Reshaping the jaw with orthognathic surgery
“My patients come to me because of some dysfunction of the jaw," explains Amin Kazemi, DMD, MD, a Virtua oral and maxillofacial surgeon. In most cases, this dysfunction is marked by a facial deformity that's visible to the untrained eye.
Why surgery?
Among the most common reasons for orthognathic surgery are severe overbites and underbites. In severe underbites, the teeth of the lower jaw overlap those in the upper jaw when biting. People with severe underbites have chins that thrust forward in a pronounced manner. In a severe overbite, where the teeth of the lower jaw are significantly overlapped by those of the top jaw, patients' chins recede to an exaggerated degreee.
Other candidates for orthognathic surgery may have what's called an open bite, where the front teeth don't meet while biting; or misaligned jaws, where the jaws don't match up at all. These patients may have cheekbones that appear flat, eyes that seem to bulge out of their sockets or teeth that protrude too far.
But, that doesn’t mean the procedure is purely cosmetic. Facial deformity is merely the visual component of a much larger functional issue. Misaligned jaws cause difficulty biting and chewing food. They also can be painful and can contribute to speech difficulties and breathing problems like sleep apnea.
Careful preparation
Orthognathic surgery, which deals with the alignment of the jaw, is used to correct these problems. Dr. Kazemi plans the surgery to the smallest detail by performing a complete mock surgery using jaw molds. He also takes soft tissue measurements and standard and cephalometric x-rays that focus on the bones in the face and head. "This not only helps in planning the procedure, it also allows me to show the patient exactly what's going to happen," he says.
Once patients understand the basic mechanics, it’s time to talk about aesthetics. “There’s no standard ‘perfect’ profile,” explains Dr. Kazemi. “What we consider attractive is deeply personal, but it’s also influenced by culture. It's very important that I understand my patients' expectations."
The result
Ultimately, orthognathic surgery is performed to improve the function of the jaw. “Severe malocclusion of the jaw, whether from deformity or trauma, is a lot more than a cosmetic issue,” says Dr. Kazemi. For his patients, orthognathic surgery offers relief from pain and improvement in function in addition to a more ideal profile and facial symmetry.