Orthognathic Surgery

What is orthognathic surgery?

Orthognathic surgery, often called corrective jaw surgery, is an operation that repositions the upper jaw (the maxilla), the lower jaw (the mandible), or both. The word orthognathic comes from Greek roots meaning “straight jaw.” The goal is to bring the jaws and teeth into a more balanced position so that the bite works properly, breathing and speech are easier, and the face is more symmetrical.

The surgery is usually performed by an oral and maxillofacial surgeon, a specialist trained in surgery of the mouth, jaws and face. It is almost always planned together with an orthodontist, the dental specialist who straightens teeth with braces or aligners. In many hospital groups, including Acibadem, this care is coordinated through the Dental & Oral Health department together with maxillofacial surgery.

Orthognathic surgery is used to treat problems that braces alone cannot fix because the underlying bone, not just the teeth, is out of position. Common conditions include:

• Malocclusion (a “bad bite”), where the upper and lower teeth do not meet correctly, such as a severe overbite, underbite or crossbite.
• Open bite, where the front teeth do not touch when the back teeth are closed.
• Jaw asymmetry, where one side of the face has grown differently from the other.
• Retrognathia or prognathism, meaning a jaw that is set too far back or too far forward.
• Facial differences related to birth conditions such as cleft lip and palate, or after injury.
• Obstructive sleep apnea in selected patients, a condition in which the airway narrows during sleep; moving the jaws forward can enlarge the airway.

Who is a candidate for orthognathic surgery?

People often ask who needs orthognathic surgery. In general, it is considered when a jaw position problem causes functional difficulties and cannot be corrected with orthodontic treatment alone. Typical indications include:

• Difficulty biting, chewing or swallowing food.
• Speech problems related to jaw position.
• Chronic jaw pain, headaches or excessive tooth wear caused by an uneven bite.
• An open bite, protruding lower jaw, receding chin or noticeably unbalanced face.
• Difficulty closing the lips comfortably.
• Breathing problems, including sleep apnea, that a specialist believes are related to jaw structure.

Surgery is usually postponed until the jaws have finished growing. This is often in the mid to late teenage years for girls and slightly later for boys, but your surgeon will confirm this with X-rays. Adults of any age may be candidates if they are healthy enough for general anesthesia.

Orthognathic surgery may not be suitable when:

• Jaw growth is not yet complete, because the correction could be lost as growth continues.
• The problem involves only the teeth and can be treated with braces or aligners.
• A person has uncontrolled medical conditions, such as poorly managed diabetes or bleeding disorders, that make major surgery unsafe.
• Gum disease or tooth decay is active and untreated; these usually need to be addressed first.
• Someone smokes heavily and is unwilling to stop, because smoking slows bone and soft-tissue healing.
• Expectations focus only on appearance and the person is not prepared for the lengthy combined orthodontic and surgical process.

Only a specialist assessment can determine whether the surgery is appropriate for you. This article is informational and does not replace that evaluation.

How the orthognathic surgery procedure works

The orthognathic surgery procedure is one stage in a longer treatment plan that usually spans one to three years. Understanding the sequence helps set realistic expectations.

Before surgery: planning and orthodontics

The surgeon and orthodontist take photographs, dental impressions or digital scans, and X-rays, often including a three-dimensional scan called a CT (computed tomography) scan. These are used to plan exactly how far, and in which direction, the jaws will move. Many centers now use computer-assisted planning to create custom guides or splints, which are plastic templates that fit over the teeth and help the surgeon position the jaws accurately during the operation.

Most patients wear braces for a period before surgery, often 12 to 18 months. This may sound backward, but the braces move the teeth into the position they need to be in once the jaws are realigned. During this phase the bite may look temporarily worse; this is expected.

During surgery

The operation is performed in a hospital under general anesthesia, meaning you are fully asleep. In most cases the surgeon works entirely inside the mouth, so there are no visible cuts on the face. The main steps are usually:

• Small incisions are made in the gum tissue to reach the jawbone.
• The bone is cut in carefully planned lines. In the upper jaw this is often called a Le Fort I osteotomy; in the lower jaw it is often a bilateral sagittal split osteotomy. An osteotomy simply means a surgical cut in bone.
• The jaw segments are moved into the new position guided by the surgical splint.
• Small titanium plates and screws are fixed to hold the bone in place while it heals. These are usually left permanently and rarely cause problems.
• In some cases the chin is also reshaped (genioplasty) to improve balance.
• The gum incisions are closed with dissolvable stitches.

Surgery on one jaw typically takes around two to three hours; surgery on both jaws may take three to five hours or longer, depending on complexity.

After surgery

You wake up in a recovery area and are then moved to a ward. Many patients stay in hospital for one to three nights. Rather than wiring the jaws shut, most surgeons today use light elastic bands between the upper and lower braces to guide the bite. You will receive pain relief, antibiotics in many cases, and instructions for a liquid or very soft diet.

Preparation for orthognathic surgery

Good preparation reduces complications and makes recovery easier. Your team will give you specific instructions, but the following are commonly advised:

• Complete the pre-surgical orthodontic phase. Surgery is scheduled only when the teeth are in the planned position.
• Medical assessment. Blood tests, an anesthesia consultation and sometimes a heart tracing (ECG) are arranged to check you are fit for surgery.
• Dental check. Any decay or gum inflammation should be treated beforehand to lower infection risk.
• Medications. Tell your team about everything you take, including supplements. Blood-thinning medicines and some anti-inflammatory drugs may need to be paused; never stop a prescribed medicine without advice.
• Stop smoking and avoid alcohol for several weeks before and after surgery, as both impair healing.
• Fasting. You will be asked not to eat or drink for a set number of hours before the anesthesia.
• Home planning. Stock soft foods, a blender, straws if your surgeon permits them, ice packs, and extra pillows to sleep with your head raised. Arrange time off work or school, usually two to four weeks, and someone to help you in the first days.

Recovery and aftercare

Orthognathic surgery recovery time varies with the type of surgery, your age and general health. The following timeline describes what many patients experience, but yours may differ.

The first two weeks

Swelling of the face is expected and often peaks around the second or third day before gradually improving. Bruising, a feeling of tightness, and numbness of the lips, chin or cheeks are common. Pain is usually manageable with prescribed medication and tends to ease within a week or two. Speaking clearly and opening the mouth widely can be difficult at first. A liquid diet (soups, smoothies, protein drinks) is usual in the early days, moving to a soft, no-chew diet as directed. Careful oral hygiene with a soft brush and prescribed mouth rinse is important because food collects around braces and elastics.

Weeks two to six

Most people return to school, desk work or light activities within two to three weeks, although fatigue is common. Swelling continues to decrease. The diet progresses from soft foods toward more normal textures, typically around six weeks, when the bone has healed enough to tolerate gentle chewing. Strenuous exercise and contact sports are usually avoided for at least six to eight weeks to protect the healing bone.

Three months and beyond

Bone healing is largely complete by about three months, but final settling of swelling and full return of feeling in the lips and chin can take six to twelve months. Orthodontic treatment usually resumes a few weeks after surgery to fine-tune the bite, and braces are typically removed six to twelve months after the operation. Regular follow-up visits with both the surgeon and orthodontist are part of standard aftercare.

Everyday aftercare tips

• Sleep with your head elevated in the first week to limit swelling.
• Use cold packs on the cheeks for the first 48 hours, then warm compresses if your surgeon recommends them.
• Take all medications as prescribed, including the full antibiotic course if one is given.
• Do not remove elastics unless instructed.
• Stay well hydrated and aim for enough protein and calories, even on a liquid diet, to support healing.

Orthognathic surgery risks and benefits

Every operation carries some risk, and it is important to weigh orthognathic surgery risks and benefits honestly with your surgeon.

Potential benefits

• A functional bite that makes chewing and biting more efficient.
• Reduced tooth wear and, for some people, less jaw or facial pain.
• Improved speech when jaw position was contributing to the problem.
• Improved breathing and sleep in selected patients with obstructive sleep apnea.
• Better facial balance and lip closure, which many patients report improves confidence.

Common side effects

• Swelling, bruising and discomfort for several weeks.
• Temporary numbness of the lower lip, chin, cheeks or gums caused by stretching of the nerves during surgery. This usually improves over months but in some people, especially after lower jaw surgery, some numbness is permanent.
• Nasal congestion or minor nosebleeds after upper jaw surgery.
• Stiffness and reduced mouth opening that improves with time and gentle exercises.
• Weight loss during the liquid-diet phase.

Less common but more serious risks

• Infection at the surgical site or around the plates.
• Bleeding, occasionally requiring transfusion.
• Poor healing of the bone (non-union) or unfavorable bone fractures during the operation.
• Relapse, where the jaw drifts partly back toward its original position.
• Damage to teeth or tooth roots near the bone cuts.
• New or changed symptoms in the temporomandibular joint (the jaw joint).
• Need for a second operation to adjust position or remove plates that cause irritation.
• General anesthesia risks, which are low in healthy people but increase with certain medical conditions.

Your surgeon will explain how these risks apply to your particular situation and the specific movements planned.

Results and outlook

The available evidence suggests that most people who complete combined orthodontic and orthognathic treatment achieve a stable, functional bite and are satisfied with the outcome. Improvements in chewing efficiency and bite alignment are generally well documented. Studies of quality of life also tend to show gains in self-perception and social confidence, although individual experiences vary widely.

Long-term stability depends on the type and size of jaw movement, how well the orthodontic phase is completed, and whether retainers are worn as instructed after braces are removed. Certain movements, such as large advances of the lower jaw or closure of open bites, are known to carry a higher chance of partial relapse, and your surgeon may discuss this with you in advance.

For sleep apnea, jaw advancement surgery can substantially widen the airway in appropriate patients, but the response is not universal and a sleep study after healing is typically used to confirm the effect. Facial appearance continues to refine for up to a year as swelling fully resolves, so final assessment of results is usually made around that time.

Cost considerations

The cost of orthognathic surgery differs widely between countries, hospitals and individual cases, so no single figure applies. Factors that generally influence the total include:

• Whether one jaw or both jaws are operated on, and whether a chin procedure is added.
• Length of the operation and anesthesia time.
• The number of nights in hospital.
• Fixation hardware such as titanium plates and screws, and custom or computer-designed surgical guides.
• Imaging and planning, including CT scans and digital modeling.
• Pre- and post-surgical orthodontic treatment, which is often billed separately from the surgery.
• Follow-up visits, medications and, if needed, later plate removal.

Insurance or public health coverage often depends on whether the surgery is judged medically necessary, for example for a functional bite problem or sleep apnea, rather than for appearance alone. Requesting an itemized estimate from the treating hospital helps clarify what is and is not included.

Frequently asked questions

Who needs orthognathic surgery rather than just braces?

Braces move teeth within the jawbone; they cannot change the position or size of the jaw itself. When the bite problem, facial imbalance or breathing difficulty is caused by the bones being misaligned, orthodontics alone may be insufficient. A joint assessment by an orthodontist and an oral and maxillofacial surgeon is the usual way to decide.

How long is orthognathic surgery recovery time?

Many patients return to school or desk work within two to three weeks and to a normal diet around six weeks. Bone healing is largely complete by three months, but residual swelling and numbness can take up to a year to resolve fully. Orthodontic fine-tuning usually continues for several months after the operation.

Is the orthognathic surgery procedure painful?

Discomfort is expected, but most people describe it as pressure, tightness and swelling rather than sharp pain, and it is generally controlled with prescribed medication. Pain usually eases noticeably within the first one to two weeks. Numbness in the operated area often reduces the sensation of pain in the early days.

Will my jaw be wired shut?

In most modern practice, no. Titanium plates and screws hold the bone securely, and light elastics between the braces guide the bite. Some surgeons may use tighter elastics or, rarely, wiring for specific cases, so it is worth asking your surgeon what to expect.

What are the main orthognathic surgery risks and benefits I should weigh?

The main benefits are a functional bite, reduced tooth wear, and possible improvements in speech, breathing and facial balance. The most common lasting risk is some degree of numbness in the lower lip or chin. Less common risks include infection, bleeding, relapse and the need for a second operation. Discussing your individual risk profile with your surgeon is essential.

Will orthognathic surgery leave visible scars?

In most cases the incisions are made inside the mouth, so there are no external scars. Occasionally a very small incision is made on the skin near the angle of the jaw to place screws, which typically heals to a barely noticeable mark.

Can orthognathic surgery treat sleep apnea?

For some people whose obstructive sleep apnea is related to a small or set-back jaw, moving the upper and lower jaws forward can enlarge the airway. It is generally considered when other treatments have not worked or are not tolerated, and a sleep specialist is usually involved in the decision.

When to see a doctor

You may wish to be assessed by an orthodontist or an oral and maxillofacial surgeon if you experience any of the following on an ongoing basis:

• Difficulty biting into food, chewing or swallowing.
• Teeth that do not meet, a bite that has changed, or noticeable wearing down of teeth.
• Chronic jaw, face or temple pain, or frequent headaches linked to clenching.
• Difficulty closing your lips at rest, or persistent mouth breathing.
• A visibly receding or protruding jaw, or facial asymmetry that concerns you.
• Loud snoring, pauses in breathing during sleep or daytime sleepiness that may point to sleep apnea.

After orthognathic surgery, seek urgent medical attention if you notice:

• Bleeding from the mouth or nose that does not stop with gentle pressure.
• Difficulty breathing or swelling that is rapidly worsening, especially if it affects the throat or tongue.
• Fever, increasing pain, foul taste or discharge from the incisions, which may signal infection.
• Sudden change in how the teeth meet, a loose feeling in the jaw, or a snapping or grinding sensation, which could indicate loosened hardware or a bone problem.
• Persistent vomiting, inability to keep fluids down, or signs of dehydration.
• Numbness that is worsening rather than improving, or new weakness in the face.

These symptoms do not necessarily mean something is wrong, but they warrant prompt assessment by the surgical team or an emergency department.