A complete evaluation and consultation for corrective jaw surgery consists of several steps:
Initial Evaluation (approximately 30 min):
Make sure to bring any relevant notes, photographs, radiographs, CT scans, models, etc. that you may have. We will review them during your evaluation.
Any significant medical problems (heart problems, heart murmur, high blood pressure, diabetes, stroke, blood clot, etc.)
Any medications you are currently taking
Any allergies you may have (medications, latex, food, etc.)
Any previous facial trauma
Any previous facial surgery
Any tooth or gum problems
Previous and/or current orthodontic treatment
Issues with eating, speaking, breathing, and TMJ pain
At this point a survey exam of face, teeth, and jaws will be performed
The basic pattern of facial imbalance will be identified
a brief overview of corrective jaw surgery
a discussion about your particular pattern of facial imbalance
a review of relevant facial anatomy
a detailed discussion about the surgical procedures
a review of before and after photos of patients treated at our center
an overview of the surgery and recovery period
an estimated timeline of orthodontics and surgery
an explanation of health insurance coverage and fees
all risks, benefits, and alternatives to corrective jaw surgery
Work Up (approximately 45 minutes)
A “work up” involves the collection of records that will be used to perform a detailed evaluation of your facial bone imbalance.
A cone-beam CT 3-D facial scan
Cephalometric analysis of radiographs
Direct facial measurements
An intra-nasal examination
Additional studies are sometimes required to further evaluate specific regions of the facial bones, such as a CT scan, MRI, or bone scan.
Final Consult (approximately 45 minutes)
Once we and your orthodontist have thoroughly studied and evaluated the records, we will meet with you and your family for a final consult. At this time all of our findings and recommendations and will be discussed and we will be able to answer any questions you may have. Together, we will develop a comprehensive treatment plan tailored to your individual needs.
If necessary, because of scheduling or for out-of-state patients, this may be performed via video conferencing.
Through our experience over many years, we understand the psychological and emotional stress involved in this type of decision making. We are certain that with proper understanding and communication, we will both be comfortable with our final decisions.
Timeline of Corrective Jaw Surgery
It is important to understand that your treatment, which typically includes orthodontics before, during, and after surgery, may take one to several years to complete. Your facial surgeon and orthodontist understand the practical and emotional difficulties that such a long term commitment presents for you and your family.
Before your surgery, orthodontic braces are used to move the teeth into a new position. Because your teeth are being moved in preparation for your “bite” after surgery, you may feel that your bite is getting worse rather than better. However, when your jaws are repositioned during surgery, your teeth will then fit together properly. This process will typically last 6–18 months; however, it may take longer for more advanced facial bone imbalances.
Pre-Operative Instructions (10 weeks prior to surgery)
Make sure to read and follow all pre-operative instructions at least ten weeks prior to your surgery (See Chapter 27)
“Final Wire” (8-10 weeks prior to surgery)
Once your orthodontist has finished the pre-operative orthodontics, a “final wire” will be place. This wire will maintain your teeth in their final pre-operative position. It will remain in position for 3–6 weeks prior to pre-operative planning. The actual amount of time will be determined by your orthodontist on an individual basis. A safe rule of thumb is to plan to have the “final wire” placed 10 weeks prior to your surgical date.
Pre-Operative Planning (3–6 weeks after the final wire has been placed)
After your pre-surgical orthodontic treatment is completed and the final wire has been in place for 3-6 weeks, new updated records will be taken. These records will be used to plan and guide your surgery. Acrylic splints, which help to guide the surgery, will be fabricated from these records and used at the time of surgery.
Splint Try-In (1–2 weeks prior to surgery)
Typically the splints fabricated during the pre-operative planning will be tried in 1–2 weeks prior to surgery.
Day of Surgery
Depending on the procedures, corrective jaw surgery may be performed in a hospital, an ambulatory surgical center, or in a surgical office. Surgery may take from one to several hours to complete.
After surgery, you may remain in the hospital for 1–3 days until you have recovered. Your surgeon will provide instructions for a modified diet, which typically begins with liquids and is slowly transitioned to a normal diet over 6–8 weeks. You will also be asked to refrain from using tobacco products and avoid strenuous physical activity. Surgery of this kind is noted for its lack of pain. There is discomfort, and some of the early post-surgery periods can be unpleasant due to swelling and jaw fixation. However, most patients do not complain of pain and typically do not require their prescribed pain medication. Swelling is common in the post-operative period. Typically facial swelling peaks on the third day after surgery and the major portion of swelling resolves in five to seven days. In some cases, your jaws will be closed together at the completion of surgery and may remain like this for up to four weeks.
While the initial healing phase is about six weeks, complete healing of the jaw bones takes between nine and 12 months.
When Can I Return to Work?
Typically, you can return to non-physical work after two weeks. This would include attending classes and lectures, desk work, computer work, etc. This does not include anything that involves strenuous physical activity or prolonged speaking. If you do choose to return to work at this time it is important to make any necessary preparations to avoid creating a physically stressful situation. This may require precautions such as leaving class ten minutes early to allow enough time to arrive at your next class, enlisting someone to drive you and carry your books, computer, or any heavy objects, etc.
When Can I Return to Strenuous Physical Activity?
Strenuous physical activity is considered any activity that raises your heart rate. When your heart rate is elevated it will raise your blood pressure which can affect your healing. You may return to such activities after five weeks. Refer to chapter 28 for details regarding physical activity after surgery.
Post-operative orthodontics may last from three months to a year or more. This decision depends on the type and degree of facial bone imbalance, and will be made by your orthodontist.