Jaw surgery (orthognathic surgery)

What is jaw surgery?

Jaw surgery, known medically as orthognathic surgery, repositions your jaw bones so your upper and lower jaw fit together properly. It’s usually carried out alongside a course of braces, when braces alone cannot correct the way your teeth and jaws meet.

What conditions can jaw surgery treat?

Jaw surgery can help with a range of problems affecting your bite, breathing, and the shape of your face. Your surgical team might suggest jaw surgery if you have:

• a noticeable difference in size between your upper and lower jaw
• a jaw that has grown unevenly, giving your face an uneven or asymmetrical look, such as an off-centre chin
• a gap between your front teeth caused by your jaws growing apart
• an overbite, underbite, or overjet, where your teeth do not meet properly (together known as a malocclusion)
• one or both jaws sticking out further than they should (called prognathism)
• pain, clicking, or difficulty opening and closing your mouth, caused by problems with your jaw joint (the temporomandibular joint, or TMJ)
• obstructive sleep apnoea, where a small or set-back jaw narrows your airway while you sleep
• a broken jaw, or a jaw affected by cysts, tumours, or cancer
• a condition you were born with, such as cleft lip and palate (a condition affecting the lip and the roof of the mouth).

What are the benefits of jaw surgery?

Correcting your jaw can make a real difference to how you eat, speak, and feel about your appearance. Because surgery is the only way to change the actual shape of your jawbone, it can fix problems that braces alone never could.

If jaw joint problems have been causing you pain or making your jaw click and lock, surgery can also ease this when other treatments have not helped. And if a small or set-back jaw has been affecting your breathing, surgery can improve this too, along with easing symptoms of obstructive sleep apnoea.

Many people notice a difference in the balance and symmetry of their face after surgery, which can help with confidence and wellbeing.

Are there different types of jaw surgery?

Which type of jaw surgery you’re offered depends on which jaw needs adjusting, and by how much. If it’s your upper jaw that sits too far forward or back, you’ll likely have a maxillary osteotomy (surgery on the upper jaw bone). If it’s your lower jaw, this is called a mandibular osteotomy (surgery on the lower jaw bone).

When both jaws need correcting, this is known as bimaxillary or double jaw surgery. Whichever type you have, the principle is the same: your surgeon cuts the jawbone and moves it into a better position, then secures it with tiny titanium plates and screws. These are usually left in place for good, though they can be removed later if needed.

What happens before the operation?

Getting ready for jaw surgery takes time, since braces usually need to prepare your teeth first. Your care, from planning to surgery, is usually looked after by a team that includes a maxillofacial surgeon (a specialist in complex jaw and facial surgery), an orthodontist, and sometimes other dental specialists.

Before your operation goes ahead, you can expect:

• braces to align your teeth, which usually takes around 18 months
• a thorough examination from your surgeon, including a look at your medical history and a discussion of your options
• imaging such as models, X-rays, or a computer scan, to help plan exactly how your jaw needs to move
• input from your orthodontist, who is likely to be involved at several stages of your care
• confirmation that your jaw has finished growing, since most people need to wait until the late teenage years before having this surgery.

In the days before the operation itself, it also helps to:

• stock up on soft food and drink, such as soups, smoothies, and soft fruit, ready for when you get home
• arrange for someone to drive you home and stay with you afterwards, since you will have had a general anaesthetic
• collect any medicines from the pharmacy in advance, so they are ready when you need them.

What happens during the procedure?

You’ll be given a general anaesthetic (medicine that puts you into a deep sleep so you do not feel anything). Once you’re asleep, your surgeon will usually work through the following steps, though exactly what happens depends on your own situation:

1. Your surgeon makes cuts to reach your jawbone. These are almost always made from inside your mouth, so there is no visible scarring, though very occasionally a small cut is also needed on the outside of your jaw, which heals quickly and becomes hard to notice.
2. Small cuts are made in the jawbone itself.
3. Your jaw is moved into its new, corrected position.
4. Bone is removed, reshaped, or added, depending on what you need.
5. Your jaw is secured with tiny titanium plates and screws, or sometimes wires. These are usually left in place for good, though they can be removed later if needed.
6. The cuts are closed.
7. The surgical wound is dressed.
8. A splint (a device worn over your teeth) is fitted to hold everything steady while you heal.

The operation itself is complex, and can take 1–4 hours to complete.

What does recovery look like?

In hospital

Most people stay in hospital for 1–2 nights after jaw surgery. Your team will keep a close eye on you while you recover from the anaesthetic and start to heal.

You’re more likely to notice numbness and swelling than serious pain in these first few days. Your mouth will open as normal straight after surgery, so you’ll be encouraged to eat and drink early on, even if it’s just fluids at first. Bruising, a blocked nose, a sore throat, and general tenderness are also normal at this stage.

At home

Once you’re home, your side effects, such as swelling and bruising, should start to ease within 1–2 weeks. You’ll need a soft or liquid diet at first, for around a month. This is partly because of ongoing swelling, and partly because of any small elastic bands used to help your bite settle.

Initial recovery usually takes around 4–6 weeks, though your jaw will keep healing for several months afterwards. Full healing can take up to a year in total. Most people manage light activity, such as short walks, after 1–2 weeks, and return to work or school after 3–4 weeks.

A few things can help while you recover. Wear your splint as instructed, to help your mouth muscles adjust to your jaw’s new position, and prop yourself up on pillows to ease facial swelling. It also helps to ice your jaw for the first 24 hours, with 20 minutes on and 10 minutes off, repeating as needed.

Keep all your orthodontic appointments and stick to a soft, balanced diet. Take any medicines exactly as prescribed, to help with pain and reduce your infection risk.

You’ll usually need to keep wearing braces for 6–9 months afterwards, before moving on to a retainer to hold your teeth in their new position. In rare cases, a second, smaller operation may be needed to fine-tune your bite.

What are the risks and complications?

As with any major operation, jaw surgery carries some risks. Because it is planned in advance, it is worth taking the time to weigh these up against the benefits with your surgeon before you decide to go ahead.

General risks that come with any operation include:

• heavy bleeding
• infection
• a reaction to the anaesthetic.

Complications that are more specific to jaw surgery can include:

• damage to your teeth
• not being able to open your mouth as wide as you would like
• ongoing jaw pain
• numbness around your mouth that does not fully go away
• scarring.

You’re more likely to have numbness and swelling than severe pain. But as with any complex surgery, there’s a chance of nerve damage or other problems, which your surgeon will talk through with you before you go ahead.

Contact your surgical team straight away if you notice:

• a temperature above 38.3°C
• pain that gets worse rather than better
• shortness of breath
• signs of infection, such as discharge or hot, red skin
• vomiting or diarrhoea that does not settle.