What are Double jaw & Bimaxillary Orthognathic Surgery?

Orthognathic Surgery

Orthognathic surgery, or corrective jaw surgery, is a surgery to correct jaw irregularities and realign the jaws and teeth to enhance function and appearance.

Purpose:

• Correct jaw misalignments (overbite, underbite, open bite, crossbite)
• Correct facial asymmetry or deformities
• Enhance chewing, speech, and breathing (at times for sleep apnea)
• Augment orthodontic treatment when braces are inadequate

Common Conditions Treated:

• Congenital jaw deformities
• Facial trauma
• Temporomandibular joint (TMJ) disorders
• Cleft palate and other craniofacial anomalies

Types of Orthognathic Surgery:

• Maxillary Osteotomy – upper jaw repositioning
• Mandibular Osteotomy – lower jaw repositioning
• Bimaxillary Osteotomy – both upper and lower jaw repositioning
• Genioplasty – chin surgery (can be done with jaw surgery)

Bimaxillary Surgery

Bimaxillary orthognathic surgery is the corrective surgery both for the top jaw (maxilla) and bottom jaw (mandible). It's commonly done when there is severe misalignment or face imbalance that can't be dealt with by doing single-jaw surgery or having braces alone. 

When Would Bimaxillary Surgery Be Prescribed?

• Extreme underbite or overbite
• Facial imbalance or long face syndrome
• Open bite (where front teeth no longer touch each other)
• Obstructive sleep apnea from jaw position
• Trouble eating, speaking, or breathing
• Severe aesthetics or psychosocial issues

Jaw Surgery

Jaw surgery (also referred to as orthognathic surgery) is a form of corrective facial surgery that reshapes or repositions the upper jaw (maxilla), lower jaw (mandible), or both to correct functional or aesthetic problems.

Who Requires Jaw Surgery?

Jaw surgery is often advised when:

• The jaws are not properly aligned and cannot be adjusted with braces
• Chewing, swallowing, or speaking becomes complicated
• The bite is abnormal (overbite, underbite, crossbite, open bite)
• Facial imbalance or asymmetry
• Chronic TMJ or jaw pain is present
• There is a requirement to treat sleep apnea associated with jaw structure

Double Jaw Surgery

Double jaw surgery (also referred to as bimaxillary orthognathic surgery) is surgical correction of the top jaw (maxilla) and bottom jaw (mandible). It's reserved for when both jaws are out of alignment and must be realigned to treat functional or cosmetic problems.

Who Requires Double Jaw Surgery?

This procedure is advised when:

• There's an extreme underbite, overbite, or open bite
• Facial asymmetry or long/short face is present
• There are respiratory difficulties, including sleep apnea
• Chewing, biting, or speaking is limited
• Orthodontic treatment by itself is not adequate

Factors Affecting Orthognathic Surgery Cost

A number of factors determine the expense of orthognathic (jaw) surgery, and being familiar with them will serve to assist you in planning—whether for insurance, budgeting, or seeking treatment overseas.

• Type and Complexity of Surgery
• Geographical Location
• Surgeon’s Experience and Reputation
• Hospital or Clinic Fees
• Diagnostic and Planning Tools
• Orthodontic Treatment
• Anaesthesia and Medication
• Duration of Hospital Stay
• Post-Operative Care and Recovery
• Insurance Coverage

Orthognathic Surgery Recovery

Healing from orthognathic surgery (jaw surgery) is gradual and usually lasts several months, with the most important healing process taking place within the first 6–8 weeks. The complete recovery of bone healing, orthodontic adjustments, and return to usual function may require 6–12 months.

Recovery Timeline Overview

• Week 1–2: Swelling, bruising, limited jaw movement, liquid diet
• Week 3–4: Decreased swelling, begin soft food, resumption of speaking gradually
• 1–3 Months: Return to light activities, orthodontic adjustments
• 3–6 Months: Extensive healing, return to the majority of normal habits
• 6–12 Months: Final bite adjustments, removal of braces (if worn)

Orthognathic Surgery Before and After

Orthognathic surgery before and after can be dramatic—physically, functionally, and emotionally. Patients usually undergo extensive changes in facial appearance, jaw alignment, speech, chewing, breathing, and self-esteem.

Before Surgery

Common Problems

• Misaligned jaw or bite (overbite, underbite, crossbite, open bite)
• Trouble chewing, swallowing, or speaking
• Chronic pain in the jaw or TMJ disorders
• Facial imbalance (asymmetry, protruding chin, receding jaw)
• Mouth breathing or sleep apnea
• Gummy smile or long lower face
• Self-consciousness regarding facial profile

Typical Appearance

• Unbalanced facial profile
• Misaligned or uneven smile
• Chin may be too forward, back, or off-center
• Lips don't close on their own

After Surgery

Functional Benefits

• Aligned jaws and bite
• Easier chewing and swallowing
• Clearer speech
• Improved airway for breathing (aids sleep apnea)
• Relief from TMJ or muscle pain

Aesthetic Benefits

• Proportionate facial features
• Symmetrical jawline and chin
• More harmonious side profile
• Natural lip closure and improved smile
• Chin and nose may look more refined (even without rhinoplasty)

Emotional Benefits

• Increased confidence
• Decreased social anxiety or self-image issues
• Improved quality of life

Orthognathic Surgery Risks

Orthognathic surgery is usually safe, but like any surgery, it poses some risks. Knowing these possible complications may assist you mentally and physically in preparing for the procedure.

Orthognathic surgery complications:

• Infection
• Bleeding
• Nerve Damage
• Relapse
• Jaw Stiffness or Pain
• Swelling and Bruising
• TMJ (Temporomandibular Joint) Issues
• Anaesthesia Complications
• Scarring
• Dental Complications

Orthognathic Surgery Procedure

The orthognathic surgery procedure is a step-by-step process to rectify jaw alignment, enhance bite function, and improve facial appearance. It is generally done under general anaesthesia and necessitates preoperative planning, surgical performance, and post-operative management.

Steps Involved in the Orthognathic Surgery Procedure

Pre-surgery Preparation

• Consultation: A complete evaluation by the surgeon to get an idea about your medical history, talks about symptoms, and assess the extent of the jaw misalignment.
• Imaging: 3D X-rays (Cone Beam CT) and digital scans to evaluate jaw structure and plan the surgery accurately.
• Orthodontic Treatment: Braces are worn before surgery (usually for 6–18 months) to align the teeth. This ensures that the teeth are in the right position for the jaw repositioning.

Anaesthesia and Initial Setup

• The surgery is done under general anaesthesia, meaning you’ll be completely asleep during the procedure.
• Monitoring devices will be installed to monitor your vital signs such as heart rate, blood pressure, and oxygen levels.

Surgical Procedure

Depending on the severity of the issue, either or both of the following surgeries are performed:

Maxillary Osteotomy (Upper Jaw Surgery)

• Incisions within the mouth are performed to reach the upper jaw.
• The upper jaw is cut off from the remaining facial structure.
• The jaw is advanced, rearward, up, or down to correct the positioning and enhance the bite.
• Stabilization of the realigned jaw is achieved through the use of plates and screws.

Mandibular Osteotomy (Lower Jaw Surgery)

• Incisions within the mouth are performed close to the lower jaw.
• Either forward or backward, the lower jaw is realigned so that the upper and lower jaws have a proper bite.
• Similar to the maxillary osteotomy, the jaw is fixed in place by the use of titanium plates and screws.

Bimaxillary Osteotomy (Both Jaws Surgery)

• Upper and lower jaws are both reset together to right complicated misalignment and achieve ideal bite.

Genioplasty (Chin Surgery)

• Reshaping and repositioning of the chin, if required, to the new jaw contour.

Post-operative Care

• The patient is rolled into the post-operative room post-surgery, where they're closely monitored once the anaesthesia affects them.
• Swelling is to be anticipated in the jaw, face, and neck. Ice packs will reduce swelling in the first few days.
• Drains or tubes can be inserted to avoid fluid accumulation.

Hospital Stay

• 1–4 days of hospital stay is usual, depending on the complexity of the operation and personal healing.
• Pain and swelling are controlled with medication.
• You will receive oral hygiene instructions to avoid infection.

Recovery

• Week 1–2: You’ll follow a liquid or soft food diet to allow the jaw to heal. Jaw movement is restricted during this time.
• 3–6 weeks: Gradually, you’ll be able to eat soft foods, and jaw stiffness will begin to subside.
• You’ll have regular follow-ups with your surgeon and orthodontist to monitor healing, ensure proper bite alignment, and adjust your braces if needed.
• Your recovery will take about 3–6 months, with your orthodontics being continued until your bite is fully lined up.

Orthognathic Surgery for Sleep Apnea

Orthognathic surgery is sometimes prescribed as a therapy for sleep apnea, more specifically obstructive sleep apnea (OSA), when other therapy such as CPAP (continuous positive airway pressure) therapy or lifestyle modification is not helpful. The aim of orthognathic surgery in sleep apnea is to advance the position of the jaw to enhance airflow and reduce the obstruction of the upper airway.

How Orthognathic Surgery Helps in Sleep Apnea?

Obstructive sleep apnea (OSA) happens when the muscles of the throat are too relaxed while sleeping, creating a temporary narrowing of the upper airway. This may result in pauses during breathing and low oxygen levels, which can disturb sleep.

Orthognathic surgery corrects this by positioning the jaw, which can:

• Widen the airway by advancing the upper jaw (maxilla) or the lower jaw (mandible), allowing for increased airflow.
• Repair structural abnormalities that can cause airway obstruction, such as a receding or narrow jaw or a misaligned mouth and jaws.
• Improve positioning of the tongue and prevent its collapse, the most frequent reason for airway obstruction during sleep.