Orthognathic Surgery in UAE – Surgical Correction of Jaw / Facial Deformities

What is Orthognathic Surgery?

Ortho means straighten and gnathia means jaw, and hence, Orthognathic Surgery means surgical straighting of the jaw(s). The main objective of Orthognathic Surgery is the correction of a wide range of minor and major facial and skeletal (jaw) irregularities. The shape of the face depends on the architectural framework of the facial skeleton. Through an Orthognathic Surgery in UAE, the Oral & Maxillofacial Surgeon could reposition the bones of the face and the jaw to a more aesthetically acceptable position while improving the bite and function

Orthognathic surgery is generally performed to correct malocclusion (bad bite) in cases where routine orthodontic treatment has not or will not be effective.

There are several classifications of malocclusion (the improper coming together of teeth) which may require orthognathic surgery:

Class I Occlusion

This malocclusion means that the lower anterior incisors sit directly behind the upper anterior incisors when the patient bites down. This is considered less destructive than Class II and Class III malocclusions.

Class II Malocclusion

This is identified when the lower anterior incisors lie significantly behind the upper anterior incisors during the biting process; in some cases hitting the soft tissue behind the upper incisors. This is commonly referred to as an overbite and can cause discomfort, bone damage, excessive wear of the front teeth, and tooth loss.

Class III Malocclusion

This is commonly known as an under-bite and occurs when the lower anterior incisors and lower jaw are positioned beyond the upper teeth, making the lower jaw much more prominent than the upper jaw.

Who Needs orthognathic surgery or corrective jaw surgery?

Jaw growth is a gradual process in accordance with the growth of a person. In some instances the upper and lower jaw or one side of the jaw to the other may grow at different rates. This may cause many functional and aesthetic problems. Injuries to the jaws at a young age or birth defects may affect the normal growth of the jaws. While Orthodontic treatment (braces) can correct many problems if only the teeth are involved, Orthognathic Surgery in UAE maybe required if the jaws (bone) also need correction.

What are the reasons for orthognathic surgery in UAEand bite correction?

1-Improve Masticatory Function
2-Improve Facial Cosmesis
3-Treat or Prevent Joint Problems
4-Improve Speech
5-Treat Obstructive Sleep Apnea Syndrome

The malocclusion of the teeth can create greatly destructive forces among the five powerful muscles that control the closing and opening of the jaw. These muscles generate a tremendous force when clenching, grinding or chewing. Misalignment can seriously damage the function and aesthetic appearance of the teeth in many ways if left untreated, such as:

Tooth Wear

In the case of an overbite, the pressure and wear on the teeth is not spread evenly. This can also lead to TMJ, migraine headaches, and tooth loss.

Chronic Jaw, Muscle Pain & Headache – The misalignment of the teeth alters the way the facial muscles interact. In some cases, the meniscus cartilage which acts as a buffer between the jawbones can be painfully damaged.

Loose Teeth

When uneven pressure is continually exerted in unintended places or soft tissue is damaged by an overbite, adjacent teeth may become loose in their sockets which causes pain and reduces proper function.

Difficulty Swallowing, Chewing, or Biting Food

Each can be associated with muscle pain and/or poor alignment of the upper and lower jaws.

Speech problems

It can be treated better once the jaws and bite is normally placed

Obstructive sleep apnea

Maxillomandibular advancement is carried out in cases of OSA which has not responded to other conventional medical and surgicl management or in cases where jaw deformity is contributing to OSA

What complaints / concerns do patients present with?

Functional problems:

a. Difficulty with biting and chewing
b. Inability to make teeth meet together
c. Discomfort due to the malocclusion
d. Palatal or gingival soft tissue trauma (e.g. deep overbite)
c. Speech difficulties / sleep disorders
d. Temporo-mandibular joint pain and discomfort.
e. Wishes to have teeth replaced /told jaws are not aligned

Aesthetic problems:

a. Facial appearance – Protruding /retruding Jaw / Chin
b. Smile – gummy smile / lack of teeth show / want better smile
c. Deviation of the jaw / change in bite

What are the common dentofacial deformities?

ORTHOGNATHIC SURGERY / CORRECTIVE JAW SURGERY IN ABU DHABI

The common Dentofacial deformities and their clinical appearances are the following:

1. Protruded Maxilla (upper jaw) and excessive growth

The upper jaw is protruded beyond the normal limits along with the teeth. The person cannot close the lips (lip incompetence) without effort. The teeth are often visible at rest and in most cases there is excessive visibility of the gum (gummy smile). A gummy smile is mainly due to the vertical excess of the maxilla although it can be due to short lip also .The common procedures done on the maxilla are Lefort 1 Osteotomy and anterior Maxillary Osteotomy

2. Retruded Maxilla

This deformity is due to under development of the upper jaw . These patients usually have a concave facial profile , with very little if any of upper teeth being seen.
It is also in people who have cleft lip or palate. After the surgical correction of the cleft lip and palate at a young age the growth of the maxilla is retarded along with mal alignment of teeth. This results in a dish shaped face with a hooked or flaring nose and irregularly aligned, rotated or missing teeth.

3. Protruded Mandible (lower jaw)

In some people there will be extra growth of the lower jaw resulting in long jaw. The face is very long with protrusion of the lower jaw with thick lips. Normally on biting the lower teeth will be inside the upper teeth while in people with long jaws often the lower teeth will be outside the upper arch. The common procedure done on the mandible are Sagittal Split Osteotomy done on the Ramus, Body Osteotomy, Genioplasty etc.

4. Retruded Mandible

In some people due to developmental deformity or due to hereditary factors the lower jaw is very small and or placed in backward position. There may be no proper development of the chin. Mandible and chin can be advanced by surgery.

5. Facial Asymmetry

Sometimes a part of the face maybe overdeveloped or underdeveloped causing one part of the face to be small or large. One side of the face is not in symmetry with the other side giving an unaesthetic appearance. In these cases a single jaw surgery or sometimes two jaw surgery is required to correct the asymmetry.

6. Cross bites and narrow jaws

Occasionally, a narrow upper or lower jaw can be present. In an adult ,surgical procedures in the maxilla (SARPE- surgically assisted rapid palatal expansion) is the most common surgery done to expand the narrow upper jaw with orthodontics and surgery. Very less frequently a similar procedure is done in the mandible also to achieve expansion

What is pre surgical assessment and analysis?

A detailed aesthetic facial, radiologic and dental examination is the first step. A multidisciplinary treatment plan must be formulated from all the findings along with an orthodontist and when possible patient is evaluated along with the orthodontist in joint clinical session. The Oral & Maxillofacial Surgeon and the Orthodontist will work closely together during the treatment. Choosing this type of treatment requires a considerable commitment from you because the alteration of the positions of both your jaw and teeth is not a speedy process.

Corrective jaw surgery Abu Dhabi | Orthognathic surgery UAE

When is pre-surgical orthodontics done ?

Orthodontic treatment is started before surgery. The teeth are moved and re positioned into proper alignment before surgery. This  pre-surgical phase can take any where between 6 months to 1 and half years . This may also involve removal of your some premolar teeth and during this phase the facial appearance and bite may appear to get worse and will get better only after surgery and  post surgical orthodontic phase.

How we will prepare for surgery?

Mental Attitude

Having a strong positive attitude towards the surgical procedure and outcome will serve to make the whole experience a more positive one. If you are feeling negative or very skeptical about things, DO NOT have the procedure performed. Arrange for family or friends to be with you during the first two or three days. Their support is important.

Physical Preparation

For several weeks before your surgery, avoid substances to which you are allergic. Try to get some physical exercise, sleep well and allow yourself to rest. Our bodies heal while we sleep and rest.

Smoking

Smoking is discouraged the week before surgery and 2-4 weeks after the surgery.

Stopping smoking before surgery will help your body cope better with the anesthesia. Smoking following surgery can interfere with the tissue healing and cause wound breakdown.

Vitamins

Taking Vitamin C, 1000mg. 1-2 times daily. It will strengthen your immune system, promote healing and lessen pain. However, do not take it the night before surgery as Vitamin C can lessen the effects of anesthesia. Resume taking it after surgery as soon as approved by your surgeon. Vitamin E is also an important supplement. It functions as the most important antioxidant found in the body. Recommended doses of Vitamin E are 400 to 800 IU daily. Always begin Vitamin E supplements in small amounts. Stop Vitamin E two days before surgery and do not take it for five to six days afterward. High amounts of Vitamin E could potentially contribute to excessive bleeding. Multivitamins with iron are also necessary to replace any blood loss and should be taken starting at least two months before surgery.

A thorough examination with facial measurements, photographs, x-rays is done when the orthodontic preparation is completed. Prior to scheduling your operation, the surgeon will carefully review your medical history. It is most important that you advise him of any past and present medical problems, illnesses, operations, medications you are currently taking (both prescription and over-the-counter), allergies, and any adverse reactions to medications or to a previous general anesthetic.

A complete medical examination along with blood tests is done to rule out any health problems that would interfere with the surgery or the administration of General Anesthesia. The patient is admitted to hospital on the same day as surgery.

What are the common surgical procedures?

1. Lefort I Osteotomy:

This is the surgical procedure done on the maxilla (upper jaw) to shorten or lengthen the maxilla to correct maxillary protrusion,vertical excess or retrution. The upper jaw is cut and repositioned to correct the deformity.

2. Anterior Maxillary Osteotomy:

This is used to correct the protrusion of the maxilla. This procedure is often combined with LeFort 1 osteotomy or independently as per the requirement

3. Saggital Split Osteotomy:

This procedure is done on the mandible (lower jaw) to shorten or lengthen the mandible to correct long jaw or retruded jaw respectively. After putting an intraoral incision a split is made at the ramus of the mandible. The jaw is repositioned and the jawbones are held together with the help of screws and bone plates.

4. Genioplasty:

This is used to correct the defects of the chin. Chin can be moved in all the three dimensions by surgery. Chin can be augmented, reduced, moved to the sides etc.

5. Surgically assisted Rapid Palatal expansion (SARPE) :   

This is the surgery done to assist in the expansion of the maxilla(upper jaw) by orthodontic appliances.

What is done before and during the orthognathic surgery operation?

Day of Surgery and Anesthesia

Typically , you will be advised to come to the hospital after 6-8hrs of fasting at 6 am on the day of the surgery. You may receive medications in preparation for the general anesthesia and to reduce any pre-surgical anxiety. An intravenous (I.V.) will be placed in your arm; this is to provide a means of delivering both fluids and medications, eliminating the need for repeated injections. This tube may remain in place for a few days. It will be necessary for the anesthesiologist to pass a breathing tube (endotracheal tube) from the nose into the trachea (wind pipe). This will be done while you are asleep.

Your Operation will start  usually between 7.30 am and 8.30 am and  can last anywhere between  2  hrs to 6 hrs depending upon the type and extent of surgery .After the completion of the surgical procedure, the endotracheal tube will be removed as soon as possible.

During long cases it is also necessary to place a urinary catheter. This allows the anesthetist to monitor blood flow especially when hypotensive anesthesia is used (this is often used to reduce blood loss and decreases the need to receive a blood transfusion). It is left in so fluids and medicine can be given to you for 12 to 24 hours postoperatively.

Surgery

Surgery might aim to reposition part or all of the top and/or lower jaw(s). The surgeon gains access to the bones inside the mouth via the gums. Once the areas of bone have been revealed and loosened they are moved into a new position and fixed in position with small metal plates and screws, which usually remain in the bone. Sometimes these plates will be removed later, which will mean another operation. The jaw position is also maintained using a thin, clear plastic splint (or wafer), which sometimes remains secured to the lower teeth for some weeks. Usually dissolving stitches are used to neatly close up the gums. Incisions are made inside the mouth and hence there will not be any visible external scars. However, in certain rare cases external incisions may become necessary, if so, care is taken to conceal it in the natural skin creases or folds.

ICU /High dependency ward

Following completion of surgery, you will be transferred to the recovery room. There you will be monitored closely by nurses until you are sufficiently awake. From the recovery room, you may be transferred to the intensive care unit (I. C. U.) or high dependency ward depending on your type of surgery.

What will I feel like after the orthognathic surgery in UAE?

When you wake up from your anaesthetic, you will feel sleepy, swollen and sore around the mouth and face. During the surgery, we take great care to protect the nerves that run through the jaws, however, immediately after your surgery some areas of your face might feel numb.

When you first wake up, you will not be able to open your mouth as some gentle elastic bands are used with the braces on the upper and lower teeth, to guide your teeth into position. Patients will wake up to find a bandage wrapped around their jaw. Chin and nose This is a pressure dressing to reduce swelling and is usually removed 48 to 72 hours after surgery.

In some hospitals you may be provided with Heliotherm masks on the face to reduce swelling and pain

Swelling

Significant facial swelling should be anticipated following your surgery. During your surgery and hospital stay, steps are taken to minimize the swelling. The head of your bed will be kept elevated after surgery and this position should be maintained while you are lying down for about 10 days after you leave the hospital.

At first, your appearance might cause concern to your family, but this is to be expected. You should warn them, or any other visitor, to expect this so that they will not be overly surprised. This is a normal healing response and should resolve greatly within the first two weeks. Should you look in the mirror, remember this is only a stage of transition. You may feel more swollen then actually you are. You will also notice with the swelling that follows these types of surgeries, it may be difficult to make facial expressions for the first few days or weeks. Don’t despair, just tell your friends that you’re smiling on the inside… as the swelling and numbness subside, movements will quickly improve. With upper (maxillary) and lower (mandibular jaw surgery), it is not unusual to have bruising. Bruising with a maxillary procedure can extend from the whites of the eyes into the check areas – “black eyes”. With lower jaw procedures it can extend from the area of the jaw line down into the neck and chest. Do not worry. This gradually resolves but can take up to several weeks to completely go away. Remember, the bruising, if not present immediately, can become evident within three to four days after the surgery. You should be up and about within a day or two and back to a normal routine after 4 to 6 weeks

When will I see the difference in the appearance of my face?

For the first few days your face will be swollen and you might have some multicoloured bruising. As the swelling goes down and the bruising fades, you will start to see the improvement in your face.

Nasal congestion – throat soreness – blocked ears

For several days following surgery, you might experience nasal congestion (more likely with upper jaw surgery). The nasal tubes used for your anesthesia can also cause your nose to feel “stuffy” and your throat to feel irritated when you wake up. These should resolve within a few days. If necessary you will be given nasal decongestants. You may also feel after upper jaw surgery that your ears are plugged. This occurs as a result of the swelling around the Eustachian tubes and will pass in several days to a week.

Drinking and eating

You are encouraged to begin taking fluids by mouth on the day following your surgery and when we feel you are drinking well, the IV is removed from your arm. Some of your postoperative medication (antibiotics, pain meds and fluids) will be given through this line until you are swallowing better At first, your appearance might cause concern to your family, but this is to be expected. You should warn them, or any other visitor, to expect this so that they will not be overly surprised. This is a normal healing response and should resolve greatly within the first two weeks. Should you look in the mirror, remember this is only a stage of transition. You may feel more swollen then actually you are. You will also notice with the swelling that follows these types of surgeries, it may be difficult to make facial expressions for the first few days or weeks. Don’t despair, just tell your friends that you’re smiling on the inside… as the swelling and numbness subside, movements will quickly improve. With upper (maxillary) and lower (mandibular jaw surgery), it is not unusual to have bruising. Bruising with a maxillary procedure can extend from the whites of the eyes into the check areas – “black eyes”. With lower jaw procedures it can extend from the area of the jaw line down into the neck and chest. Do not worry. This gradually resolves but can take up to several weeks to completely go away.

Communication & swallowing

For a few days following surgery, you may have some difficulty talking and swallowing. This is related to the swelling and a possible sore throat, numbness, and if your jaw is wired together, or restrained by orthodontic elastics. You may want to have a small notebook on hand to write messages. You will be unable to answer the telephone in your usual manner. You should warn your friends who plan to call you in the hospital or at home that they may have some difficulty understanding you at first. Most people are able to communicate relatively clearly. It is advisable not to carry on lengthy conversations, as you may experience fatigue.

Difficulty swallowing can result in drooling. This can be embarrassing but will fatiguing and is best resolve usually within the first week. Practicing and forcing yourself to do these tasks will expedite their proper return to function.

Plastic splint

In some circumstances, you may find a plastic splint is attached to the biting surface of the teeth. This is common if the fit of the lower teeth to the upper teeth is not ideal or in circumstances where the upper jaw has been divided into pieces so as to widen, narrow, close spaces or level. It is usually left in place for a minimum of six weeks.

Nausea & vomiting

Patients are often concerned with being nauseated and or vomiting after surgery. This does not happen very often or to everyone. You will have an empty stomach before your surgery . If nauseated, you should remain calm Should nausea persist, it can sometimes be due to the medications you are prescribed. You are routinely given “anti- nausea” medication as well.You will have a suction apparatus near your hospital bed. Nausea does not present as much of a problem as you may fear.

Pain

You will be given a pain control medication while in the hospital and upon discharge from the hospital and this should be used to manage any significant pain you might have.

Bleeding

Bleeding associated with the surgery usually stops at the end of the procedure. It is not uncommon, however, to experience slight bleeding from the incision sites intra-orally the following day of surgery. It is not unusual to have blood in the saliva or on your pillow for up to one (1) week after surgery. Subsequent to this, minor bleeding may occur from the incision sites as a result of mechanical trauma (such as associated with the brushing of the teeth). When maxillary surgery is performed it is not unusual to experience minor normal-like nose bleeds. These occur as a result of small tears of the nasal mucosa often associated with nose blowing and or when the air humidity is dry.
If you encounter a significant bleed from the surgical site or your nose, you should come to the clinic or the emergency department ASAP.

Post surgical blues

Following any kind of surgery, a patient may go through a stage of mild depression – usually three to five days afterwards. This is sometimes associated with a steroid medication, given in hospital, to minimize swelling. A slight mood-elevating effect is associated with this drug. Therefore, as the drug gradually leaves your body you may experience a form of depression. This is a normal response. Its effects are mild, at worst, and we feel if you are aware of it, you will deal with it better. During the first few days at home, you won’t be very active. We feel that, if you are aware of the potential from the start, you will work at minimizing this by keeping your mind and body active. By the fourth or fifth day, you should return to good spirits. You must remember that your recovery involves only a few weeks of inconvenience and good attitude will help the time to pass quickly

How long will I need to stay in hospital after the orthognathic surgery in Abu Dhabi?

You will likely be in the hospital for two to five days after your surgery, but the length of stay depends on the complexity of the surgery and your healing capabilities.

Will I have loss of weight after surgery?

ORTHOGNATHIC SURGERY / CORRECTIVE JAW SURGERY IN UAE

Following your surgery and throughout the post-operative recovery period, especially if your jaw is wired shut, you could lose as much as 6 to 8 kilos of your body weight. Once the jaw is functioning more normally (or unwired), patients quickly return to their normal weight. If excessive weight loss occurs, it may mean that you are not consuming an adequate volume or nutritionally proper forms of foods and liquids.

What will I need to do after I leave hospital?

After surgery, it is very important that you keep your mouth and braces clean to prevent infection. A soft baby tooth brush and a dental air floss can be very helpful for doing this. Your teeth should be kept as clean after surgery as you did before. Obviously, this will be more difficult initially as a result of the swelling, numbness, discomfort and the limited opening from the restraining elastics or if your jaw is wired shut. initially you can’t brush the insides of the teeth at all. Irrespective of this, the cheek side of the teeth can and should be kept clean. Use a small child’s toothbrush. Confine it to the tooth surface, and make small circular movements on two teeth at a time. On the tongue side, all you can do is use your tongue to clean the teeth and the plastic splint between your side teeth if present. Use a dilute mouthwash and your tongue to wipe every possible inside surface and rinse frequently. Healing problems and postoperative infections can be significantly reduced by proper cleaning. Using a “ dental air floss” may definitely make cleaning easier. You can fill the reservoir with dilute mouthwash for a fresher taste. Also diluting 3% hydrogen peroxide in the water can make it foamy and help clear the mouth of debris. Caution: Do not use the “Air floss” in the first 5 days and do not set it at a high pressure for the first week following surgery, as food debris could be pushed through the incision sites. Simply set the pressure dial to a low number such as one or two, for this period. You will discover your “stitches” during your mouth cleaning – leave them alone, they are “self-dissolving” in most cases and will gradually disappear in about 2-3 weeks, or they will be removed by the surgeon.

Dietary requirements

During the first week after your surgery, your dietary intake is very important! During your hospital stay, you may be served soft diet initially. Your diet should consist of only liquids, or puréed foods until instructed otherwise. Each day gets a little easier as you learn how to consume a liquid diet. A good diet is essential for good healing and recovery .This is no time to go on a diet – you will find you will lose weight regardless. In addition to any liquid and puréed food (i.e. the consistency of infant baby foods), to aide supplementing your diet, nutrient supplements such as “Ensure” can be used .These are balanced in all the appropriate fats, carbohydrates (sugars), proteins, minerals and vitamins. The dietitian will advise you on how to prepare liquid and soft diets that are also nutritious. Essential nutrients must all be present to promote complete soft tissue healing and boney union at the surgical site. Nutrients such as calcium, iron, vitamins A, C, and D, and protein will be especially important in your diet. At times, you may not feel like eating, but please remember that good healing requires a sufficient dietary intake and this may require five to six meals per day. A blender may be used to pure almost any food. Fruit and raw eggs are excellent nutritional additions to milk shakes.Routinely, the hospital provides a large plastic syringe The tip of the syringe can be placed in the back of the mouth to allow passage of liquids or pureed food. Once the bone of the jaw has regained some of its strength, through the process of healing, you will gradually be guided back to a normal diet. Be aware, however, that this may take several weeks. In addition to nutrients you must ensure that you are taking adequate fluids. On the average this means the volume of liquid required to be consumed (with or without nutrients) is two and half liters .

Loose or broken wires or Elastics

The elastics that hold your teeth in their new alignment will need to be replaced with fresh ones once the elastic bands lose their flexibility. We will do this at first for 4 weeks and will then show you how to do it for yourself at home. Usually elastics are placed for 6 weeks but you are encouraged to wear night time elastics for 3 to 4 months. A wire or elastic can loosen or break during this period. Some gradual loosening is to be expected with elastics and wires as they do stretch a little over time. During your normal post-op visits, we may tighten your elastics if it’s necessary.

How long will I need to take off work/study to recover after orthognathic surgery?

Activities

The sooner you return to normal activities, the more rapid will be your recovery. The recovery from surgery and accompanying anesthesia can deplete your energy and increased bed rest may be necessary. However, staying in bed all day simply delays your recover and many times results in an inability to sleep at night. Short walks or other mild activity during the first few days postoperatively will commonly be of great benefit. As your strength returns, increase your activity toward your normal level.

Participation in sports

The only activity restriction we recommend is that of contact sports – those in which there is a risk of hitting your face with any significant force – not be attempted for at least 10 weeks after surgery.
Your fixation may limit your participation in sports or in exerting yourself. If you hold your teeth together, you will see how it might be difficult to breathe deeply should you become winded by exercise. Rely on your common sense. You may be able to participate in some sports or exercise activities at a reduced level. It is doubtful that any of these activities will affect the healing of your jaw, however, a possible increase in discomfort with being “closed” should be considered. It is not recommended to swim in deep water with your jaw wired (or any situation where you could “panic”, for that matter.) It should be obvious that any blow to the face or jaw that might occur with sporting accidents could be very harmful to your recovery, and you should not participate in such activity for several months or until you obtain the OK from the surgeon.

Your return to work or school

You are encouraged to return to work or school as soon as you feel up to it. Each individual will differ in his or her speed of recovery. This depends on your age, physical condition, and the nature of the operation itself. The usual recovery time for most procedures is 4 weeks, although some individuals may need an extra week or two. Its better to push yourself a little to get back to work or school as soon as possible. Quite frankly, the healing period goes faster when you are busy.

How long will it take for my jaws to heal?

ORTHOGNATHIC SURGERY / CORRECTIVE JAW SURGERY UAE

Patients often wonder how long their jaw will be “weak” or perhaps more susceptible to fracture following surgery. This is difficult to answer although, it is safe to say that the bone is probably not as strong as normal for at least six months after the surgery and for several years following a bone operation as a process called “remodeling” occurs in the site of the bone cuts eventually, the bone will re-establish its normal anatomy and will not be prone to fracture any more than had it not been operated on.

Elastics removal

After the retraining elastics removed you will likely be able to open sufficiently enough to be able to brush the inside of your teeth. Do not, however, expect to be able to open more than about one cm (two fingers width) for the first few days. The jaw will feel “stiff”. This occurs as a result of the jaw muscles being still for so long. This causes them to be very inflexible and less stretchable for a period of time. Therefore, you would be wise and more realistic to not have that “Big Mac” or steak just yet. If you attempt this now your muscles will spasm and become sore. You are best to continue on with liquids or very soft foods, which have been “mashed”. You will be given a series of jaw exercises to help promote opening and these should be performed as instructed. Some discomfort should be expected with these exercises

Length of Fixation

In the unlikely event that your jaws are wired closed, wire cutters should be obtained before discharge from the hospital to be used to release the fixation in an unexpected emergency. It is extremely uncommon and unlikely that a need to cut the wires will arise and it should be kept in mind that doing so prior to completion of healing would generally require further surgery and possibly compromise the overall result of your treatment.

Infection

Antibiotics are given before and after the surgery. Unless you had bone grafting also done you are not usually given antibiotics when you go home.If you had an upper jaw surgery, please avoid blowing your nose for two (2) weeks, since this would increase your chance of infection and could also provoke a nose bleed. You should come to the clinic if you notice any signs of infection; such as: increases swelling after five (5) days, swelling that is painful/hard/hot, a fool taste or odour in your mouth or a temperature above 100F/38C.

Fixation devices

(plates and screws) are strong enough to hold the bones into the new position during the healing period. The fixation devices are considered permanent but on occasion may have to be removed if they become loose or, when as sometimes occurs, they can be felt below the gum surface. In this latter circumstance, some individuals do not like their presence.

How often will I need to return to the clinic for checkups after orthognathic surgery?

During the month after your orthognathic surgery in UAE, you will be reviewed weekly so we can monitor and assess your progress. After this first month, we will see you every three months for six months.

You will be advised to see your orthodontist after 6 to 8 weeks from the date of sugery orthodontic appointments during this time for adjusting your ‘braces’.

The length of time it takes for people to heal depends on how old and fit they are but in general the jaw bones are almost healed after two to three months.

Note: For expertise advice on Corrective jaw surgery in (Abu Dhabi) UAE or Orthognathic surgery in UAE, please contact me.

Will some areas of my face and mouth feel numb after orthognathic surgery?

During the surgery, we take great care to protect the nerves that run through the jaws, however, immediately after your surgery some areas of your face might feel numb. After surgery on the upper jaw, the numb feeling is (usually) only in the cheeks, upper lip and teeth. After lower jaw surgery, you might have some numbness of the lower lip, chin and teeth, and possibly the tongue.

Nerves can repair themselves if they are just bruised and if the cut ends lie closely can mend on their own. This means that most numbness after orthognathic surgery will return to normal or near to normal over the weeks or months after the operation.

You also have nerves that control the movement of your facial muscles and jaws. These do not run in the areas of the face and jaws that are routinely operated on during orthognathic surgery in UAE and so the movement of the face and lips should not be affected by this surgery.

Might I have long-term numbness after orthognathic surgery?

Very rarely after orthognathic surgery, you will be left with an area of permanently dulled or altered sensation.

What is Post surgical orthodontics?

ORTHOGNATHIC SURGERY / CORRECTIVE JAW SURGERY IN UAE

Most people require at least some orthodontic treatment after the surgery to fine-tune the tooth alignment and obtain the best fit of the upper and lower teeth in the new position of the jaws. This can take from three to twelve months, after which the fixed braces are removed. After fixed appliances are removed, there is usually a period of settling in of the teeth. During this time, fixed or removable retainers are used to control unwanted tooth movement. In the upper jaw a removable retainer is usually used, which can be removed for cleaning. In the lower jaw, a discreet fixed retainer is usually glued behind the lower front teeth and can be used for up to 12 months.

What are the common side effects /complications of the surgery ?

Complications and risks

In all surgical procedures there are complications that may occur even under the best of circumstances. The “surgical” procedures are planned and carried out to avoid these as much as possible. Some occur with a low but expected frequency of which you will be advised. Others happen so infrequently that their incidence is not known. the goal is to make you aware, as best and realistically as possible, of the risks and complications involved with your specific surgery. Fortunately most are not severe and are rectifiable, resolving on their own or are treatable.

Tooth vitality

There is always a possibility that a tooth can become devitalized (lose its blood supply) after some types of surgery. This is uncommon and occurs most frequently when doing upper jaw surgery, or any surgery where bony cuts are made between or near the roots of teeth. It does not mean that you will necessarily lose the tooth (teeth). It can often be resolved with endodontic (root canal) treatment. Very often the teeth feel “dead” or “dull” after surgery. This is temporary and related to a change in their feeling.

Bleeding

With most jaw surgeries, a small amount of blood loss will occur. In some instances the surgery is in or near to areas of major blood vessels so heavy bleeding can happen. It is occasionally necessary to administer a blood transfusion either during or after surgery. This is done only if it is felt to be absolutely necessary and in your best interest for a speedier recovery. As previously stated, not uncommon to have a little oozing from the incision sites or if upper jaw surgery is performed, from the nose, for a few days post operatively. The latter can be helped by not blowing your nose. The development of a delayed nose bleed (two to three weeks after upper jaw surgery) that cannot be stopped has been reported. This is truly a complication and you must return to the hospital immediately. This type of bleeding happens extremely rarely. Sometimes blood can collect in the tissue spaces. This is called a hematoma. In most circumstances your body will just eliminate it in the process of normal healing. In a few cases it may have to be drained out.

Relapse

The stability of the new position of the jaw or facial bones after surgery is dependent on good surgical and orthodontic planning and techniques, as well as the stretchability of the adjacent soft tissues and muscles. The latter tend to drag the jaw back to its original position and this is called “relapse” or “slippage”. A slight bit of relapse occurs with all jaw procedures. In most instances, however, this does not significantly affect how the upper and lower teeth come together, or the facial appearance. If it does, then further orthodontics may correct the problem. But if not, then it will have to be accepted or the operation repeated. An unusual form of and prolonged relapse occurs if the condyles are subjected to excessive pressures. This can occur in large movements, or also when the condyles are not seated properly, and most commonly both occur when a patient already has some joint problems (i.e. clicking joints). It results from reshaping (resorption) of the condyle. Most commonly, this type of relapse is observed for a time to see if it will become stable. Arthritic complaints may also accompany this type more frequently. The resulting bite problem would then be dealt with as required.

Permanent numbness and other nerve damage

Permanent numbness may occur as a result of jaw surgery. This may be total (anesthesia) or partial (paraesthesia). It shows itself as numbness in the upper lip, cheeks and the roof of the mouth (palate) when performing upper jaw surgery and the lower lip and chin and, rarely, the tongue on one or both sides, when lower jaw surgery is performed. Permanent numbness with upper jaw procedures is rare. It is more common with certain types of lower jaw surgery. Fortunately the incidence is also relatively uncommon. It does not result in any functional loss (movement is not effected), nor how the lip looks. But, most people are so little affected by it that they do not elect to have anything done. Extremely rarely, and at an occurrence rate that is not known, a sensory nerve that has been damaged may, as it attempts to heal itself, do so abnormally. This may result in the nerve becoming hypersensitive. This hypersensitivity usually is evident as a partial numbness with a painful or burning sensation in an area when stimulated or it may occur without stimulation and is called a “neuropathic response”.

Infections

Every attempt is made to prevent infection by performing the surgical procedure in a sterile and aseptic OR room and by administrating antibiotics. In some instances, however, infection of the soft tissues, bone or sinuses may occur, requiring additional medical or surgical intervention. Infection may also compromise bone healing and the health of segments of the jawbone. Sometimes they occur because the incision site is disturbed and opens up, or in other circumstances because of irritation from a loose wire screw or plate. With upper jaw surgery the sinuses may become infected. Each must be managed independently.

Bone pain

Another rare finding is what we describe as “vague bone pain” or discomfort. This can happen in any bone in the body that has been fractured or operated on. Symptoms are usually vague and often seasonal in nature .These are difficult to explain, but they seem to gradually resolve with time and perhaps with the use of occasional analgesics. Patients must learn to live with this, when no obvious cause can be found to treat.

Jaw discomfort and limitations of opening

Within a reasonable period of time (four to six months) following surgery, your jaw should function reasonably normally without any significant discomfort; although with postoperative orthodontics, this period may be prolonged due to continued movement of the teeth. Much attention recently has been focused on the temporomandibular joint (the hinge around which the lower jaw opens and closes). Symptoms in this joint can develop secondary to an improper jaw relationship and are one of the reasons people such as yourself seek orthognathic surgery to correct the discrepancy. Establishment of a more harmonious relationship between the upper and lower jaws can reduce abnormal stresses on the TMJ. It cannot be promised that a favorable outcome of any TMJ Symptoms will result if you undergo surgery. In fact, dysfunction or degenerative changes in the joints may develop in spite of jaw repositioning. In rare instances, Orthognathic surgery patients can experience jaw joint discomfort with or without “clicking” and/or limited opening or deviated jaw movement. This problem occurs as a result of displacing the joint disc forward of the ball. It then interferes with the balls freedom of motion. Also, if the disc of the joint is not in its proper place, patients become more prone as anyone with a displaced disc, to the development of arthritic joint changes. These can be mild, somewhat seasonal in nature and can usually be controlled with mild pain medicine. If it occurs, it very rarely progress in severity but in some circumstances it may, and it may persist indefinitely. If the condyles are additionally under pressure, this may result in significant bony arthritic changes and be a source of excessive relapse as we have already discussed. Additional treatment may be necessary in this circumstance, including surgical intervention in the form of arthrocenteses (washing the joint out), and/or less commonly, attempting to reposition the disc back to its normal position. If your joints clicked prior to the surgery it is more likely that they will continue to do so, but in some circumstances the clicking can become worse or go away. Other causes of limited opening are usually temporary and include muscle spasm and scarring, as well as scarring of the incision sites.

Periodontal infections around the teeth near the osteotomy site may cause mobility of the concerned teeth. This may be corrected by periodontal flap surgery and bone grafting.

Necrosis of bone is seen rarely. This could be due to reduced blood supply to the area and will require surgical removal of the infected bone and related tooth/teeth

Major complications like loss of osteotomised segment of the jaw, due to necrosis, blindness, major infections, uncontrolled bleeding, though reported in literature are uncommon. Most of these are inadvertent and unexpected complications

Facial esthetics

The orthodontic and surgical treatment, which has been recommended to you, has been planned to have your teeth come together properly, so as to restore the normal relationships of your bite. Obviously, if a whole or part of a jaw is moved to do this, there will be changes in your appearance. These changes are generally favorable,desirable pleasing ones that produce a better balance to your appearance The nature of the changes in your particular situation will be explained prior to surgery. Becoming accustomed to the new appearance often time requires a period of emotional adjustment for you as well as close friends and relatives.
Rarely, incidences occur where in order to achieve the proper bite, changes in the soft tissues occur which may not be pleasing to a particular patient. These are not always anticipatable, though some may be improved with additional surgery. Finally, it must be recognized that no matter how improved one’s appearance may become, some individuals cannot psychologically handle the change. This occurs often as a result of statements by family members and friends who have known and accepted you for years as you were. For others, it is because they thought the changes in their appearance might be beneficial to them in their relationships with others or in work. When this does not seem to be the case, they seek fault in the surgical result, rather than their own emotional state. Finally, for some individuals, it results from their initial inability to define there esthetic concerns, or these concerns are unrealistic. Be sure you know why you are undertaking such treatment.
Unrealistic expectations by the individual will result in dissatisfaction of the “new” face. Some imagine and attribute all their psychological problems to their facial deformity and will not be satisfied even if good results are achieved. Individual satisfaction is very subjective and a positive attitude from the parents, relatives and friends are important.

Orthognathic surgery Abu Dhabi | Corrective jaw surgery UAE

When will I see the difference in the appearance of my face? What should I expect immediately after surgery in UAE ?

For the first few days your face will be swollen and you might have some multi-coloured bruising. As the swelling goes down and the bruising fades, you will start to see the improvement in your face.

Nasal congestion – throat soreness – blocked ears

For several days following surgery, you might experience nasal congestion (more likely with upper jaw surgery). The nasal tubes used for your anesthesia can also cause your nose to feel “stuffy” and your throat to feel irritated when you wake up. These should resolve within a few days. If necessary you will be given nasal decongestants.  You may also feel after upper jaw surgery that your ears are plugged. This occurs as a result of the swelling around the Eustachian tubes and will pass in several days to a week.

Drinking and eating

You are encouraged to begin taking fluids by mouth on the day following your surgery and when we feel you are drinking well, the IV is removed from your arm. Some of your postoperative medication (antibiotics, pain meds and fluids) will be given through this line until you are swallowing better.At first, your appearance might cause concern to your family, but this is to be expected. You should warn them, or any other visitor, to expect this so that they will not be overly surprised.  This is a normal healing response and should resolve greatly within the first two weeks. Should you look in the mirror, remember this is only a stage of transition. You may feel more swollen then actually you are. You will also notice with the swelling that follows these types of surgeries, it may be difficult to make facial expressions for the first few days or weeks. Don’t despair, just tell your friends that you’re smiling on the inside… as the swelling and numbness subside, movements will quickly improve. With upper (maxillary) and lower (mandibular jaw surgery), it is not unusual to have bruising. Bruising with a maxillary procedure can extend from the whites of the eyes into the check areas – “black eyes”. With lower jaw procedures it can extend from the area of the jaw line down into the neck and chest. Do not worry. This gradually resolves but can take up to several weeks to completely go away.

Communication & swallowing

For a few days following surgery, you may have some difficulty talking and swallowing. This is related to the swelling and a possible sore throat, numbness, and if your jaw is wired together, or restrained by orthodontic elastics. You may want to have a small notebook on hand to write messages. You will be unable to answer the telephone in your usual manner. You should warn your friends who plan to call you in the hospital or at home that they may have some difficulty understanding you at first. Most people are able to communicate relatively clearly. It is advisable not to carry on lengthy conversations, as you may experience fatigue.

Difficulty swallowing can result in drooling. This can be embarrassing but will fatiguing and is best resolve usually within the first week. Practicing and forcing yourself to do these tasks will expedite their proper return to function.

Plastic splint

In some circumstances, you may find a plastic splint is attached to the biting surface of the teeth. This is common if the fit of the lower teeth to the upper teeth is not ideal or in circumstances where the upper jaw has been divided into pieces so as to widen, narrow, close spaces or level. It is usually left in place for a minimum of six weeks.

Nausea & vomiting

Patients are often concerned with being nauseated and or vomiting after surgery. This does not happen very often or to everyone. You will have an empty stomach before your surgery .If nauseated, you should remain calm.Should nausea persist, it can sometimes be due to the medications you are prescribed. You are routinely given “anti- nausea” medication as well. You will have a suction apparatus near your hospital bed. Nausea does not present as much of a problem as you may fear..

Pain

You will be given a pain control medication  while in the hospital and upon discharge from the hospital and this should be used to manage any significant pain you might have.

Bleeding

Bleeding associated with the surgery usually stops at the end of the procedure. It is not uncommon, however, to experience slight bleeding from the incision sites intra-orally the following day of surgery.It is not unusual to have blood in the saliva or on your pillow for up to one (1) week after surgery. Subsequent to this, minor bleeding may occur from the incision sites as a result of mechanical trauma (such as associated with the brushing of the teeth). When maxillary surgery is performed it is not unusual to experience minor normal-like nose bleeds. These occur as a result of small tears of the nasal mucosa often associated with nose blowing and or when the air humidity is dry.

If you encounter a significant bleed from the surgical site or your nose, you should come to the clinic or the emergency department  ASAP.

Post surgical blues

Following any kind of surgery, a patient may go through a stage of mild depression – usually three to five days afterwards. This is sometimes associated with a steroid medication, given in hospital, to minimize swelling. A slight mood-elevating effect is associated with this drug. Therefore, as the drug gradually leaves your body you may experience a form of depression. This is a normal response. Its effects are mild, at worst, and we feel if you are aware of it, you will deal with it better. During the first few days at home, you won’t be very active. We feel that, if you are aware of the potential from the start, you will work at minimizing this by keeping your mind and body active. By the fourth or fifth day, you should return to good spirits. You must remember that your recovery involves only a few weeks of inconvenience and good attitude will help the time to pass quickly


Note: For any other clarification or appointment on Orthognathic surgery in Abu Dhabi (UAE), please don’t hesitate to contact Dr. Thomas. Please add your testimonial in our testimonial page if you have already taken any treatment on Corrective jaw surgery from Dr. Thomas Arayathinal, UAE.