): Especially after lower jaw surgeries, temporary numbness in the lower lip and chin is physiologically normal. Nerves may recover over a period ranging from a few weeks to several months.

In conclusion, orthognathic surgery is a life-changing treatment for patients who have struggled for years with chewing difficulties due to skeletal problems, have digestive issues, and hide their smile because of aesthetic concerns. With proper planning, an experienced surgical team, and the patient’s compliance with treatment, it is absolutely possible to achieve the healthy, aesthetic, and functional facial profile you have dreamed of for years.