JAW SURGERY TREATMENT IN TURKEY ISTANBUL

In many cases, abnormalities with the bite or tooth alignment can be corrected by utilizing today’s modern dental and orthodontic treatment technologies. Skeletal and dental anomalies, on the other hand, might be difficult to treat, even with the most advanced non-surgical procedures. Corrective jaw surgery (also known as orthognathic surgery) may be recommended at this point. Jaw surgery can be performed to treat serious orthodontic disorders involving the relationship of the teeth and jaws, such as underbites (the most common surgical correction) and congenital abnormalities (birth defects) related to jaw development. It can even help with sleep apnea, a possibly deadly condition. After completing the regular four years of dentistry school, an oral and maxillofacial surgeon spends four years in a hospital-based residency program before performing orthognathic surgery. Dental surgeons train with other medical and surgical residents in fields such as emergency medicine, general surgery, and anesthesiology there. Aside from anesthesiologists, they are the only medical practitioners who can provide all levels of sedation and general anesthesia.

What are the Different Types of Jaw Surgery?

In general, jaw surgery can be performed for either corrective or cosmetic purposes. Cosmetic benefits can arise in many cases of reconstructive jaw surgery. Your doctor can discuss your cosmetic enhancement choices at your initial consultation. Genioplasty (chin surgery) is the most widely practiced aesthetic jaw surgery. There are numerous techniques available for mostly corrective procedures, treating abnormalities with the upper jaw, lower jaw, both, the chin, or the palate.

Upper Jaw Surgery (Maxilla Osteotomy)

A deformed upper jaw, or maxilla, can cause a variety of issues, including an open bite. Because the upper jaw is connected to the rest of the skull, this can be a difficult procedure that necessitates cuts below both eye sockets to make a single sliding unit. The upper jaw is often stabilized using titanium screws and plates once it has been moved into the appropriate position.

Lower Jaw Surgery (Mandible Osteotomy)

Deformities of the mandible, or lower jaw, might include a receding jawline, a projecting jawline, an open bite, a tiny jaw, and other issues. Most of the time, bone cuts (osteotomies) are performed around the molars so that the entire lower jaw, including the teeth, can move forward and back as needed. Other surgical or orthodontic treatments are performed to increase the size of a small jaw. Titanium screws for stabilization are also widely employed.

Double Jaw Surgery (Maxillomandibular Advancement)

Some people require single jaw surgery to treat their issues, while others require double jaw surgery. Your doctor will assess whether upper jaw surgery, lower jaw surgery, or double jaw surgery is suitable for your needs and goals during the evaluation process. Some diseases may appear to affect either the upper or lower jaw, but both areas may require attention to obtain the desired effect. During your initial consultation, your doctor and his competent medical team will go over all the details, including the goal of each procedure performed, to provide the best appropriate treatment with the least invasive approach.

Genioplasty (Chin Surgery)

Genioplasty, often known as chin surgery or chin augmentation is a surgical procedure that moves the chin forward or backward to solve functional or cosmetic concerns.

Rapid Palatal Expansion Osteotomy

Orthodontists may generally expand the palate without surgery; however, when the maxilla (upper jaw) is oval-shaped and smaller than the mandible (lower jaw), a rapid expansion is required. An orthodontist will insert a palatal expander on the maxilla teeth before the treatment to allow for post-surgery adjustments. Using the expansion device, the maxilla is removed from the cranial base and the palate is spread slightly. The doctor will turn the expansion device a little more each week, gradually advancing the palate to the desired size.

Who is a Candidate for Jaw Surgery?

Orthognathic (jaw) surgery may be beneficial for those who have abnormalities with their jaws, teeth alignment, or facial asymmetries, which cause difficulty chewing, talking, sleeping, or performing routine activities. A protruding jaw, a congenital defect, or an imbalanced facial appearance can all be corrected with these procedures. They can tell you if you are a candidate for jaw surgery after a comprehensive examination at the doctor’s office and maybe a visit with your regular dentist or orthodontist. In general, if orthodontic treatment is capable of resolving the issue, that is where you will begin. While orthodontics can effectively align the teeth, it is occasionally necessary to align the jaws as well. Most orthodontic appliances, such as braces and retainers, will be utilized before and after the surgical phase of treatment to achieve effective and aesthetically attractive outcomes. 

The following conditions can be effectively treated with corrective jaw surgery:

• An open bite, a protruding jaw, or a receding chin.
• The cleft palate is an example of a congenital deformity that can be treated with jaw surgery.
• Malocclusions (bite problems) caused by underbites or overbites.
• Obstructive Sleep Apnea, when more conservative methods fail.
• Food swallowing, chewing, or biting problems.
• Headache and pain in the jaw or jaw joint.
• The face appears unbalanced from the front or side.
• Inability to bring the lips together without strain.
• Dry mouth and chronic mouth breathing.
• Trauma to the face.

The Choice to Have Jaw Surgery

If orthodontics alone are not effective in treating your jaw condition, your surgeon may consider surgery. The recommended treatment will be strongly influenced by the diagnosis of your problem. Surgery is frequently paired with orthodontic treatment and can range in duration from several months to two years or more. You should expect the total treatment to take a long time. Psychological counseling may be a crucial aspect of treatment for some patients. Your surgeon will be happy to go over the treatment’s advantages, disadvantages, and limitations with you. Failure to address a functional issue may result in:

• Prevents you from properly biting and chewing your food, closing your lips together, and speaking correctly.
• Long-term dental health is compromised.

The choice to have surgery is always yours. When you are pleased with the information you have obtained and believe you have been adequately informed of the risks and benefits, make your decision. If you decide to have surgery, your surgeon will need that you sign a consent form. Take your time reading it. Ask your surgeon if you have any further questions about the risks and advantages of the surgery, orthodontic treatment, the consent form, terms mentioned in the consent, or anything else. If you are unsure about your surgeon’s advice or diagnosis, you may want to speak with another surgeon. When deciding whether to have surgery, keep in mind that your surgeon cannot guarantee that the surgery will always be successful or that there will be no risks. The operation and its outcome may fall short of your expectations. You are advised to have a thorough discussion with your surgeon about the treatment and expected outcome of the procedure.

How to Prepare for Jaw Surgery?

Your symptoms, past treatment (if any), medical and dental history, and social and lifestyle factors will all be documented by your surgeon. Your comprehensive medical and dental history is required to plan the best possible treatment. A detailed questionnaire will be needed from you.

It is critical that you inform your surgeon about all current and recent medications you are taking. Aspirin, cough treatments, hormone replacement therapy, and the contraceptive pill are examples of such medications. Inform the surgeon if you have ever had an allergy to antibiotics, anesthetics, or any other drugs. Inform your surgeon if you have a history of bruising after being hurt or having surgery, or if you have any blood problems such as hemophilia. Generally, surgery is not done during pregnancy. Inform your surgeon if you are, maybe, or plan to become pregnant.

Some teeth may need to be extracted before orthodontic treatment to make room for the remaining teeth to move. The orthodontist will straighten the teeth before surgery to make the procedure easier and to assure a solid result. Orthodontic treatment typically lasts 12 to 24 months, with surgery performed at some time during the middle. You will need to wear braces throughout this period and may need to have them adjusted frequently. You may believe that your bite is deteriorating while receiving orthodontic treatment. However, when the surgeon realigns your jaws (after orthognathic surgery), the teeth will be in their right position. Orthodontics combined with orthognathic surgery can improve your outcome.

Your surgeon will make final surgical preparations before your orthodontic treatment is completed. More records are being taken. When your surgeon and orthodontist determine that your teeth are in the proper place, they will schedule surgery. To decide on the surgical operation (to be conducted on your jaws) and predict the results, your doctor may use x-ray examinations and models of your teeth and jaws. A plastic dental splint formed from a model of your teeth and jaws can be made to serve as a guide for precise tooth and jaw alignment during surgery.

Under general anesthesia, orthognathic surgery is conducted at a hospital. You will most likely be admitted to the hospital on the day of your procedure. Eat or drink nothing for 6 hours before surgery. If you have morning surgery, don’t eat or drink anything after midnight the night before. You may choose to give your own blood two to four weeks before surgery if you are having both upper and lower jaw surgery. If there is a large blood loss during the surgery, the blood may be given to you. Other procedures, such as grafting or aesthetic procedures, may be recommended by your surgeon to improve the outcome of the surgery.

Jaw Surgery Procedures

Maxillary Osteotomy Procedure

Your surgeon will do the following during this procedure:

• Make a cut in the gums above your upper teeth to provide access to the upper jaw bones.
• Cut into the bone of your upper jaw so that they may move it as a single unit.
• Move your upper jaw forward so that it aligns and fits correctly with your lower teeth.
• Use plates or screws to secure the realigned bone in place.
• Close the wound in your gums with stitches.

Mandibular Osteotomy Procedure

When you get a mandibular osteotomy, your doctor will do the following:

• On each side of your lower jaw, just behind your teeth, create a cut into your gums.
• The lower jaw bone is cut, allowing the doctor to carefully relocate it into a new place.
• Change the position of the lower jawbone by moving it forwards or backward.
• Place plates or screws to secure the repositioned jawbone in place.
• Stitches are used to close the incisions in your gums.

Bimaxillary Osteotomy Procedure

The techniques employed for this surgery include those outlined before for maxillary and mandibular osteotomies. Because operating on both the upper and lower jaws can be difficult, your surgeon may employ 3-D modeling software to help in the planning of the surgery.

Genioplasty Procedure

Your surgeon will do the following during a genioplasty:

• Make an incision around your lower lip in your gums.
• They cut a piece of the chin bone, allowing them to reposition it.
• Move the chin bone into its new position with care.
• Small plates or screws can be used to help retain the corrected bone in its new position.
• Stitch the incision closed.

Jaw Surgery Recovery

Depending on the complexity of the procedure and your rate of recovery, your hospital stay will often range from one to three nights. You will be given intravenous fluids and drugs to avoid dehydration and infection, as well as to alleviate pain and swelling. After surgery, the intravenous line and drip will stay linked to your arm until you can take appropriate fluids and oral medications. The sooner you start eating, drinking, and moving around normally, the sooner you will be discharged from the hospital.

Stitches. In most situations, dissolving stitches are used. These dissolve progressively over three to four weeks. Do not be concerned if they fall out earlier, as long as there is no persistent bleeding.

Jaw support. During the healing process, some patients’ jaws may be kept together by elastic bands.

Brushing and oral hygiene. Cleanliness and care of the mouth are crucial for quick healing and infection prevention. Brushing your teeth can be tough during the first week after surgery. You will be needed to rinse your mouth with warm salt water and chlorhexidine (antiseptic) mouthwash at least four times a day, particularly after meals.

Diet. It is advised that you eat soft meals for four to six weeks until the swelling and discomfort subside. Healing requires adequate nutrition. Because of the discomfort, eating small quantities five to six times a day is advised in the first few days after surgery. Dietary restrictions will be advised by your surgeon. You may gradually resume normal eating habits in the later stages of healing. However, it is critical to rinse your mouth quickly after each meal.

Work and school. It is normally recommended that you take at least two weeks off work or school after your surgery. Your surgeon can provide you with a medical certificate to cover you during your time off.

Appearance. Your appearance may have changed slightly, so be prepared for a surprise from your family and friends. It won’t be long before you or they adjust.

Orthodontist. When it is time to return to your orthodontist for band adjustment, your surgeon will inform you. This is usually two to three weeks after surgery. The braces will remain on your teeth for another six to twelve months so that the orthodontist can modify your bite for the greatest potential results.

Follow-up care. Following orthognathic surgery, you may need six to twelve months of orthodontic treatment to fine-tune the position of your teeth and bite. Your doctor and orthodontist will want to see you regularly to ensure that your teeth and jaws are properly aligned. It is critical to practice proper dental hygiene and to see your dentist regularly.

Jaw Surgery Complications

Every surgical treatment has some level of risk. Complications can arise even when the greatest standards of surgical practice are followed. While your surgeon will make every effort to eliminate any potential dangers or issues, complications may occur that have long-term consequences. In general, your surgeon will not go into detail about every possible side effect or uncommon complication of surgery. However, it is critical that you are well-informed about the benefits and dangers of any surgical operation. Most people who have jaw surgery do not experience issues, but if you have any questions or concerns about potential complications, be sure to discuss them with your surgeon. The following potential complications are provided to enlighten you rather than to worry you.

General Risks of Surgery

General anesthesia side effects. You may have difficulties swallowing, a dry painful throat, and generalized muscle soreness after general anesthesia. These symptoms usually go away by the next day. After waking up following a general anesthetic, you may feel nausea and vomiting for one to two days. If necessary, you will be given medication to help you stop vomiting. Although uncommon, general anesthetic risks include bronchitis, pneumonia, hoarseness, heart attack, stroke, and death. Patients above the age of 65 and those who already have a cardiac disease may be at a higher risk of a heart attack.

Infection. Infection is a concern with any surgery, but it is especially high in diabetic patients. Although infection may develop around plates and screws after jaw surgery, the risk is modest. Antibiotics are typically provided after surgery to reduce the risk of infection. If an infection does occur, symptoms such as increased pain, swelling, and a bad-tasting discharge in the mouth usually appear 10 to 14 days after surgery. If an infection or bleeding occurs, call your surgeon right once. In rare cases, the oral incision must be reopened, cleansed, and restitched.

Scarring. The majority of oral incisions heal fast and well. However, some people’s healing may be slow, mainly because they are elderly.

Vein inflammation (Phlebitis). Intravenous fluid and medication veins may become irritated, resulting in swelling, redness, and limitation of arm or hand movement for some time.

Specific Risks of Jaw Surgery

Discomfort and pain. The level of pain and discomfort is determined by the complexity and difficulty of the surgery. The soreness is typically greatest in the first 2-3 days after surgery and should eventually lessen. Strong analgesics will be prescribed. Analgesics are normally no longer required 7-10 days after surgery as the pain lessens.

Bleeding. If there is excessive bleeding during the procedure, a transfusion may be required. Bleeding is also possible in the first 24 to 48 hours after surgery, especially if you continue to spit, smoke, touch the incisions with your fingers, or consume hot feet. Sleep with your head elevated on pillows to reduce the chance of bleeding. It is essential to avoid smoking, refrain from vigorously rinsing your mouth until the day after surgery, and obtain plenty of rest. If the healed wound becomes infected, bleeding may ensue.

Swelling. Following surgery, swelling is to be expected. Swelling is at its peak 48 hours after surgery and gradually reduces over three to four weeks. The majority of the swelling goes away within 14 days. The swelling increases with the complexity and difficulty of the surgery. As a result of the swelling, you may have difficulties closing your molars together for a few days.

Bruising. Some persons may get bruising of the face, neck, and chest as the swelling subsides. It usually goes away in 7 to 10 days.

Nerve damage. Because nerves are moved and may be stretched during surgery, nerve injury impairs feeling (sensation). The most usually affected areas are the chin, lower lip, upper lip, cheeks, and palate. Patients over the age of 40 who undergo certain types of lower jaw surgery are at a higher risk of persistent numbness and loss of sensation. Within three to six months, most patients’ sensation is back to normal. Tingling and itching are indications that sensation is returning. It is critical not to bite your lips or place hot food or drink near the numb areas until all sensation has returned. Your smell sensation may be impaired for a while after upper jaw surgery.

Nasal sinus. The nasal sinus will be compromised for several weeks after upper jaw surgery. In rare situations, the patient may require further surgery to address persistent and ongoing issues.

Limited facial movement. After extensive jaw surgery, limited mouth opening is common due to swelling and, later, general jaw stiffness. After the procedure, elastic bands are put between the teeth to stabilize the lower jaw and guide the teeth into a proper occlusion (bite). The function of the jaw will gradually improve. During the four to six weeks following surgery, mouth opening returns to normal. Because of generalized facial swelling, the muscles involved in facial expression may not function effectively while the jaws are locked into a rigid position.

Loose bone screws. Bone screws, in general, do not come loose. If this happens, the problem is solved by removing the screws once the bone has healed. Additional surgery may be required to remove wires, pins, screws, plates, or splints.

Wound separation. This is an unusual complication. In general, poor oral hygiene might lead to wound opening.

Delayed or non-healing of bone. The bone may heal slowly or not at all in certain cases. In healthy patients, delayed or non-union of the jaw bone following surgery is uncommon. This risk is increased by smoking. Where there is little or no bone contact between the sites where the bone has been cut, the jaw bone may fail to heal. If the bone heals too slowly, further surgery may be required. Such issues are frequently resolved with bone grafting.

Relapse. Relapse of the new jaw position or unexpected movement of the jaw structures is rare, although it can happen. If the jaw does not stay in its new position, additional surgery is usually necessary. The likelihood of relapse increases when the jaw is relocated a longer distance. Relapse prevention may include bone grafts to produce a more stable outcome.

Tooth decay. On rare occasions, the blood supply to teeth may be compromised, and teeth near the bone, cut between or near the roots of teeth, and root canal treatment may be needed.

Jaw joint pain. The temporomandibular joint (TMJ) is the jaw joint that you can feel when you move your jaws near your ears. Following jaw surgery, TMJ pain or abnormal function may occur. Surgery may exacerbate pre-existing jaw joint disorders, necessitating additional treatment. Inform your surgeon if you have a history of jaw pain.

Velopharyngeal incompetence. When the soft palate (velum) and throat (pharynx) do not close the area between the mouth and nose during the speech, this happens. In cleft palate patients, the condition may occur following some types of upper jaw surgery. The result is that speech sounds more nasal than it did before surgery.