For distinct misalignments of the jaws, e.g. an extremely distal occlusion/mandibular rethrognatism of the lower jaw with a retruded chin, a regular orthodontic treatment is not feasible. In these cases, the orthodontic treatment is supplemented with orthognathic surgery during which one or two jaws are cut and repositioned by a specially trained maxillofacial surgeon. This is called orthognathic surgery. These procedures have been developed since 1970 and have constantly been improved. Orthodontists who mainly take care of children with removable appliances are overchallenged by these demanding combination treatments. In our offices, we routinely handle orthognathic surgery cases which require particularly profound information, treatment planning and great skill in handling fixed appliances. We are permanently providing a number of adult patients with treatment before or after these surgeries. The cooperation with our preferred centers (Dr. Zoder, Heidelberg, University Hospital Heidelberg) runs smoothly and we are a renowned partner to all of them. Unfortunately, this does not work out all the time and everywhere and bad cooperation between orthodontist and oral surgeon has got disadvantages for the treatment process and result. We give our best to provide optimal conditions for a successful interdisciplinary treatment.
An important step in the treatment planning is the simulation of the results beforehand. In order to do so, the X-ray findings and the lateral portrait photographs are superimposed on screen. The lateral portraits can be changed within seconds, simulating different treatment options. It is easy to compare whether an intervention in one or both jaws gives a better result, or whether a jaw should better be shifted more or less. Since it is all about aesthetics, it is crucial to involve the patient: it is you who has to live with the altered face afterwards and you should be pleased with the aspired result. As well, we recommend taking along partners or close relatives to consultation since they can support you in making a decision. The world’s leading software Quick Ceph, which was developed by a U.S.-based German orthodontist, allows us the treatment simulation.
Just like all other surgical procedures, orthognathic surgery has got risks like bleeding, inflammation and the risks from general anesthesia. Apart from these general risks, the repositioning of the upper jaw does not bear any apprehensive special risks. In contrast, repositioning the lower jaw does: surgical adjustments of the lower jaw are associated with damage to the lower jaw nerve which provides the teeth, lower lip and parts of the chin with sensation, and on the other hand with damage to the jaw joints. Very often, the maximum jaw opening is still limited by 1/3 even one year after completion of treatment. In contrast, the innervation of the facial muscles, whose nerves do not pull through the operation area, is not threatened.
The percentage of major damages that influence life quality resides in the lower, single-digit range. Neither the orthodontist nor the oral surgeon carries the risks, but only the – hopefully – well informed patient. We never put pressure on the patient concerning these extensive treatments, instead we rather see ourselves as mediators. Only if you are really sure you want such a treatment, you should get orthognathic surgery.
No other treatment exhibits changes as strong and positive as orthodontics in combination with orthognathic surgery. Since the treatments are almost always performed with fixed appliances and the greatest changes are performed by the surgeon, the treatment times in our practices are usually surprisingly short. We usually need between 12 and 15 months for the entire active treatment.
The aesthetic gain, often as well as functional aspects, can be overwhelming in some cases, in particular if breathing, sleep quality and mouth closure are remarkably improved. After treatment has been finished we pose the question which is of vital importance: Would you do it again? Most of our patients answer: absolutely yes.
The University Hospital of Heidelberg has a good information brochure on orthognathic surgery, which you can download here:
The British orthodontist company BOS offers comprehensive information on orthognathic surgery on its website. Of particular interest are films from 14 different patients, who themselves speak at length. This is honest, objective information, but unfortunately only in English. We do not know of any similarly good source in German.