Cosmetic Jaw Surgery
This implies surgery to straighten the jaws. Cases are
planned with an Orthodontist who treats the frequent malocclusion present
in such a way that the dental occlusion will be correct following the
At NCAFOS Clinics we shall have access to “invisible”
brace treatment which is suitable for some patients. This is carried out
using fix braces placed on the tongue (lingual) sides of the teeth or
by using a series of transparent dental splints (Invisalign®) http://www.invisalign.com/GB/index.html
which fit over the teeth like a boxers gum shield.
An osteotomy is a controlled surgical fracture of bone,
and is usually carried out with saws and instruments which can split the
bone along its natural “grain”. Combined with Invisible Orthodontic treatment,
and planned using Engineering Assisted Surgery techniques and customised
jigs, precision osteotomy bone cuts between the tooth roots may be used
to mobilise teeth so that they may be orthodontically moved into the correct
position using treatment lasting a few days or weeks – instead of months
or years. This concept is a major breakthrough in the treatment of misaligned
Computer Simulated Segmental Osteotomy
illustrating the mobilisation of two lower teeth
The back of the lower jaw is split bilaterally under general anaesthetic
in the region of the wisdom teeth, which are generally removed in a separate
operation at least 6 months prior to corrective surgery.
Mandibular Sagittal Split Osteotomy
and Genioplasty (Chin Surgery)
The mandible has been pushed backwards and surgery has been carried out to the chin (Genioplasty)Sensory Nerves to the lower lip pass through the jaw and are coloured blue
Whilst day case treatment is practiced in the USA, it is common practice in the UK to spend one night as an in-patient.
Some adjustment to the position of the dental occlusion (bite) is not uncommon following surgery. This is achieved by joining the upper and lower jaws together with elastic band traction for a week or two.
Facial swelling is variable and is controlled with intravenous steroid injections over the first 24 hours. Patients require a liquidised diet if the jaws are held together with elastics - or soft diet for the first two weeks, after which time more solid food can be introduced.
The Mandibular Sagittal Split Osteotomy
The sensory nerves to the lower lip are coloured blue.
Screw fixation is demonstrated on one side. Screws are placed above and below the nerve
The sensory nerve to the lower lip (inferior dental
nerve) runs in the lower jaw in the region of the osteotomy bone cuts.
Immediately following the surgery all patients should expect numbness
of the lower lip, which improves over a period of months. A degree of
permanent altered sensation remains in about 30% of patients and affects
one or both sides of the lower lip. This may range from complete numbness
as experienced with a dental injection to mild tingling. Male patients
may not feel if they cut themselves whilst shaving. The majority of patients,
who experience permanent altered sensation to the lower lip, find that
it is of little significance, and have no regrets about surgery. Reports
of psychological problems and or depression related to sexual activity
and altered/reduced pleasure from kissing in particular have been reported
but are rare. Similarly the condition of painful numbness (dysthesia)
has been reported but is rare. Repair of an injured inferior dental nerve
is possible but technically difficult. Such a repair is not guaranteed
to restore normal sensation.
Motor nerves are nerve that make muscles contract. Injury
to the facial nerve supplying movement for the lower lip has been reported
as a result of insertion of screws through the small external skin incisions.
This may produce some weakness of the lower lip - more noticeable on smiling
and may be permanent. This is a very rare complication.
Long term complications include relapse, which may occur
if the jaw is advanced or if the jaw is retracted. The cause is controversial.
It is thought to be related to continued growth in some patients - seen
when the jaw is pushed back, and muscle pull - when the jaw is advanced
large distances to accentuate a small chin. It is therefore important
to carry out such operations when growth has ceased. Muscles inserted
into the chin may be divided in the floor of mouth in cases of large jaw
advancement - circa 1cm (myotomy). The majority of cases of relapse are
noticed by slight changes in the dental occlusion only noticed by the
clinician. It is very rare for relapse to adversely affect the cosmetic
The position of the chin is critical and influences
the facial height, facial centre-lines and cosmetic appearance of the
nose. Patients seeking rhinoplasty may discover that their perceived cosmetic
problem lies elsewhere – the chin. The effect of both rhinoplasty and/or
genioplasty may be demonstrated to the patient on screen during the initial
consultation using computer technology.
A “double chin” is a common feature and may be treated
alone or in combination with the chin and lower jaw. Liposuction may be
carried out through a tiny skin incision under the chin. The removal of
fatty tissue is carried out using suction (Liposuction) which may be carried
out laterally in the neck to provide a better jaw line and for the treatment
of jowling (Liposculpture), through additional skin incisions near the
angle of the jaw.
Maxillary osteotomy surgery may be advised when an abnormally
positioned jaw is giving rise to cosmetic problems. The jaw can be moved
upwards / downwards / forwards and rarely backwards.
Le Fort I Osteotomy
Sensory nerves to the upper lip and cheeks are coloured blue
The Le Fort I osteotomy involves separating the maxilla and the palate from the skull above the roots of the upper teeth through an incision inside the upper lip. The maxilla is fixed in its new position with titanium screws and plates. Surgery time is around three hours. The operation is frequently carried out with the mandibular Sagittal split osteotomy when it is termed a Bimaxillary Osteotomy.
Bimaxillary osteotomies take around five hours to complete and may be carried out in conjunction with chin surgery and liposuction/liposculpture. Blood transfusion is required. On occasions bone grafting is required in the Le Fort I osteotomy to ensure bone healing and union across the bone cuts. The graft is frequently harvested from the hip. Bone graft material may be harvested from the chin or lower jaw in bimaxillary cases – leaving the hip intact.
Cosmetic improvement is startling for those individuals requiring these procedures, and with proper planning it is unusual for patients not to be delighted with outcome.
Le Fort II Osteotomy
Sensory nerves to the cheeks and forehead are coloured blue
The Le Fort II Osteotomy is an uncommon procedure used when there has been a problem with growth in the centre of the face and the upper jaw and nose requires movement together. This is a major surgical operation, and involves incisions in the mouth, cosmetic incisions behind the lower eyelids (transconjunctival) or through the skin below the lower eyelids (blepharoplasty). The nose is approached with a cosmetic incision over the top of the head from ear to ear (bicoronal approach) and the scalp is raised forwards to get access to the nasal bones. Sensory nerves to the forehead require to be freed from bony canals (illustrated). Hip grafts (illustrated in red) are needed to fill in any gaps after the upper jaw and nose have been moved (usually forwards).
Surgery time is around 8 hours; blood transfusions are required and the patient is nursed in a high dependency unit overnight following the operation. Suction drains are placed in the scalp to reduce bruising. Patients may have considerable facial swelling and black eyes following this procedure. Aesthetic improvement is startling for those patients requiring this type of surgery.
Le Fort III Osteotomy
Le Fort III Osteotomy
The lateral view of the Le Fort III osteotomy illustrates the use of an additional plate and bone grafting in the region of the Zygomatic arch.