Featured Case 05/20 – CORRECTIVE FACIAL/JAW SURGERY

Patient:

Joe

The problem:

“I have an underbite and cannot chew my food. It is impossible to bite a sandwich!”

Patient history:

• Joe is a 17-year-old with a developmental facial and jaw deformity
• He has had progressive challenges eating and speaking
• His mother relates that it is also very socially challenging as a teenager in school.
• He looks forward to looking “normal and being able to eat anything he likes.”
• He was referred by his orthodontists and primary physician for corrective jaw surgery (orthognathic surgery)

Pre Op Photos:

Pertinent information:

Developmental growth deformities of the face and jaws are fairly common. The 2 most concerning issues for patients are aesthetics and chewing function. It is not uncommon where the upper jaw (maxilla) or lower jaw (mandible) to grow at different rates to each other. This may produce an underbite (lower jaw ahead of upper jaw/ prognathic), overbite (lower jaw retrusion), or open bite (teeth not touching) mal-occlusion. A bad bite is referred to as a malocclusion. Many cases can be treated by orthodontics (braces) alone, but when the jawbones have too much of a discrepancy, corrective jaw surgery may be required. Corrective jaw surgery (orthognathic surgery) almost always goes hand in hand with orthodontics.

• The patient starts with braces, followed by surgery, and then a short period of orthodontic fine-tuning.
• The braces correct the dental discrepancies (crooked teeth) and the surgery corrects the skeletal (jaws, cheeks, nose, etc.) and bite relationship components, to result in balance and harmonious function.
• Surgery is typically planned after major facial growth ceases. (females >15, males >18 years of age).

This treatment approach addresses and optimizes:

1. The bite (occlusion)
2. The airway (breathing)
3. Aesthetics (facial harmony, balance, proportions, and profile)
4. Function (chewing/mastication)

All planning is performed using computer-aided diagnostics, design, and manufacturing before embarking on surgery. Surgery is typically performed in a hospital or surgery-center environment under general anesthesia. Single jaw surgery patients go home the same day and double jaw surgery patients typically stay for about 48 hours before being discharged.

Planning process photos:

Treatment:

• Computerized/digital facial analysis and treatment planning with the fabrication of computer-generated surgical guides.
• Presurgical airway (nose and throat) analysis was performed by using a small guided camera while sedated (naso-pharyngoscopy).
• Upper jaw surgery (Lefort osteotomy)
• Lower jaw surgery (bilateral sagittal split osteotomy)
• Chin augmentation (genioplasty)
• Cheek implant augmentation
• Nasal septoplasty

Post Op Photos:

Commentary:

Admittedly, Joe was very self-conscious about his appearance before surgery. It was one of the major driving forces with his decision to have treatment. An interesting concern that may be raised among family members is that they do not want patients to look like totally different people after surgery. While this surgery is truly transformational, every effort is made to preserve inherent family and patient identity features. Joe was very pleased with his final aesthetics and functional result. He and his family expressed how much this helped his self-confidence the most, among all the other benefits of this treatment. Seeing and hearing how much a procedure helps a patient is the best compliment we can receive.

Before & After Photos Photos: