1.Which patients need orthognathic surgery? The maxillofacial skeleton is often abnormal in shape and position due to congenital developmental abnormalities, surgery, trauma, etc., which leads to facial deformity and dysfunction of the oromandibular system. Orthognathic surgery is a clever design to move the maxillofacial bones to a reasonable position to improve the facial appearance and function of the oromandibular system. Many of the problems commonly known as “geodesic”, “buck teeth” and “square face” can be corrected through orthognathic surgery. 2, patient preparation At present, orthognathic surgery is not yet covered by medical insurance in China, so patients need to bear all the costs themselves. In addition, orthodontic treatment also requires patients to be able to make follow-up visits on a long-term basis (every 1-2 months). Therefore, patients need to seriously consider whether they have enough time and cost before deciding to undergo orthognathic surgery. 3, orthognathic surgery treatment procedures Orthognathic surgery is achieved by moving the jawbone, while moving the jawbone, the teeth also move accordingly. Therefore, it is necessary for the surgeon and orthodontist to work together in order to achieve the treatment goal of “both form and function”. A standardized orthognathic procedure consists of three parts: preoperative orthodontic treatment, orthognathic surgery, and postoperative orthodontic treatment. Generally speaking, the duration of preoperative orthodontic treatment is about 1 year, the duration of surgical hospitalization is about 10-14 days, and the duration of postoperative orthodontic treatment is about 1-2 years. Of course there are some individual differences. 4. Specific treatment process of orthognathic surgery (1) Patient condition data collection: Patients need to go to orthodontics for dental impressions, X-rays or maxillofacial CT; they also need to find orthognathic surgeon for consultation and preliminary preparation of surgical plan, and some necessary examinations to determine whether the patient is suitable for surgery; (2) If no abnormality is seen in the preoperative evaluation, orthognathic and orthodontic surgeons will consult and further discuss the patient’s treatment program and procedures, after which the patient begins to receive preoperative orthodontic treatment; (3) After orthodontic treatment is completed, the orthognathic and orthodontic surgeons meet again to assess the patient’s current occlusal relationship and facial shape, as well as to further confirm the surgical plan or make appropriate modifications; (4) The patient contacts the surgeon to arrange admission for surgery; (5) After orthognathic surgery is completed (6-12 weeks postoperatively), the patient can begin postoperative orthodontic treatment until the end of treatment to obtain an ideal facial shape and stable occlusal relationship. 5.Why do I need preoperative and postoperative orthodontic treatment? Due to the abnormal position of the upper and lower jaws, the upper and lower jaw teeth of patients with jaw deformity cannot bite together as normal; in order to make the upper and lower jaw teeth bite together as much as possible, the teeth of patients with jaw deformity generally have a certain degree of “compensation”. In layman’s terms, this means that the abnormalities of the teeth are used to cover up the abnormalities of the jaws. Therefore, before orthognathic surgery, it is necessary to remove the abnormal compensations of the teeth, realign the teeth, and restore the normal position of the teeth relative to the jawbone. On the other hand, orthognathic surgery can only approximately restore the patient’s occlusal relationship, so it is necessary to precisely adjust the patient’s occlusal relationship through postoperative orthodontic treatment; at the same time, a stable occlusal relationship is also helpful to prevent postoperative relapse. 6.What are the risks and common complications of orthognathic surgery? Generally speaking, orthognathic surgery is very mature and safe, but surgery always comes with risks, and even the best surgeons cannot completely avoid the occurrence of accidents. Common risks and complications of orthognathic surgery include both general anesthesia and surgery. General anesthesia (referred to as general anesthesia), refers to the inhalation or intravenous injection of anesthetic drugs into the body through the respiratory tract, producing central nervous system depression, such as loss of consciousness, loss of generalized pain sensation, and skeletal muscle relaxation; due to the disappearance of the patient’s voluntary breathing, a catheter needs to be inserted into the patient’s trachea after induction of anesthesia, with the assistance of a ventilator, to meet the inhalation of anesthetic drugs and the patient’s demand for oxygen . After the surgery, the supply of anesthetic drugs is stopped and the patient can generally obtain wakefulness after 60-90 minutes, with recovery of commanded movements, orientation and preoperative memory. At present, general anesthesia is a mature and reliable anesthetic technique, but there are still some potential risks such as regurgitation, misaspiration and aspiration pneumonia, agitation, delayed awakening, postoperative nausea and vomiting, bronchospasm, hypoxemia and hypoventilation, acute pulmonary atelectasis, cerebrovascular accident, malignant hyperthermia, etc., due to the different body types of patients; although the incidence of the above risks is extremely low, when they occur, the results are often fatal. The risks of surgery include both the general risks of surgery, such as hemorrhage, wound infection, postoperative pain and swelling, and the potential risks specific to orthognathic surgery, such as accidental fracture, loosening and dislodging of titanium plates and nails for fixation, postoperative hematoma of the floor of the mouth leading to asphyxia, poor recovery of occlusal function and facial shape after surgery, and accidental nerve injury. 7. Intraoperative and postoperative effects and precautions Orthognathic surgery is a surgery mainly done through the intraoral approach, which means that the surgical incision is mainly in the oral cavity. At the same time, orthognathic surgery requires intermaxillary elastic traction of the upper and lower jaw teeth, which means that the patient’s upper and lower jaw teeth are tethered together, making it impossible for the patient to eat like a normal person, but only through a special tool for eating liquid food. Therefore, to summarize, the main effects of orthognathic surgery on patients are as follows: (1) on the day after surgery, due to the residual anesthetic drugs and the effect of surgery, patients often experience different degrees of dizziness, headache, sore throat, vomiting, numbness in the limbs, fever, pain in the surgical area and other discomforts; (2) 72 hours after surgery is the aggravation period of inflammatory reaction and edema in the surgical area, patients will experience different degrees of swelling, pain, and (3) 3-4 weeks after surgery, the intermaxillary elastic traction, the patient can not open the mouth to speak or chew food, affecting the maintenance of oral hygiene, in case of indigestion or nausea and vomiting, there will be a certain risk of aspiration; (4) due to the influence of eating and oral settlement bacteria, the surgical wound is prone to infection, patients should use mouthwash with bactericidal function after each meal, and often use (5) The craniomandibular bandage should be used to compress the soft tissues in the surgical area for 2 weeks after surgery to prevent hematoma and promote soft tissue reattachment to the bone surface, which will restrict patients from washing their hair and face; (6) Even after the removal of the craniomandibular bandage, patients should not engage in strenuous exercise or use hot water to wash their faces and hair for 1 month, because (6) Even after the removal of the craniomandibular bandage, the patient should not engage in vigorous exercise or use hot water to wash the face or wash the head for 1 month, because the above actions may cause blood vessels to dilate and congestion, leading to re-bleeding of the blood vessels broken during surgery, forming hematoma and causing facial swelling and infection. 8.Do I need to remove the titanium plates and nails implanted in my body after orthognathic surgery? The titanium nails and plates implanted in bone tissue during orthognathic surgery are made of titanium with good biocompatibility and can “live peacefully” with human tissue for a long time. The ideal time to remove the titanium nails and plates is about 6 months after surgery, if the time is too early the bone tissue has not fully healed, too late the new bone tissue may completely cover the titanium nails and plates, making it difficult to remove them. 9.What is the approximate cost of orthognathic surgery? The cost of orthognathic surgery varies due to the type of surgery, the manufacturer of the titanium plates and nails used in the surgery, and especially the price difference between domestic and imported brands. According to our past experience, the total cost during hospitalization is as follows: about 40,000 for single jaw surgery and about 70,000 for double jaw surgery. It should be noted that the cost of surgery varies with the market price of drugs and consumables used during hospitalization. 10.What is the need for chin surgery for patients with jaw deformities? The “chin” refers to the part of the mandible that protrudes in the middle, which has a great impact on the aesthetics of the facial contour; chinplasty surgery does not need to change the patient’s occlusal relationship, but can change the position and size of the chin part of the mandible in the three-dimensional direction to assist in improving the shape of the facial contour. Jaw deformity can be manifested as an incongruity in the vertical, anterior-posterior, and left-right directions of the facial profile; after surgery on the maxilla and mandible to restore the normal occlusal relationship, if the chin profile is still unsatisfactory, the length, prominence, and symmetry of the lower third of the face can be improved through chinplasty. For example, in patients with a deformity of the mandible (“geodesic” and skewed to one side), even after jaw surgery, the chin may still be asymmetrical or skewed to one side; in addition, in some patients with a receding lower jaw, simply moving the jaw forward as a whole may still be insufficient, and in these patients, chinplasty is often needed to further improve the facial appearance. The chinplasty is often needed for these patients to further improve their facial appearance. 11.What is the effect of early treatment on the treatment of children’s “geodesis”? Does it have to be treated surgically in adulthood? For patients who have a tendency to develop “geodesic” in early childhood, there are two treatment concepts: one treatment option is to start wearing a “head cap and chin bib” in early childhood to limit the development of the lower jaw in order to correct the tendency of excessive development of the lower jaw; the other treatment option The other treatment option is to not intervene during the growth period of the jaws and to start a combination of orthodontic and orthognathic surgery around the age of 18. However, there is still a controversy about which treatment option is better, and the effect of conservative treatment cannot be accurately predicted, and some patients still cannot completely limit the overdevelopment of the jaws after conservative treatment in early childhood, and surgery is still required in adulthood. 12.How do I eat after orthognathic surgery? After orthognathic surgery, intermaxillary elastic traction, i.e. tethering the upper and lower jaw teeth together to maintain the patient’s normal occlusal relationship, is often required for a period of about 2-4 weeks. Therefore, patients are unable to chew food during this time and can only eat liquid foods such as milk, juice, and various soups. We will provide you with special eating tools to facilitate eating and reduce contamination of the surgical incision. After the removal of the elastic traction, patients can transition from semi-liquid, soft food then to normal diet. 13.How to maintain oral hygiene after orthognathic surgery? The incision of orthognathic surgery is mostly on the mucous membrane in the mouth, which is easily contaminated by food; moreover, there are many bacteria in the mouth, which usually do not cause disease, but when there is a surgical incision on the mucous membrane, these bacteria may lead to infection of the incision. Therefore, maintaining good oral hygiene after orthognathic surgery is both very difficult and very important. At present, there are several methods of oral cleaning after orthognathic surgery: first, the nurse will rinse your mouth with sterile saline three times a day; second, you should try to rinse your mouth with clean warm water and special mouthwash after each meal to clean the residual food residue; third, most of the surgical incisions are located in the vestibular groove of the mouth, and the surgical sutures are more likely to retain foreign bodies, so you can use a cotton swab dipped in Finally, after 3 days of surgery, you can try to start brushing your teeth (you can use toothpaste), as long as the action is gentle, it will not have a negative impact on the healing of the incision. 14. Duration of facial swelling after orthognathic surgery and measures to deal with it The swelling after surgery is obvious because of the rich blood supply to the jaw and face; depending on the patient’s personal constitution, the swelling will last from 2 weeks to 1 month after surgery, and even longer for individual patients. Intermaxillary traction after orthognathic surgery lasts about 2-4 weeks. After removal of intermaxillary traction, patients often experience varying degrees of mouth opening restriction, requiring 1-2 weeks of mouth opening and occlusal training, while healing of the jaws takes 3-6 months. Therefore, we recommend that patients gradually resume normal study and work after 1 month of surgery, but they should do so gradually and pay attention to rest and not overexert themselves or engage in strenuous exercise. After 3 months of surgery, most patients can transition to normal work and life. 15.How long is the hospital stay for orthognathic surgery? When can the stitches be removed? Before the surgery, it takes about 2-3 days for the preoperative routine checkups and further checkups or consultations, even inter-hospital consultations, if there is no abnormality, then you can enter the waiting period for the surgery; the waiting time for the surgery varies greatly with the number of inpatients, ranging from 2-3 days for short cases to 1-2 weeks for long cases. The hospital stay after surgery is about 7 days, depending on the patient’s recovery, and if the surgical wound becomes infected after surgery, it may take longer to change the medication repeatedly, even up to several months. Most of the surgical incisions of the oral mucosa are removed in about 7-10 days. 16.Can the results of orthognathic surgery be accurately predicted? The bite relationship after orthognathic surgery can be predicted, but the change of postoperative shape cannot be accurately predicted yet; although some computer software can simulate the incision and movement of the jaws during the surgery and visually predict the change of postoperative facial shape, which is welcomed by patients. However, it should be pointed out that although these computer software can simulate the effect of jaw bone movement, they cannot predict well the change of soft tissues after jaw bone movement, which is very important to the facial appearance. Therefore, at present, doctors can only predict more accurately the changes in the postoperative occlusal relationship, as well as roughly the changes in the postoperative facial shape. 17. Post-operative review The review time for orthognathic surgery patients is usually 1 month, 3 months, 6 months, 1 year after surgery, and after that, it can be reviewed once a year, and some necessary x-ray and occlusal examination is needed during the review. Many patients tend to ignore the post-operative review, thinking that everything is fine once the surgery is done. In fact, surgery is only one part of a complete orthognathic surgical procedure, and post-operative review is very important. It can help the doctor understand the patient’s healing status, whether there is a tendency of recurrence, etc., so that some measures can be taken at an early stage.