Saturday, August 5, 2006

The Face: Cosmetic Orthognathic Surgery or Alterations of the Jaws

The jaws and teeth are important components of the facial profile and significantly affect facial balance and aesthetics. If the positioning of the upper jaw and the lower jaw is out of balance with one another or with other facial structures, the appearance of the teeth, lips, chin-neck, nose, cheeks and forehead is affected.

Vertical imbalance of the jaws may create cosmetic concerns such as having a "toothless smile" or a "gummy smile" when speaking, resting or smiling. Horizontal imbalance of the jaws may cause cosmetic concerns by creating a facial profile with an exaggerated convex "weak chin" or concave "strong chin." Malpositioning of the jaws also causes an "underbite" or "overbite" condition.

Prior to gum and jaw treatment at the Mayo Aesthetic Surgery Center, patients are evaluated by an orthodontist and an oral-maxillofacial surgeon. The goal of treatment is to shorten or lengthen the horizontal, vertical or transverse dimensions of the jaw so that the facial soft tissue, the teeth and the other facial structures are in proper functional and aesthetic balance. Other surgical and medical evaluations also may be required to assess associated cosmetic (skin, nose and neck) and functional (speech, airway, sleep) problems.

Patients will begin treatment with orthodontic management. Most patients will need to wear braces for six months to two years to properly straighten the teeth. After the first portion of orthodontic work is complete, jaw surgery is performed to produce normal tooth function and aesthetics.

Jaw surgery (osteotomy) is performed through mouth incisions with power bone instrumentation. The repositioned bone is held in position during healing with various small internal metal devices. These devices, except on rare occasions, are retained indefinitely.

Patients undergo general anesthesia and a one-to-three-day hospitalization following surgery. A liquid/soft diet is prescribed for four to six weeks, and lower jaw function is restricted during this period of bone healing. The patient, however, is able to talk and open the mouth.

Orthognathic surgical procedures are safe and predictable. Surgical complications are minor and uncommon. Patients should expect significant swelling and bruising during the first two weeks following surgery. When the lower jaw is repositioned, a period of lower-lip numbness or tingling is present and may last for weeks or months. On rare occasions, this altered lip feeling may persist indefinitely.

Orthodontic treatment will resume six to eight weeks after jaw surgery and frequently last six to 12 months (for a total surgery and orthodontic treatment time of 12 to 24 months). Following removal of the orthodontic braces, the patient can expect a stable cosmetic and functional improvement. Additional cosmetic procedures, such as rhinoplasty and face-lift, can be considered because the internal structures (jaws and teeth) are now positioned for potential maximum aesthetic enhancement of the remainder of the face.

Because of the complexity and length of the surgical and orthodontic treatment, patients must be highly motivated and well-informed about the importance of their participation in treatment.

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