Am I a candidate for orthognathic surgery?

Orthognathic surgery is indicated when a patient’s jaws do not fit together properly, affecting the functionality of the bite as well as the smile’s appearance. This procedure is often performed in conjunction with orthodontic treatment in cases when the orthodontic appliances cannot sufficiently reposition the jaws to correct the bite.

As such, the orthodontist and orthognathic surgeon would generally collaborate in developing the treatment plan for patients in need of jaw surgery in addition to braces. They will work together to determine the timing of the treatment phases.

An oral surgeon with extensive knowledge of the facial structures generally performs orthognathic surgery. In performing this surgery, an orthognathic surgeon can help patients achieve a number of treatment goals, including enhanced aesthetics, a more efficient chewing mechanism, and the elimination of pain related to temporomandibular joint disorder (TMJ).

Many patients opt for orthognathic surgery primarily for cosmetic reasons. That is, they are dissatisfied with the appearance of their smiles or even the facial aesthetics that result from misaligned jaws. Patients who are motivated by a desire to improve aesthetics often find that they get dramatic results from orthognathic surgery.

Misaligned jaws affect more than just the appearance, though. In fact, a malocclusion can result in TMJ and the significant discomfort caused by that condition. Accordingly, orthognathic surgery may be recommended to patients with TMJ disorders who get no relief from more conservative treatments. 
 

For malocclusions that cannot be corrected by conventional orthodontic treatment, orthognathic surgery may be needed.

As with any surgical procedure, patients must be healthy enough to tolerate the surgery. Discuss any health problems with your oral surgeon in advance to be sure that they will not interfere with the surgery or the healing process.

If an orthodontist or oral surgeon does recommend orthognathic surgery in your case, you should also be prepared for the post-operative healing period. Discuss what to expect with your oral surgeon so that you can make any necessary temporary adjustments to your diet and other lifestyle issues.

For malocclusions that cannot be corrected by conventional orthodontic treatment, orthognathic surgery may be needed. Discuss your options with both an orthodontist and an oral surgeon to decide whether orthognathic surgery will help you achieve your desired outcomes.

If you have questions or would like to schedule an appointment, please contact Dr. Larry Wolford’s office using our online contact form or call 214-828-9115.

Condylar hyperplasia (CH) is a generic term describing enlargement of the condyle.  There are a number of different condylar pathologies that enlarge the mandibular condyle, with subsequent adverse effects on the morphology and function of the TMJ and mandible.  This may result in the development or worsening of a dentofacial deformity such as; mandibular prognathism (symmetric or asymmetric), and unilateral enlargement of the condyle, ramus, and body, facial asymmetry and malocclusion. 

Wolford has developed a simple, but encompassing classification that will allow the clinician to better understand the nature of the various CH pathologies, progression, and treatment options that have proven to eliminate the pathological process and provide optimal functional and esthetic outcomes.  The classification (Table 2 and Figure 29) also begins with the most common occurring form of CH and progresses to the least common occurring form.

CH Type 1:  This condition develops during puberty, is an accelerated and prolonged growth aberration of the normal condylar growth mechanism, is self-limiting but can grow into the 20’s, and can occur bilaterally (CH Type 1A) or unilaterally (CH Type 1B).

CH Type 2:  These condylar pathologies can develop at any age (although 2/3s develop in the 2nd decade), are unilateral condylar vertical and/or horizontal over-growth deformities, and are the most common occurring mandibular condylar tumors; osteochondroma (CH Type 2A) and less common osteoma (CH Type 2B).

CH Type 3:  These are other rare benign causing condylar enlargement. 

CH Type 4:  These are malignant conditions that can cause condylar enlargement.

The more common forms of CH (Types 1 and 2) will be presented relative to the clinical and radiographic findings, growth characteristics, effects on the jaws and facial structures, histology, and treatment considerations that are highly predictable in the elimination of the pathology and provide optimal treatment outcomes. 

FIGURE 29 Description

A-C) normal TMJ with balanced joint spaces.
D-F) CH Type 1 with relatively normal condylar shape, elongated condylar head and neck, and narrow joint space related to thin articular disc or displaced disc.  In the coronal view the condylar head is more rounded.
G-I) CH Type 2Av; an osteochondroma with a vertical growth vector without significant horizontal condylar enlargement or exophytic horizontal growth. This is a “young” osteochondroma with only about 3 years of growth.
J-L) CH Type 2Ah; an osteochondroma with horizontal (as well as vertical) enlargement of the condyle and exophytic outgrowth of the tumor. This tumor has been present for 6 years. Notice the significant increased vertical height of the mandibular body and ramus.

FIGURE 29