​With increasing awareness of corrective jaw surgery for both functional and aesthetic reasons, patients are likely to seek their general practitioners’ views on the procedure. We share the latest information on indications, the patient journey, and advancements that have improved surgical safety, efficacy and accuracy.

WHAT IS ORTHOGNATHIC SURGERY?

Orthognathic surgery, commonly referred to as jaw surgery, is a specialised procedure aimed at correcting skeletal and dental irregularities that affect the jaw and facial structure. 

This surgery is primarily performed to improve the function and appearance of the jaws and teeth. It is often recommended for individuals who have severe issues with bite alignment or facial aesthetic concerns that cannot be addressed with braces or other non-surgical treatments alone.

INDICATIONS

Orthognathic surgery is typically considered when a person has:

• Severe malocclusion (bad bite)
  This includes overbite, underbite, crossbite or open bite, which cannot be corrected with orthodontic treatment alone.

• Facial asymmetry
  An uneven facial appearance due to jaw irregularities.

• Difficulty speaking, eating or breathing
  Issues such as difficulty chewing, speaking or breathing that arise due to jaw misalignment.
  

• Sleep apnoea
  In cases where jaw irregularities contribute to obstructive sleep apnoea, surgery can help advance the jaws to open the airway. 

• Cosmetic concerns
  One may desire surgery to improve the balance and appearance of the face.

PROCEDURE OVERVIEW AND PATIENT JOURNEY

The specific approach to orthognathic surgery depends on the individual’s diagnosis and goals, and the procedure may involve one or both of the jaws (upper and lower).

1. Preoperative preparation

Patients will have a consultation with an orthodontist and oral and maxillofacial surgeon (OMS). Detailed imaging (X-rays, CT scans) and analysis of the bite and facial structure are conducted.

Before the surgery, patients typically wear braces for 12-18 months to align the teeth in preparation for the surgery. 

2. Surgical procedure

The surgery is performed under general anaesthesia. The most common osteotomies are:

• Le Fort I osteotomy (Figure 2): The maxilla is osteotomised and mobilised to be repositioned to a more optimal position. This can be done to correct maxillary conditions such as vertical maxillary excess ('gummy smile') and maxillary retrusion. 

• Bilateral sagittal split osteotomy (BSSO) (Figure 3): The mandible is osteotomised and split bilaterally so it can be repositioned to achieve a better bite and facial harmony. BSSO is effective to treat mandibular protrusion, retrusion and asymmetry.

• Genioplasty: The chin bone can be osteotomised and repositioned to a more desirable position. This is done to improve chin projection and symmetry. Fixation of the bone segments is carried out using titanium plates and screws. In addition, all incisions are made intraorally to avoid any scars on the skin. 

3. Postoperative recovery

Surgery-first approach

Some patients may benefit from a surgery-first approach. In these cases, surgery is done first without any preoperative braces. Braces are only done after surgery. This approach significantly reduces treatment duration and cost.

RECENT ADVANCEMENTS

Orthognathic surgery has seen significant advancements in recent years, especially with improvements in surgical techniques, diagnostic tools and postoperative care.

The use of 3-dimensional (3-D) images and virtual surgical planning (Figure 4) have revolutionised the way orthognathic surgery is carried out over the past 10 years. These tools have significantly improved surgical safety, accuracy and efficacy. Coupled with in-house 3-D printing facilities, overall outcomes, patient experience and staff experience have seen major improvements.

The state of orthognathic surgery today continues to be vibrantly innovative, with advances such as patient-specific implants (Figure 5), dynamic navigation and minimally invasive surgery.

At the National Dental Centre Singapore (NDCS), our clinicians are very actively involved in these advancements through various clinical trials to improve surgical accuracy, reduce recovery time and improve value of care.

As these technologies continue to evolve, patients can expect even better results with shorter recovery times and fewer complications, making orthognathic surgery a more accessible and effective treatment option for a wide range of functional and aesthetic issues.

CONCLUSION

Orthognathic surgery is a powerful tool in addressing severe jaw and facial issues, from functional problems like difficulty chewing and sleep apnoea, to cosmetic concerns related to facial appearance. With careful planning, a skilled surgical team and post-surgical care, it can significantly improve a patient’s quality of life and self-confidence. It requires collaboration between an orthodontist and an OMS, and the patient must be committed to both pre- and post-surgical phases of treatment to ensure a good outcome.

KEY TAKEAWAYS FOR GPs

1. Orthognathic surgery is an effective and safe treatment modality to treat severe malocclusion and various facial disharmony. 

2. Patients who will benefit from surgery typically present with severe malocclusions such as underbite, overbite and open bite. 

3. Some patients with severe obstructive sleep apnoea might also benefit from orthognathic surgery.

4. Recent advancements in technology and surgical techniques have made orthognathic surgery safer and more accurate, efficient and predictable.

Dr Leonardo Saigo is Head and Senior Consultant at the Department of Oral & Maxillofacial Surgery (OMS) at the National Dental Centre Singapore (NDCS). He has a special interest in progressing the state of orthognathic surgery in Singapore and beyond. Having recently completed a HMDP fellowship in Dusseldorf, Germany on the use of dynamic navigation in orthognathic surgery, Dr Saigo is determined to advance orthognathic surgery at NDCS. He is actively involved in various clinical projects, research, education and innovation efforts related to orthognathic surgery and other core topics of OMS. GPs who would like more information about this procedure, please contact Dr Saigo at [email protected].