Corrective Jaw Surgery (Orthognathic)

Orthognathic surgery, commonly referred to as jaw surgery, is a specialized surgical procedure used to correct abnormalities of the jawbones – maxilla (upper jaw), mandible (lower jaw), or both – and associated facial structures to achieve proper jaw alignment. These abnormalities can lead to functional problems such as difficulty chewing, speaking, and breathing, as well as aesthetic concerns. Orthognathic surgery realigns the jaws to restore proper function and improve facial symmetry, often in combination with orthodontic treatment.

Most jaw surgeries are elective, meaning they are planned procedures carried out to improve function and aesthetics. However, there are rare instances when jaw surgery may become emergency surgery, such as in the case of:

• Severe facial trauma with jaw fractures
• Life-threatening airway obstruction due to jaw displacement
• Acute infections with risk of spreading to critical structures
• Sudden inability to close the mouth properly
• Uncontrolled bleeding from the mouth or jaw area

IF THE ABOVE COMPLICATIONS ARISE, URGENT MEDICAL CARE IS REQUIRED.

Why Cuba

Surgical management of jaw conditions in Cuba is focused on restoring proper jaw alignment, improving function, and minimizing postoperative complications. Emphasis is placed on the precise repositioning of the maxilla, mandible, or both to correct dentofacial deformities, safeguarding critical neurovascular structures, maintaining soft tissue balance, and preventing long-term occlusal or aesthetic issues. Cuban surgical teams rely on evidence-based techniques and receive specialized training in orthognathic and maxillofacial surgery, allowing for safe and effective correction of complex skeletal discrepancies.

Cuba’s public healthcare system fosters a multidisciplinary approach, where maxillofacial surgeons collaborate with orthodontists, anesthesiologists, ENT specialists, and mental health professionals. This coordinated model ensures that jaw surgery is not a standalone procedure but part of a comprehensive care continuum that supports the patient’s long-term functional, aesthetic, and emotional rehabilitation.

Types of Conditions Treated by Jaw Surgery

Jaw surgery is used to treat various skeletal and dental abnormalities, including:

• Class II malocclusion (overbite)
• Class III malocclusion (underbite)
• Open bite (space between upper and lower teeth when the mouth is closed)
• Crossbite
• Jaw asymmetry
• Congenital jaw deformities (e.g., cleft palate-related discrepancies)
• Obstructive sleep apnea due to jaw positioning
• Temporomandibular joint disorders (in select cases)
• Facial trauma with bone displacement

Causes of Jaw Misalignment

Jaw misalignment can result from a range of underlying factors that interfere with normal growth and positioning of the facial bones. Common causes include:

• Genetic or congenital conditions
• Developmental abnormalities
• Trauma or injury
• Tumors affecting jaw growth
• Infections during growth periods
• Habits like thumb sucking or mouth breathing affecting development

Symptoms Indicating Need for Jaw Surgery

Patients who may benefit from jaw surgery often experience symptoms that go beyond cosmetic concerns and significantly impact daily function and quality of life. These symptoms can include:

• Difficulty biting or chewing
• Speech difficulties
• Jaw pain or TMJ disorders
• Chronic mouth breathing
• Facial imbalance or asymmetry
• Excessive wear on teeth
• Obstructive sleep apnea

Presurgical Diagnosis

A thorough and multidisciplinary presurgical diagnostic process is critical for the success of jaw surgery. It helps establish an accurate understanding of the patient’s anatomical structure, functional deficits, and aesthetic concerns. The diagnostic phase ensures that the treatment plan is both personalized and evidence based. It typically includes the following components:

• Medical and Dental History Review
  A detailed review of the patient’s general health, previous surgeries, dental procedures, and any history of trauma or congenital conditions. This helps identify any risks or contraindications that may affect surgical planning or recovery.

• Clinical Examination
  A physical assessment of the face, jaw, and oral cavity. This includes evaluating facial symmetry, the relationship between upper and lower jaws, bite alignment (occlusion), temporomandibular joint function, speech clarity, and airway patency.

• Imaging Studies
  Multiple imaging techniques are used to assess bone structure, dental positioning, and soft tissues:
  • Panoramic X-rays provide a broad overview of the jaw and teeth.
  • Cephalometric analysis measures facial proportions and skeletal relationships.
  • 3D CT scans offer detailed, three-dimensional images of the facial skeleton, allowing for precise surgical planning and simulation.

• Dental Impressions and Study Models
  Physical or digital impressions of the teeth are taken to create models. These models help in visualizing the bite, assessing occlusal discrepancies, and simulating postoperative outcomes.

Jaw Surgical Treatment Options

Surgical management of jaw conditions, whether for corrective, reconstructive, or trauma-related purposes, involves a range of techniques tailored to the nature and severity of the problem.

While local anesthesia and sedation may be used in minor procedures (e.g., genioplasty or small corrections), most orthognathic surgeries are performed under general anesthesia due to their complexity and duration.

• Open Reduction and Internal Fixation (ORIF):
  ORIF is a standard technique in jaw surgery, especially for treating fractures of the mandible, maxilla, or zygoma. It’s also used in planned orthognathic procedures where bone segments are cut and repositioned, then stabilized using titanium plates and screws.

• Closed Reduction:
  While less common in planned orthognathic surgery, closed reduction is used in select trauma cases, particularly non-displaced or minimally displaced mandibular fractures. It is also occasionally used in pediatric cases to avoid damage to developing structures.

• Soft Tissue Repair:
  This is relevant when jaw surgery involves trauma, congenital defects (e.g., cleft-related surgery), or aesthetic revision procedures. Surgeons often perform nerve decompression, mucosal repair, or muscle repositioning as part of broader treatment.

Below is a list of common jaw conditions requiring orthognathic surgery, along with the typical surgical interventions and approaches used, and the level of invasiveness:

• Mandibular Advancement (for underbite or sleep apnea)
  • Mandibular advancement is a surgical procedure used to reposition the lower jaw (mandible) forward. It is mostly performed to correct Class II malocclusion (severe overbite), improve jaw alignment, or address obstructive sleep apnea when the airway is compromised by a retruded jaw.
  • Treatment is through a procedure called bilateral sagittal split osteotomy (BSSO), where the lower jawbone is cut on both sides, repositioned forward, and stabilized using titanium plates and screws.
  • May be minimally invasive but typically involves small incisions inside the mouth

• Maxillary Advancement or Impaction (for overbite or open bite)
  • Maxillary advancement and maxillary impaction are surgical procedures used to reposition the upper jaw (maxilla) to correct structural misalignments and improve function, aesthetics, and airway capacity.
  • Maxillary Advancement
    • This is a procedure that moves the upper jaw forward to correct Class III malocclusion (underbite), midface deficiency, or obstructive sleep apnea caused by a retruded maxilla.
    • The surgical approach involves Le Fort I osteotomy by cutting the bone above the teeth, repositioning the jaw forward, and securing it with plates and screws.
  • Maxillary Impaction
    • This is a procedure carried out to raise the upper jaw vertically to correct a gummy smile, open bite, or vertical maxillary excess.
    • Le Fort I osteotomy is also used, however, the bone is repositioned upward into the facial skeleton, reducing upper gum exposure.
  • Both surgeries are usually performed under general anesthesia and are often combined with orthodontic treatment.

• Bimaxillary Surgery (for complex cases)
  • This surgery involves operating on both the upper jaw (maxilla) and lower jaw (mandible) in a single procedure to correct complex jaw and facial deformities as well as skeletal discrepancies affecting both jaws, such as:
    • Severe underbite or overbite
    • Open bite involving both jaws
    • Facial asymmetry
    • Jaw misalignment contributing to obstructive sleep apnea
    • Functional problems with chewing, speech, or breathing

• • The procedure is performed by:
    • Maxillary osteotomy (Le Fort I): The surgeon cuts and repositions the upper jaw.
    • Mandibular osteotomy (BSSO): The lower jaw is also cut and repositioned.
    • Both jaws are stabilized with titanium plates and screws.
    • The procedure is performed under general anesthesia and usually through intraoral incisions (inside the mouth), leaving no visible facial scars.

• Genioplasty (for chin abnormalities)
  • Genioplasty is a type of chin surgery used to reshape, reposition, or enhance the chin for functional or cosmetic reasons.

• • There are two types of genioplasty:
    • Sliding Genioplasty (most common): The surgeon cuts a portion of the lower jawbone (mandibular symphysis) and slides it forward, backward, upward, or downward. The new position is secured with titanium plates and screws. No implants are used; it reshapes using the patient’s own bone.
    • Implant Genioplasty: A synthetic implant is placed to enhance the chin’s shape or projection. Typically used for cosmetic enhancement without cutting the bone.

• Trauma-Related or Asymmetry Corrections
  • Trauma-Related or Asymmetry Corrections refer to surgical procedures performed to restore normal structure and function to the jaw and facial skeleton following injury or to correct developmental or acquired asymmetries. Each surgery is tailored to each patient’s unique anatomical disruptions. Common between these procedures are:

• Realignment of fractured or misaligned bones to restore normal function and facial symmetry
• May require bone grafts or reconstructive plates to rebuild areas of bone loss or structural damage
• Typically performed as open surgery, though minimally invasive approaches may be used in select cases
• Can be combined with orthodontic or soft tissue procedures for comprehensive rehabilitation

Minimally Invasive vs. Open Surgical Approaches

• Most orthognathic procedures are performed via intraoral (within the mouth) incisions, making them minimally invasive in terms of visible scarring.
• Open approaches may be used in trauma or complex reconstructive cases where external access is needed.