Jaw surgery

Upper jaw surgery

Upper jaw surgery is necessary to correct abnormalities of the superior jaw bone (maxilla). The upper jaw may be or narrow, too long, too short, too far forward or too far back to fit the lower jaw properly. In maxilla surgery, the upper jaw can be rotated or repositioned forward, backward, or it can be raised or lowered.
 Also, asymmetries between different sides of the face can be corrected. Widening of the upper jaw is possible by a surgical split in the midline followed by distraction.

Procedure

Upper jaw surgery is performed mainly by utilizing a bone dissecting procedure called ‘Le Fort I osteotomy’.

Bone incision line for upper jaw surgery

• A Le Fort I osteotomy is the most commonly used procedure to make bone incisions in the upper jaw. This procedure is performed under general anaesthesia.

• The operation is carried out entirely inside the mouth. A U-shaped incision is made through the gums above the upper teeth to gain access to the jawbone. The gum is then raised off the bone.

• The upper jaw incisions are made with highly specialised tools, which allow for a controlled parting of the bone. Additional bone is removed if the upper jaw is to be shortened. Bone can be added if necessary to lower the jaw and make it longer (bone graft).

• The upper jaw bone is then moved into its final position (planned prior to your surgery) and held in place with tiny titanium plates and screws, which are left in place permanently.
• The gums are stitched back into place with dissolvable stitches. These stitches may take three to four weeks to dissolve. After the bones heal together, the jaw regains it’s normal strength.

Advancement of the upper jaw

The underdevelopment of the upper jaw is called horizontal maxillary deficiency. The lower teeth are in front of the upper teeth— a condition called underbite.

These patients may have a sunken in or very flat face. Facial contour and dental occlusion can be harmonized with the advancement of the upper jaw by cutting it horizontally and moving it forward.

Before upper jaw advancement		After upper jaw advancement

Shortening of the upper jaw

Vertical maxillary excess is when the upper jaw (maxilla) has grown too far down. When smiling, too much gingiva is visible (gummy smile) and often there are difficulties in putting the lips together. Not only is this situation cosmetically undesirable, it can also result in sore, red, bleeding gums from chronic exposure to air.

This problem can be orthognathically corrected by excising a segment of upper jaw, therefore elevating the level of the teeth.

Before shortening of the upper jaw.		After shortening of the upper jaw.

Rotation of the upper jaw

When only the back portion of the upper jaw is overdeveloped vertically, this will result in the inability for the front teeth to meet— a condition called ‘open bite’ (apertognathia).

As the back portion of the upper jaw grows vertically downward, the lower jaw will open in a clockwise direction. This explains why open bite patients have a long facial appearance. There is little or no ability to “bite” using the front teeth. This makes eating a challenge, and causes problems with swallowing, speech, and often resulting in red swollen gums due to chronic air exposure. This condition can be corrected by removing a wedge of bone in the upper jaw.

Before rotation of the upper jaw.		After rotation of the upper jaw.

Widening of the upper jaw

Widening of the upper jaw is done with a special technique called distraction osteogenesis. For more information we refer you to our webpage on distraction.

Patient information upper jaw surgery

• Patience with form, function and sensation
  • We have to inform the patient that postoperatively patience will be needed as the swelling around the nose can last two to three months .
• Inhale instead of blowing of the nose
  • Patients should also be advised not to blow their nose, to prevent air in the cheeks during the first week as a result of air slipping through the bonecuts.
• Sensation of anterior gingiva is altered fo a longer time
  • It is usual for sensation of the gums to be completely impaired postoperatively. This sensation returns from posterior to anterior gradually over some weeks. However, because of the damage to the nerve innervating the upper incisor teeth and gums, the sensation to the gingiva around these teeth returns more slowly, taking over one year or more.
• 'Turned up' nose for some time
  • When the upper jaw is advanced or imopacted superiorly a 'turned up nose' may be present for some weeks but will return to normal after some months.