Orthognathic Surgery
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 with a fixed appliance is not feasible. In these cases, the orthodontic treatment is supplemented with orthognathic surgery during which one or two jaws are cut and repositioned. 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 office, 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 make sure that there are 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.
Risks
Like all surgical procedures, dysgnathia surgery has general risks such as post-operative bleeding, inflammation and the risk of anaesthesia. Shifts of the upper jaw do not have any special risks to be considered beyond that.
There are two particular risks with displacements of the lower jaw: on the one hand, there is occasionally damage to the mandibular nerve, which supplies sensation to the teeth, lower lip and part of the chin, and on the other hand, there is also damage to the temporomandibular joints. Very often, the maximum jaw opening is still restricted by 1/3 even one year after completion of treatment. In contrast, the innervation of the facial muscles is not threatened, as their nerves do not pass through the surgical area.
However, major damage with impairment of the quality of life is quite rare and in the lower, single-digit percentage range. The risks are borne neither by the oral surgeon nor by the orthodontist, but by the patient alone after the patient has been informed.
Therefore, in orthognathic surgery, we never urge patients to undergo treatment on our own initiative, but see ourselves more as advisors and helpers in the decision-making process. Only those who are well informed and really want it should start treatment with dysgnathia surgery.
Evaluation
There is no other form of treatment in orthodontics that regularly produces such strong positive changes as the combination with orthognatic surgery. Even experienced orthodontists are always thrilled with the results! As the treatments are almost always carried out with fixed braces and most movement is done by the surgeon, the treatment times in our practice are usually surprisingly short.
In our practice in Mannheim, we usually only need between 12 and 15 months for the entire active treatment. In contrast, we hear from other practices about much longer treatment times that count in years – this is due to our great experience with these treatments, but above all to the will of our orthodontists to work with high efficiency.
The aesthetic as well as the functional gain can be impressive in many cases, especially since breathing, mouth closure and sleep quality are often significantly improved as well. In the end, we ask all these patients the crucial question: would you do it again? This question is answered decisively in the affirmative by most of our patients.
More information about orthognathic surgery
Our practice in Mannheim usually works together with the University Hospital in Heidelberg or with the oral surgeon Dr. Zoder in Heidelberg for dysgnathia surgery. You can find Dr. Zoder’s website here: https://www.mkg-heidelberg.com/
The website of the Department of Maxillofacial Surgery at Heidelberg University can be found here: https://www.klinikum.uni-heidelberg.de/
The Department of Maxillofacial Surgery at Heidelberg University Hospital has a good information brochure about dysgnathia surgery that 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.
https://www.bos.org.uk/Public-Patients/Your-Jaw-Surgery1