When is jaw surgery recommended?

For patients who have abnormalities of the jaw in addition to misaligned teeth, orthodontic treatment may not be sufficient to achieve the desired smile goals and jaw surgery may be recommended.

This type of procedure is called orthognathic surgery, and it involves a surgical repositioning of the jaws as one component of the orthodontic treatment plan. When surgery is warranted, the oral surgeon will collaborate with the orthodontist to work toward successful outcomes.

Any number of jaw abnormalities may be addressed by orthognathic surgery. Patterns of jaw growth that lead to over-development or under-development of either the maxilla or mandible can be reversed through surgery.

Such problems can be genetic or congenital, present from birth or early childhood, or arise from irregular patterns of development or severe injury to the jaw. Children, teens and adults may be candidates for orthognathic surgery.

Orthognathic surgery can help correct many problems, such as unattractive facial imbalances, open bites and difficulties with breathing, eating and speech. In this way, this procedure can improve facial aesthetics and jaw function. Upper and lower jaws that do not fit together properly also can cause discomfort, and this symptom also may be alleviated by jaw surgery.

This type of surgery can be extensive and may need to be performed in a hospital setting or specialty surgical center. It often involves general anesthesia, so patients should be sure to ask about any risks they may face and any steps they must take to prepare for the anesthesia.

At your initial consultation, your oral surgeon will gather information needed to plan for the procedure. This first appointment also gives the patient the opportunity to ask any questions or bring up any concerns about the surgery. Your oral surgeon will communicate with the orthodontist to coordinate the timing of the surgery.

Orthognathic surgery has significant benefits for patients who need this intervention. If your orthodontist recommends surgery as a companion to braces, discuss your options with our oral surgeon, Dr. Larry M. Wolford. 

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.