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Who needs Orthognathic Surgery?
Jaw growth is a slow and gradual process and in some instances the upper and lower jaw or one side of the jaw to the other may grow at different rates. This may cause many functional and psychological problems. Injuries to the jaws at a young age or during birth (delivery) or birth defects may also affect the normal growth and positioning of the jaws. While Orthodontic treatment (braces) can correct many problems if only the teeth are involved Orthognathic Surgery maybe required if the jaws (bone) also need repositioning. The results of orthognathic surgery can have a dramatic and positive affect on many aspects of your life.

The common Maxillofacial deformities and their clinical appearances are the following:

1. Protruded Maxilla (upper jaw): The upper jaw is protruded beyond the normal limits along with the teeth. The person cannot close his lips (lip incompetence) without effort. The teeth are always visible and in most cases the whole of the gums are visible on smiling (gummy smile). A gummy smile is mainly due to the vertical excess of the maxilla.
2. Retruded Maxilla: This deformity is due to under development of the upper jaw mainly seen in people who have cleft lip or palate. After the surgical correction of the cleft lip or palate at a young age the growth of the maxilla is retarded along with displacement or destruction of the tooth bud. This results in a dish shaped face with a hooked or flaring nose and irregularly aligned, rotated or missing teeth.
3. Protruded Mandible (lower jaw): In some people there will be extra growth of the lower jaw resulting in long jaw. Their faces are very long with protrusion of the lower teeth and thick lips. Normally on biting the lower teeth will be inside the upper teeth while in people with long jaws usually the lower teeth will be outside the upper arch.
4. Retruded Mandible: In some people due to developmental deformity or due to hereditary factors the lower jaw is very small resulting in a “bird face”. There is no proper development of the chin.
5. Facial Asymmetry: Sometimes a part of the face maybe overdeveloped or underdeveloped causing one part of the face to be small or large. One side of the face is not in symmetry with the other side giving an unaesthetic appearance.
6. Akylosis of Tempromandibular Joint (TMJ): Injury during birth or trauma or infection at a young age to the tempromandibular joint will result in restricted mouth opening and reduced growth of the mandible.
7. Nasal Deformity: Nasal deformities are often seen along with deformities of the jaw. Some common deformities of the nose are: deviated nasal septum, flared or constricted ala of the nose, saddle nose, hooked nose, asymmetrical nose, etc.

At what age can Orthognathic Surgery be done?
The ideal age for Orthognathic Surgery is after the growth period has been completed. After 18 years for girls and 20 years for boys. Ankylosis of the TMJ is an exception. For this the surgery should be done as early as possible to rehabilitate function and growth of the mandible. If the patient has got psychological problems due to the deformity of the face then the other orthognathic surgeries may be taken up at an earlier age.

What are the Post-Surgical care to be taken?
Immediately after surgery you will be shifted to the recovery room until the general anesthesia has worn off. You may be kept in the ICU (intensive care unit) for 24 hours to monitor your vital signs. You family would be allowed to see you for a short period of time. An Intravenous (IV) line to your arm will be used to provide the required medications and nutrients, until you are able to take sufficient food by mouth. Elastic bandages may be placed over your face to reduce the swelling. Minor bleeding maybe seen after the surgery. If surgery of the maxilla has been done then there will be oozing of blood from the nose, which will stop within 24 hours.
You can expect temporary swelling of the lips, cheek and nose. This is a normal healing response and will disappear after a week or so. You will experience nasal congestion and sore throat due to nasal tubes used for general anesthesia. You may also have vomiting or nauseating sensation due to the medications used. After been shifted to the room you will be on a soft diet, as you won't be able to chew properly. In some cases the jaws maybe immobilized with wires and so you will be able to take only a liquid diet.

Oral Hygiene has to be maintained meticulously. You have to brush your teeth properly. If you have difficulty in using an adult tooth brush initially you may use a baby toothbrush. You have to brush you teeth and wash your mouth with an mouthwash after every intake of food. Poor oral hygiene will result in infection, a bad taste to the mouth and increased swelling of the face.

You will have to stay at the hospital for a week or more, till you have recovered from your surgery. After going back home you can return to work or school as soon as you feel like it. It is preferred to take rest for 2-3 weeks. Your appearance will have changed due to the repositioning of the jaws and so you should be prepared for signs of surprise from your family and friends. But it won't take long for them to adjust to the "new" you.
The initial healing will take 6 weeks but the completion of healing process will take up to 9-12 months. During this period you have to visit your surgeon and orthodontist regularly. Throughout this period oral hygiene has to be minted strictly. In most cases the braces are removed after 6-8 months following surgery.

What are the Complications of Orthognathic Surgery?
Complications seen in any major surgery under general anesthesia maybe seen in orthognathic surgery. Swelling, pain, nausea, vomiting, bleeding, infection, chest infections, etc are some of the potential risks of any major surgery under general anesthesia. Other complications specific to orthognathic surgery are

• Loss of sensation resulting in numbness or tingling sensation of the chin, cheek, nose or tongue may occur after surgery. Sensation returns to the affected areas as the nerve fibers regenerate and mend themselves, after a few months of surgery. Rarely some individuals may experience permanent altered sensation.
• Sinus complications such as sinusitis may occur after surgeries of the maxilla. This may not require any further treatment as it  usually corrects itselves after a period of time.
• Nonvitality of teeth near the osteotomy site are seen rarely. This may require root canal treatment of the involved tooth at a later date.
• Relapse or unpredicted shifting of the new jaw position occur uncommonly. If it does then further surgical intervention would be necessary.
• Periodontal infections around the teeth near the osteotomy site may cause mobility of the concerned teeth. This may be corrected by periodontal flap surgery and bone graft.
• Necrosis of bone is seen very very rarely. This could be due to reduced blood supply to the area and will require surgical removal of the infected bone.
• Unrealistic expectations by the individual will result in dissatisfaction of the "new" face. Some individuals imagine and attribute all their psychological problems to their facial deformity and will not be satisfied even if good results are achieved. After all, the surgeon is only a human being, he only tries to correct or repair what you already have, and every surgery has its own limitations. Individual satisfaction is very subjective and a positive attitude from the parents and their relatives are very essential.