procedures

Orthognathic Surgery ( Corrective Jaw Surgery)

What is orthognathic surgery?

Orthognathic surgery, commonly known as corrective jaw surgery, describes a number of surgical procedures used to correct various facial skeletal deformities that are often associated with a poor bite (malocclusion). The majority of these conditions are developmental, that is, the result of abnormal growth of the jaws. Less often these conditions result from an injury to the face or a degenerative problem such as arthritis of the jaw joints.

Individuals with these conditions often experience problems chewing normally, or they may have difficulty comfortably bringing their lips together, swallowing, speaking, or even breathing (sleep apnea). Certain deformities can be associated with jaw habits that produce jaw joint and muscle pain. Over time, an uncorrected malocclusion can lead to excessive tooth wear. Crooked or crowded teeth can be difficult to keep clean, and this could lead to poor oral health, gum disease, and loss of teeth.

When the orthodontist recommends orthognathic surgery for a patient, it is generally because the jaws have grown disproportionately or in the wrong direction, and the resulting malocclusion is beyond the scope of routine orthodontic treatment. Under these circumstances, orthodontic care combined with orthognathic surgery is generally regarded as the preferred treatment, providing the most functional, stable, and aesthetic result.

What to expect:

At the consultation

This is the time for you to discuss any problems you are experiencing and what you desire to attain through treatment. We must also learn your health history to ensure that you are a suitable candidate for surgery. Treatment is always tailored to your specific diagnosis, so an office examination is needed prior to any detailed discussion about surgery. A thorough evaluation also includes examination of records, including dental models and standardized diagnostic imaging. We utilize modern equipment for obtaining high quality digital imaging with the lowest necessary exposure to ionizing radiation. These records are shared with your orthodontist to avoid duplicate imaging and to reduce your treatment costs.

Proper treatment requires a careful workup. For this reason, please anticipate that the consultation appointment will take approximately 2 hours. For our patients who reside locally, we prefer to complete the process with a follow-up visit 2 weeks after the initial appointment. Prior to this appointment, the surgeon will confer with your orthodontist to establish clear goals of treatment, and our insurance specialist will determine if your insurance company provides benefits for orthognathic surgery. The second visit is devoted to presenting your specific surgical plan and answering all of your questions. The entire process can be completed in one visit (approximately 2.5 hours) for patients who have time constraints or who do not live in the Los Angeles area. For these patients, our insurance specialist will follow up with you once the insurance work has been completed.

A detailed written surgical treatment plan will be provided to your orthodontist once the consultation has been completed and you will receive a copy of this report.

Insurance and Finances

We are sensitive to the reality that corrective jaw surgery may be a significant expense for our patients. While payment for surgical services is ultimately the responsibility of the patient, medical insurance often covers orthognathic surgery. We will submit the claim for your initial consultation fee immediately following your visit, so that your payment can be reimbursed as soon as possible. At this time we will also contact your insurance company to determine your benefits for orthognathic surgery. This involves submitting a letter explaining the medical necessity of care along with records that verify your condition. Please bring your medical insurance information to the first appointment. Once we have received written confirmation that your insurance company provides benefits, any changes you make could affect coverage. Please contact our office in the event that changes are unavoidable. In those cases where medical insurance does not cover orthognathic surgery, we can discuss potentially affordable alternatives.

It is our duty to inform you that we are not contracted with any insurance plans. Regretfully, the medical insurance industry often places such little importance on orthognathic surgery that it frequently provides insufficient reimbursement for in-network surgeons to maintain a practice focused on this life-changing treatment. This does not; however, imply that we cannot prior authorize your surgery, submit claims, and obtain reasonable reimbursement for our services and the medical facility costs. Our office is dedicated to this process, and while we cannot change insurance company policies, it is our mission to provide exceptional care for a fair fee. Our experience and efficiency in performing thousands of successful orthognathic surgical procedures affords us an opportunity to do this. Your good general and oral health is what we are all about!

During treatment

Preparation for orthognathic surgery generally involves orthodontic treatment for as little as a few months up to a year or longer, depending upon the complexity of the case. During this time your orthodontist will align your teeth so that they will fit properly when the jaws are aligned correctly. It is common, even expected, that the dental malocclusion will become more noticeable during this pre-operative phase of treatment. Braces will remain on your teeth throughout the entire treatment process, including during surgery.

You will be re-evaluated once your orthodontist feels that you are ready for surgery. A surgical date may be scheduled at that time, and this will be coordinated with a preoperative office appointment.

Surgery may be done in an in-patient or out-patient setting, depending upon the procedure(s) to be done. Our office staff will make the necessary arrangements, including a pre-admission appointment. In most cases we will ask your personal physician to complete a pre-operative physical examination (H&P) prior to surgery.

Most surgery starts early in the morning. Out of town patients may want to stay nearby the night before surgery. We can recommend local accommodations that are a short distance from the hospital. Patients undergoing surgical procedures on only one jaw may go home the same day, while patients having surgery on both jaws will most likely stay overnight. Patients often ask if their jaws will be wired together after surgery. It is seldom necessary to wire the jaws together after corrective jaw surgery.

Patients should expect to use meal replacement drinks for a balanced diet the first one to two weeks after surgery. Afterward, they may advance to a blended diet until about the sixth to eighth post-operative week, at which time they generally begin a solid diet. Healing is closely monitored after surgery.

Patients are appropriately concerned about the degree of pain they will experience after surgery. While pain can be expected after any type of surgery, many orthognathic surgery patients tell us that their post-surgical discomfort was much less than they anticipated. We of course prescribe the pain medications you may need to transition through the recovery process with as little discomfort as possible.

Facial swelling, while variable, is an inevitable part of the healing process. Swelling generally increases for a couple of days after surgery and then begins to subside. Cold packs, head elevation, and use of the facial muscles will help to reduce swelling. Much of the swelling resolves within the first few weeks after surgery, but more subtle changes in your facial appearance will continue for up to a year.

Many of our patients either work or attend school. Students generally elect to have surgery during a school vacation. Depending upon the specific plan, our working patients should allow one to three weeks for a level of recovery that will permit them to return to work. The recovery time may be longer for certain occupations.

We will advise you when it is time to return to your orthodontist to resume orthodontic treatment. This is often only one month after surgery. At this time, much of the orthodontic treatment has been accomplished and your orthodontist may only need to fine-tune your new bite. This important process may require as little as a few months to as long as a year. We follow our patients throughout this process, though with less frequency, until the completion of orthodontic treatment. We always enjoy seeing our patients after the conclusion of active orthodontic treatment. At that visit we like to ensure that the plan has been a success, both for the patient and the surgeon. By this time, many patients have become so accustomed to their new bite and appearance that they are fascinated with their before and after photos.

Please see our "frequently asked questions" for more information about orthognathic surgery.