Tuesday, April 23, 2013

Case of the Month: April 2013 (Orthognathic Surgical Correction)

This month's case illustrates the sometimes life changing transformation that orthodontics combined with orthognathic (jaw) surgery can make.  This particular patient presented to our office at age 15 wanting straighter teeth, an improved bite and an increase in the prominence of her lower jaw.

She was diagnosed as having a constricted maxilla (upper jaw), retrusive mandible (lower jaw) in part to a high jaw angle, proclined and protrusive upper incisors (front teeth), and an excessive overjet (front to back distance between the upper and lower incisors).  Her facial balance needed improvement due to the lower jaw being so retrusive, which also causes the lip balance to appear strained when trying to keep the lips closed.

The initial cephalometric radiograph below illustrates the jaw and bite discrepancies from a lateral view (patients facial photos are not shown for privacy purposes):

During our orthodontic consult, we explained that jaw surgery would be required to meet all of the patient's goals and expectations due to the severity of the skeletal discrepancies.  Many cases with more mild skeletal problems can be fixed with orthodontics alone, but some cases require the jaw bones themselves be moved to create the proper balance.  A referral was made to Dr. Steve Widner, an oral surgeon in central Austin.  After discussing the patient's case, Dr. Widner and I agreed that two-jaw surgery involving expanding the upper jaw along with tipping the back part of the upper jaw up and an advancement of the lower jaw would meet everyone's expectations.  The upper front teeth would also have space to tip back once the upper jaw was widened surgically.

Orthodontic treatment was initiated with the expected 12 months of pre-surgical tooth movements needed.  Essentially it is the orthodontist's job to align and level each arch individually so that when the jaws themselves are moved, the dental arches and bite will fit together nicely.  Once we were ready and all preparations were made, the jaw surgery was completed and about 9 months of post-surgery orthodontic finishing was done.  Jaw surgery usually requires 2 weeks of rest (usually no school or work) post-surgery and patients start feeling 100% about a month after the surgery.  A month of rest and healing is worth the dramatic quality of life improvement in my opinion.

The following before and after photos impressively illustrate the powerful changes that jaw surgery combined with orthodontics can make for those who can benefit from it:

Believe it or not that is the same patient in the before and after photos and needless to say she is thrilled and can't wait to start college.


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