The jaw is not merely an aesthetic whim. When the bones of the face do not fit together as they should, the consequences go far beyond appearance: chronic pain, chewing problems, difficulty speaking clearly, impossible snoring… Orthognathic surgery exists precisely to correct those situations where orthodontic appliances alone cannot do the job.
If you are reading this because someone has mentioned this operation to you and you are not quite sure what it entails, you are in the right place. Let’s get to the point.
What is Orthognathic Surgery
Orthognathic surgery is a surgical intervention that repositions the bones of the jaws (upper, lower, or both) to correct malformations or bone imbalances that affect the bite, chewing function, and, in many cases, also facial aesthetics.
The term comes from Greek: orthos (correct) and gnathos (jaw). In other words, "correct jaw." As descriptive as it is useful.
What distinguishes this surgery from other dental treatments is that it acts on the bone, not on the teeth. That’s why it is always combined with orthodontics, generally before and after the operation. Orthodontics aligns the teeth; surgery places the bones in their ideal position. Together, they form an unbeatable team.
If you have doubts about whether you are a candidate, the most sensible thing is to consult a specialist in orthognathic surgery in Madrid with experience in complex cases, as the diagnosis requires a thorough analysis of the facial structure and dental occlusion.
Types of Orthognathic Surgery
There is not just one orthognathic surgery; there are several modalities depending on which bone is intervened and what the underlying problem is. It is important to understand this because the surgical plan depends entirely on your specific anatomy.
Upper Jaw Surgery (Le Fort I Osteotomy)
This is the most common technique to correct problems in the upper jaw. The surgeon separates the upper jaw bone from the rest of the skull and repositions it forward, backward, up, or down as required by the case.
It is used in situations such as:
- Retracted upper jaw (sunken face in the midsection)
- Excess vertical of the upper jaw (excessive gummy smile)
- Anterior open bite
Lower Jaw Surgery (Mandibular Ramus Sagittal Osteotomy)
Here, the work is done on the jaw. It is the indicated procedure when the jaw is too far forward (mandibular prognathism) or too far back (retrognathia).
The surgeon divides the mandibular bone and displaces it to its correct position. It is then secured with mini-plates and titanium screws, which in most cases remain permanently without causing any problems.
Bimaxillary Surgery
This is the combination of the two previous types. Both the upper and lower jaws are intervened in the same operation. It is the most complex type, but also the one that allows for the most complete changes when both bones are involved in the problem.
It is indicated in severe malocclusions, significant facial asymmetries, or cases where operating on just one jaw would not yield optimal results.
Mentoplasty or Genioplasty
In some cases, a correction of the chin is also added. It is not always necessary, but when there is asymmetry or insufficient projection of the chin, this technique perfectly complements the results of the main surgery.
When This Surgery is Needed
The million-dollar question. Not everyone with a slightly irregular bite needs to go under the knife. Orthognathic surgery is considered when the problems are of skeletal origin, that is, when the misalignment is not just in the teeth but in the bones of the face themselves.
These are the most common situations in which it is indicated:
- Mandibular prognathism: the lower jaw protrudes in front of the upper jaw, resulting in an inverted bite and a characteristic facial appearance.
- Retrognathia: the chin or jaw is positioned too far back, which can hinder breathing and give a "concave profile" appearance.
- Open bite: the front teeth do not contact when closing the mouth, complicating chewing and potentially affecting speech.
- Facial asymmetry: one side of the face has grown more than the other, something that is sometimes clearly visible and other times requires cephalometric analysis to detect.
- Structural origin sleep apnea: in some cases, repositioning the jaw significantly improves airway obstruction.
- Chronic difficulty chewing or swallowing that cannot be resolved with conventional orthodontics.
A practical rule: if the orthodontist tells you that the teeth can no longer do more without moving the bone, it is time to talk to a maxillofacial surgeon.
What the Complete Process Looks Like
Orthognathic surgery is not something that happens overnight. The process has several well-defined phases:
1. Planning and Diagnosis. Cephalometric X-rays, 3D scans, photos, and dental models are taken. With all this, the team virtually plans the operation before touching anything.
2. Pre-surgical Orthodontics. This lasts between 12 and 18 months in most cases. It serves to align the teeth within their respective bones before repositioning those bones.
3. The Surgery. It is performed under general anaesthesia, lasts between 2 and 4 hours depending on the complexity, and requires hospital admission of 1 to 3 days.
4. Recovery. The first weeks are the most demanding: soft diet, noticeable swelling, and a bit of patience. Functional recovery is progressive, and the definitive results are assessed from 6 to 12 months.
5. Post-surgical Orthodontics. This lasts another 6 to 12 months and serves to fine-tune the final occlusion and ensure that everything stays in place.
Risks and What You Should Know Before Deciding
Like any surgery, it has its risks. The most common include temporary numbness in the lips, chin, or cheeks (due to the involvement of sensory nerves), prolonged swelling, and infection, although the latter is rare in specialised centres.
What is important to understand is that the results are stable and permanent once the bones heal properly. This is not something that needs to be repeated or that reverses over time.
The key to minimising risks and maximising results lies in who you trust with the intervention. The experience of the surgical team, the planning technology used, and the postoperative follow-up make a huge difference between a good result and an excellent one.
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