1.Indications for orthognathic surgery
Due to congenital developmental abnormalities, acquired surgical procedures and trauma, etc. resulting in dental and maxillofacial malformations, and leading to facial deformities and dysfunction of the oromandibular system, because most of these patients have severe bony deformities of the maxillofacial area, conservative orthodontic treatment is difficult to correct bony malocclusion, so orthognathic surgery is often required to treat them. Orthognathic surgery is designed to move the bones of the jaws and face to a reasonable position so that the treatment of dental and maxillofacial malocclusion can be completed. Patients should be in good general condition and have no serious systemic diseases, so a systemic examination should be done before treatment.
2.The information to be prepared for patient consultation
Patients who consult with me should prepare x-ray films (including: whole jaw surface tomographs, cephalometric frontal and lateral films), plaster bite models, etc. so that we can make accurate judgments and recommendations for you. Do not equate orthognathic surgery with plastic surgery. The treatment plan for orthognathic surgery is rigorous, and any diagnosis or recommendation made without examination information is inaccurate. Orthodontic – orthognathic treatment is much more rigorous, generally emphasizing both morphology and function, and the procedures and processes are different from plastic surgery.
3, the preparation of patients
Orthognathic surgery has not yet been included in the scope of medical insurance, all treatment costs need to be borne by the patient, at present, the total cost of single jaw (from hospitalization to discharge of all costs) about 15 to 30,000, the total cost of double jaw about 30 to 60,000, domestic equipment is relatively cheap, so there are differences in costs. In addition, orthodontic treatment takes 1~2 years and requires regular follow-ups (once a month). Therefore, patients need to seriously consider the time and cost before deciding on orthognathic surgery treatment.
4.Procedure of combined orthodontic and maxillofacial treatment
The standardized orthognathic surgery procedure includes: preoperative orthodontic treatment, orthognathic surgery, and postoperative orthodontic treatment. The general preoperative orthodontic treatment time is about one year, the surgical hospitalization time is about 10~14 days, and the postoperative orthodontic treatment is about six months to one year. There are individual differences among patients, and the treatment time will be slightly different.
5.Why do you need pre-operative and post-operative orthodontic treatment?
Pre-operative patients will have physiological growth of upper and lower jaw teeth in opposite jaw direction to establish occlusal relationship because of abnormal jaw position in anterior-posterior direction or horizontal direction, or even three-dimensional direction, so such patients have physiological skewed teeth before surgery, and pre-operative orthodontics is to align the physiologically skewed teeth (tooth axis) to the normal position of the jaw, and this treatment is called “decolonization”. Postoperative orthodontics is to adjust the position of teeth more finely and establish a good occlusal relationship. A stable occlusal relationship is an important guarantee of the surgical effect and can effectively prevent the recurrence of postoperative deformity.
6.The basic orthognathic surgery
Orthognathic surgery includes three basic procedures: mandibular ascending sagittal splitting, maxillary Lefort type I osteotomy and chinplasty, and one or several procedures can be chosen according to the need of surgical design to achieve good surgical results. After the bone block is moved to the new position, it is fixed with micro or small titanium plates. The strong fixation of the bone block facilitates the early healing of the bone block, greatly shortens the time of postoperative intermaxillary fixation, facilitates the patient’s early opening and closing training, and enables the patient to achieve normal opening and establish a good occlusal relationship as soon as possible after surgery.
7.Schedule after hospitalization
The first day of admission: take preoperative whole jaw surface tomographs, cephalometric orthopantomographs and cephalometric lateral radiographs, go to orthodontics department to take 2~3 sets of plaster models and finish pinching hooks on the square wire arch.
The second day of admission: make laboratory and electrocardiogram examination, projection measurement and analysis, plaster model surgery, complete surgical design and make surgical jaw plate.
The third day of admission: perfect the preoperative preparation and try on the jaw plate.
The fourth day of admission: orthognathic surgery is performed.
The first day after surgery: simple activities in bed, such as sitting up and turning over, avoiding strenuous activities, and cold compresses in the bilateral mandibular angle area (about 15 minutes each time, twice a day).
The second day after surgery: remove the negative pressure drainage tube in the mandibular angle area, wear a jaw plate for intermaxillary fixation, and walk around in bed.
The third day after surgery: increase the activity, promote digestion, increase the amount of food, and accelerate the healing of the wound.
Apply anti-inflammatory and anti-swelling drugs for 3~5 days after surgery.
The seventh day after surgery: remove intra-oral surgical sutures and process discharge.
8. Common risks and postoperative complications of orthognathic surgery
With the continuous development and improvement of combined orthognathic-orthodontic treatment, orthognathic surgery is now very mature and the safety of surgery is relatively high. However, surgery always comes with risks, and even excellent surgeons with many years of experience cannot completely avoid accidents. The risks of orthognathic surgery include both general anesthesia and surgery.
At present, general anesthesia is a mature and reliable anesthesia technique, but there are still some potential risks due to the difference of patient’s constitution, such as: reflux, misaspiration, aspiration pneumonia, agitation, delayed awakening, postoperative malignancy and vomiting, bronchospasm, hypoxemia and hypoventilation, acute pulmonary atelectasis, cerebrovascular accident, malignant hyperthermia, etc. Although the possibility of the above risks is extremely low, when they occur, the The results are often fatal.
Surgical risks include general surgical risks, such as hemorrhage, wound infection, postoperative pain and swelling, etc.; they also include potential risks specific to orthognathic surgery, such as accidental fracture, loosening and dislodging of fixed titanium nails and plates, postoperative bleeding leading to asphyxia, poor recovery of postoperative occlusal function and facial shape, accidental nerve injury, etc.
9.Post-discharge precautions
After discharge from hospital, two weeks of intermaxillary elastic traction and fixation are required. During this period, patients cannot open their mouths and chew food, and they still need to eat a liquid diet, to increase nutrition, make nutritious soup, increase protein intake, maintain oral hygiene, and gently brush teeth and rinse mouth. You cannot do strenuous exercise within one month after the operation. Three months after the operation, the bone reconstruction will be completed and the normal bone strength will be reached, so you can do normal physical exercise and other activities.
10.Schedule of follow-up consultation after discharge
Two weeks after discharge, the intermaxillary plate fixed in the mouth will be removed. After the plate is removed, two 3/16 rubber bands will be used for intermaxillary elastic traction to guide the establishment of normal post-operative occlusal relationship. Orthodontic treatment. During this period, follow-up with the orthognathic surgeon is very important, even though this period is crucial to establish a stable and normal postoperative occlusal relationship, and the mouth and jaw function can be restored as soon as possible under the guidance of the surgeon.
The swelling of the face will be eliminated by 60-70% in 1 month after surgery, about 90% or more in 3 months after surgery, and completely eliminated in 6 months after surgery, and the shape and function of the face will return to normal.
Follow-up visits to the surgery at 3 months after surgery, postoperative facial phase and X-ray films were taken to follow up the recovery of soft and hard tissues after surgery.
After the surgery, we will follow up with the surgery 6 months later, and take postoperative facial pictures and X-rays, and follow up the recovery of soft and hard tissues after the surgery.
From 6 months to 12 months after surgery, the titanium plates and nails for internal fixation of the jaws can be removed. The titanium plates and nails can be removed or not, depending on the patient’s personal requirements, depending on the individual’s perception of the foreign body in the body. Titanium plates and nails have no side effects on human tissue and can be kept in the body for life.