JAW/ORTHOGNATHIC SURGERY
What is orthognathic surgery?
Orthognathic surgery originates from the greek words. ??orthos? meaning ??to straighten? and ??gnathos? which means ??jaw?. Hence, ??orthognathic surgery? means ??surgery to straighten the jaws?. In Oral & Maxillofacial Surgery, jaw surgery forms an integral part of the practice. As specialists dealing with the jaw and mouth, OMS surgeons understand the occlusion (bite) of the jaw very well. This is very important in ensuring success to the outcome of the surgery. A good knowledge of occlusion is also an important prerequisite in the planning of each case so that fruitful discussions with the orthodontist may take place.
Who needs orthognathic surgery?
Patients who need such surgeries usually complain of difficulty in biting due discrepancies in the upper and lower jaw positions. This could either be due to a long or short lower jaw or even an asymmetrical/crooked jaw. The other common complaint is that patients are very conscious of their jaw. This is a more common complain in cases of long lower jaws.
In snoring and obstructive sleep apnea, jaw surgery is also performed to improve the posterior airway space, so that there is an improvement in breathing and hence the elimination of sleep apnea. However, selection of these patients is very stringent and jaw surgery is only indicated if it is absolutely necessary.
What is the treatment like?
Firstly, there must be a clinical evaluation of the patient to determine the concerns of the patient. Next the objective of treatment is determined so that the expectations of the patients can be addressed. Most often, the diagnosis and treatment planning of jaw surgeries are done in conjunction with an orthodontist (braces specialist).
In most cases, a preparation period of braces treatment is required for up to one and a half years. The patient will undergo surgery when ??ready?. Post surgically, the patient usually will require up to four weeks of rest. The braces treatment will continue for another year to year and a half after the surgery depending on the complexity of the case. The normal post-braces retainers must still be worn. Follow up with the surgeon must continue for the next five years.
The best way to know if you are suitable for jaw surgery is to visit your dental surgeon or oral & maxillofacial surgeon. These dental professionals are in the best position to advice on your case.
treatments and techniques
Procedures done by Singapore Oral and maxillofacial Surgeons
- 1.Minor Surgery
- a .Surgical removal of tooth (eg wisdom tooth surgery)
- b. Endodontic(root canal) Surgery
- 2. Oral and Maxillofacial infections
- 3. Cysts of the mouth and jaws
- 4. Benign tumours
- 5. Disorders of the salivary glands
- 6. Maxillary Sinus
- 7. Maxillo-facial Injuries
- 8. Orthognathic surgery
- 9. Cleft lip/palate
- 10. Malignant growth(Cancer) in Head and Neck Region
- 11. Oral Medicine
- 12. Control of facial pain / Sedation
- 13. Dental Radiology / Imaging
- 14. Care of Surgical Patients
- 15. Pre-prosthetic surgery
- 16. Temporomandibular joint(TMJ) Disorders/ Clenching Pain/Surgery
- 17. Implant surgery
- 18. Laser Surgery in the Maxillofacial Region
- 19. Aesthetics procedures around Maxillofacial area, such as fillers, botox etc.
- 20. Aesthetic surgery (eg. rhinoplasty, blepharoplasty and facelifts)
- 21. Skeletal recontouring
FreQuently asked Questions
Q1. When do we need to remove our wisdom teeth and how do we decide if it is an extraction or if it is surgery
A1. Our wisdom teeth can sometimes be the cause of gum infection or tooth decay depending on the manner in which it is erupted. If the symptoms are persistent, it is usually indicated for excision. The decision to either extract or to perform surgery is dependant on the type and depth of impaction of the tooth. It is also dependant on the size and shape of the roots. If the tooth is fully erupted with no bony obstruction, then an extraction will usually be successful. In most cases, however, a minor surgical procedure is required.
Q2. What is the difference between local and general anaesthesia.
A2. Local anaesthesia is when a small injection is given to achieve numbness to the surgical site. The procedure is then carried out with the patient's cooperation. General anaesthesia is always performed in an operating theatre. The service of an anaesthetist is required. The surgery is performed after the patient is anaesthetized (sleeping). There is a need for the patient to recover in a ward after the procedure. It is common for healthy patients who undergo general anaesthesia for wisdom tooth surgery to be discharged on the same day. This is known as a day surgery procedure.
Q3. I heard about sedation, what is sedation?
A3. Sedation is when the patient is put into a half sleep state for the surgery to be carried out. Local anaesthesia is also given but this is usually done after the patient is sedated. There are different forms of sedation. Some methods will utilize medical inhalational gases for the sedation. Other methods will an intra-venous line to be inserted through a vein on the hand/arm. The intra-venous method is further divided into a single dose sedation technique and a continuous infusion technique. The latter method will require the full attendance of an anaesthetist. Do discuss with your Oral & Maxillofacial Surgeon with regards to the best technique for your case.
Q4. I heard about excessive bleeding if extractions are done at midday, is that true?
A4. Although this fact has been repeated many times over especially from the older generation, there are no scientific studies to verify this fact. With modern medications and techniques, any form of bleeding in a healthy individual should be easily managed by your OMS Surgeon.
Q5. What are the signs and symptoms of oral cancer?
A5. Most oral cancers start off as a non-healing ulcer in the mouth. The ulcer tends to grow with time and bleeds occasionally. It may or may not be painful. If there is an unusual growth noted in the mouth, the OMS surgeon will usually perform a biopsy during which a small sample of the soft tissue is removed and sent to the histopathology lab for analysis. The results will be known within a week. If you have a history of smoking or betel nut chewing ("Serei") or if you are an alcoholic, then your chances of developing oral cancer increases. Please see an OMS surgeon quickly. Early treatment saves lives.
Q6. I heard about dental implants. Is it safe to have metal in our body and will it set off alarms at the airports?
A6. Dental implants are made of titanium. Titanium has been shown to osseo-integrate or "bond" with bone. It is unlike steel which is usually encapsulated with soft tissue growing and wrapping around it. So, unlike, old steel orthopedic plates which will require removal after a period of time, titanium implants do the opposite and bond with the bone. Many modern orthopedic implants are made of or are at least coated with a layer of titanium due to its osseo-integration properties. Titanium does not set off alarms at the airport. If you travel a lot, you may ask your OMS surgeon to write a letter to certify that you have dental implants in your jaws. Your OMS surgeon will be happy to oblige.
Q7. How long can dental implants last?
A7. The science of Dental implantology has been around since the nineteen sixties. It was discovered quite by accident by a Prof Branemark while he was studying blood flow in rabbit's ears. Since then, dental implants have come along way in terms of clinical research and materials. The modern dental implant is very predictable in terms of success rates and if all conditions are ideal and the dental implants are well maintained in the mouth, it should last for more than twenty years or even a lifetime! The OMS surgeon and the restorative specialist will play their part in the treatment, but the patient plays the more important part of careful use and care of the dental implant retained prosthesis.
Q8. It is true that removal of the upper front teeth can cause mental and eye problems?
A8. Again, this rumour has been heard many times over. The nerves supplying the upper front teeth are sensory nerves. It is not involved in the mental processes and functions of the brain. It is theoretically not possible that extraction of the upper front teeth can directly cause mental problems. Although toothache to the upper posterior teeth can sometimes radiate to the eye on the same side, it is not related directly to the nerves supplying the eye.
Q9. My lower jaw is very long and I really wish to have it surgically corrected, it the procedure safe? What are the long term problems if I undergo the surgery?
A9. The procedure for surgery to the lower jaw is known as orthognathic surgery. Specifically, it will be a Bilateral Saggital Split Osteotomy or a Vertical SubSigmoid Osteotomy. Each procedure has its advantages and disadvantages as well as risks. It will be best that you seek advice with your OMS surgeon as it is too long to be covered here. However, it is a relatively safe procedure which is performed on a regular basis in our local hospitals. It is likely that you will have to undergo braces therapy in preparation for the surgery as well as after the surgery. The long problems are few and are unique for different techniques used. Please see your OMS surgeon for further advice.
Q10. My son fell down and lost his two front teeth when he was 9 years of age. When is the best time for him to have dental implants placed?
A10. The best time to have dental implants placed is when the patient is fully grown. In Singapore, it is usually at the age of 18 to 20 years for boys, and 16 to 18 years for girls. There are variations to this range. If the implant is placed too early, it will remain behind as the rest of the dentition and jaw grows. This will lead to a "submerged" tooth situation and will be difficult to remedy.