Jaw Surgery Before & After Case 1
For this patient, a variation of osteogenesis imperfecta — with a history of >10 different fractures as a child — led several other surgeons to decline surgery.
Our practice has decades of experience with more challenging conditions, and we stepped up to offer surgery after a thorough discussion of the risks and recovery process.
The surgery, thankfully, was a success. It included a multi-piece Lefort 1 advancement and BSSO setback.
For many years we have been using VSP (Virtual Surgical Planning) and custom 3D guides and plates. The improved consistency, accuracy, and efficiency are worth the planning time and process.
Best of all is the positive effect we can have on patients’ lives. Improved breathing, eating, speaking, and long-term dental and TMJ health, all make the surgery and recovery worthwhile when the surgery is needed.
Jaw Surgery Before & After Case 2
Some children are born with a slightly smaller lower jaw or ear. Other children may have severe asymmetry affecting multiple areas including the eye, ear, cheek, upper and lower jaw, and nerve function. Other organ systems may also be affected, including the heart, kidneys, spine, and arms/hands, and need to be evaluated as well.
As each and every child is unique, their treatment plan must also be tailored to their needs. The goals are always to offer the best chance at a happy and healthy life, while minimizing the number of surgeries and the risks involved.
For this gentleman, the occlusion of his teeth was severely slanted, with TMJ pain and popping.
To correct this, we performed upper and lower jaw surgery with TMJ replacement at the same time. We waited to do this until he reached skeletal maturity and had a long enough break from contact sports to heal.
After the first few months of recovery, his jaw is free of popping and pain, and his symmetry is improved. Further procedures like fat grafting may be offered to further fine tune any asymmetry if desired.
As you can see, we love our patients, especially ones we have cared for since they were little!
Jaw Surgery Before & After Case 3
This handsome young man has a history of a unilateral cleft lip and palate.
He is seen here 7 months after jaw surgery (maxillary advancement, mandibular setback, and chin advancement), and 1 month after rhinoplasty.
His occlusion (or how his teeth fit together) is now centered and leveled, with the teeth now able to chew optimally. This will help with TMJ and dental health long-term.
The bony work also helped to balance his facial profile, giving his upper lip and chin more support.
The rhinoplasty improved his breathing by straightening the septum and supporting his nasal passages, like having a Breathe-Right strip on the inside of his nose.
His lip scar will also continue to improve after a re-repair and re-orientation of the muscle of his lip.
Jaw Surgery Before & After Case 4
The upper jaw often does not grow as much as the lower jaw, or may grow canted, in our patients born with a cleft.
Not every patient with a cleft will need this surgery, but it is one we perform routinely given the number of cleft and non-cleft craniofacial patients we see.
We usually wait until patients are fully skeletally mature before doing this surgery, to minimize the risk of needing to do any future surgeries.
Occasionally, the difference in the upper and lower jaw is so severe that we do perform distraction surgery prior to full maturity, knowing that we may need another surgery in the future.
He is seen here at 6 weeks after his operation, with his splint out and smile ready to show off!
Jaw Surgery Before & After Case 5
It can be a tough surgery and tougher recovery, but the benefits to breathing, chewing, and facial balance can be tremendous.
This man worked through the worst of it – the months of prep work, swelling, drainage, difficulty sleeping, and more – with superb care and composure.
In this case, additional bone grafting to the upper cheeks helped improve lower eyelid support and balance, and augmented the bony healing and stability after the osteotomy.
We look forward to watch him continue on to greater things!
Jaw Surgery Before & After Case 6
About 1 in 3 patients with cleft lip and palate benefit from jaw surgery. Aligning the upper and lower teeth helps people fully chew their food, and reduces wear and tear on the TMJ’s.
We also consider facial balance and harmony when planning the surgery and final outcome.
Jaw surgery can often be done in a single surgery, sometimes involving just the upper jaw, and sometimes with the lower jaw as well.
Here, the amount of advancement was well over 10mm, which is the point at which we usually move towards distraction over a single surgery.
Distraction involves cutting the bone and freeing up scar tissue, but then gradually moving from the starting position by 1mm per day.
New bone is deposited in the space made as the upper jaw moves forward. The surrounding blood vessels, lining, and old scar tissue all expand and accommodate the new bony position.
We usually keep the hardware in place (much more comfortably after finishing advancement!) for 3 months while the new bone hardens.
At that point, minor adjustments can be made as needed with additional movement or augmentation, or just removal of the hardware.
Here, we performed some fat grafting to the upper lip, expecting about half of the fat to reabsorb and half to stay long term.
He is seen here at about a month after that surgery — we look forward to sharing more photos as all the swelling comes down!
Jaw Surgery Before & After Case 7
At some point, if the upper and lower roots are just too far apart, no amount of orthodontics will allow the teeth to line up.
That difference leads to problems chewing, breathing, and speaking. Some people also are more self-conscious of their smile.
Here, a four-piece Lefort 1 was performed, to correct a difference in the transverse dimension, in addition to the anterior-posterior direction.
He is seen here at 6 weeks, well on the road to recovery!
Jaw Surgery Before & After Case 8
This difference in bite causes problems with speech and chewing, and can increase the wear and tear on teeth and the TMJ’s.
Here, a custom-planned Lefort 1 advancement and chin advancement (genioplasty) corrected her malocclusion, while also giving a little bit more chin definition without going through the recovery and risks of a BSSO for the mandible.
Jaw Surgery Before & After Case 9
The smile says it all! Jaw surgery is used in cases where the upper and lower jaws are too misaligned to correct with braces alone.
Functional issues include difficulty with fully chewing and then choking on food, affected speech, and sleep apnea.
Long term, there may be problems with the TMJ, and supraeruption or loss of teeth and bone thickness. Obstructed breathing can cause a wide range of negative health effects, increasing the risk of obesity, diabetes, stroke, heart attacks, and more.
Thankfully we have worked for decades to get the surgery included under insurance (when meeting insurance criteria), with some of our most reliable partners right now Aetna and United Healthcare.
The recovery is significant, but so are the benefits!
Jaw Surgery Before & After Case 10
Braces alone sometimes aren’t enough to get a smile just right.
If the upper and lower dental arches are too far apart, or the facial harmony would be improved, orthognathic surgery may be recommended.
The main goals are often to align the upper and lower teeth, to help with chewing food completely and safely, and to improve facial balance from the upper, middle, and lower face.
Here, mandible-only surgery with a bilateral sagittal split osteotomy was done to correct a class II malocclusion.
Jaw Surgery Before & After Case 11
The small size of her mandible has required her to have a tracheostomy her entire life. She has had multiple jaw distractions, where the mandible has been broken and gradually lengthened.
The combination of her condition and her surgeries had left her with ankylosed, or totally frozen and immobile, TMJ’s on both sides.
We performed custom TMJ replacements – similar to a knee or hip replacement – with the condyles replaced with titanium heads, and a titanium and plastic joint fossa custom made to fit at the base of her skull.
She is seen here at 6 weeks after her surgery, with her range of motion the best it has ever been. She continues to improve every week as she progresses with her physical therapy.
She has been able and wanting to talk more, too, and we look forward to repairing her cleft palate (which has never been accessible). One day we may be able to remove her trach as well!
Jaw Surgery Before & After Case 12
Upper and lower jaw surgery (LeFort I advancement and bilateral sagittal split osteotomy) was performed to close and level his occlusion.
He is happily now back to full activities on his skates!
Jaw Surgery Before & After Case 13
Commonly we perform this surgery for our patients with a history of a cleft. Growth of the upper jaw may not keep up with the lower jaw. The teeth then do not line up, and normal chewing is affected.
We also perform this surgery for patients with sleep apnea, or other imbalances of the jaws including overbites, underbites, open bites, and cants (like with hemifacial microsomia).
Jaw Surgery Before & After Case 14
I love helping someone get to the finish line, matching up their smile with their bright personality.
Upper and lower jaw surgery was done to bring the maxilla forward, and level the mandible, so that all of his teeth can be used while chewing.
This is at 6 weeks post-op, which is when we usually clear everyone for full activities.
In the recovery period, I recommend at least 1 week off from school/work, as the swelling can make it hard to breathe and feel rested.
The body is also working extra hard to heal itself, and calories and protein are harder to come by in liquid format for 99% of people.
That is also the point when our out-of-town patients usually head home if coming from a distance.
Jaw Surgery Before & After Case 15
The planning helps us identify any potential problems or anatomic considerations before the day of surgery, minimizing the risks of nerve or tooth injury. The guides and custom plates also provide 3D verification that the movement and final position agree with the occlusion-based, traditional technique.
The custom hardware is more precise and stronger, avoiding damage to teeth, nerves, and with titanium that can be as strong as traditional plates, but with a lower profile. The genioplasty also has a more precise result with custom planning.
This is particularly helpful for our patients with significant asymmetry, like people with hemifacial microsomia.
Finally, putting time in on the planning side ahead of time, helps reduce the time under anesthesia, so recovery is faster and easier.
Jaw Surgery Before & After Case 16
If the upper arch is too constricted/narrow, we can separate the maxilla into multiple, separately mobile sections.
This is useful for cleft patients, but that experience carries over for our noncleft patients as well.
Careful dissection and use of ultrasonic saws preserves the blood flow through the soft tissue between bone cuts.
Here we performed this preparation and planning with Invisalign, in coordination with Dr. @GenecovOrthodontics.
Jaw Surgery Before & After Case 17
This is especially true with our patients with clefts due to the scar tissue and abnormal blood flow who are at risk of an incomplete advancement or significant relapse.
We are able to use “internal” distractors in most cases, which leaves the distractor hidden inside the upper lip, rather than requiring an “external” HALO device.
The HALO is useful in some cases, but with the HALO overall we have historically seen a slightly higher rate of minor and major complications with infections, hardware failure, or wound problems.
Working with Dr. Fearon on complex craniofacial cases like Lefort 3 advancement, and some of his lessons learned, we have come back to using more HALO external distraction as well.
Jaw Surgery Before & After Case 18
In other cases, the actual roots of the teeth need to be moved with jaw surgery, to reposition the entire foundation. The teeth work more effectively and efficiently after correction. This takes stress off of the TMJ and muscles used for chewing.
In some cases, we do this for sleep apnea, where the airway can be made larger by bringing the jaws and the attached soft tissue forward.
All surgeries carry risks like infection, permanent numbness, or damage to teeth, and the recovery for this surgery is more substantial than most.
A proper consultation and experienced team can help you make a well-informed decision about whether surgery would be right for you.