Jaw Surgery - Maxillofacial - Orthognathic Surgery

Plastic Surgeon Dr. Richard O'Donnell's Patient - Before and After Photo

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Cosmetic and Reconstructive Surgery Cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient’s appearance and self esteem.

Reconstructive surgery is performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally performed to improve function, but may also be done to approximate a normal appearance.

In orthognathic surgery, an osteotomy (bone cut) is made in the affected jaw, and the bones are repositioned in a more normal alignment. Generally, the bones are held in their new positions with plates, screws and wires. The patient may also need arch bars placed on both jaws to add stability (a procedure called intermaxillary fixation). For patients with deformities in both jaws, simultaneous osteotomies may be undertaken to achieve correction.

Patients with deficient bone or soft tissues of the face may require distraction osteogenesis. A distraction device is applied.  Bone osteotomies are performed. The distraction device is then used to slowly apply a distractive force at the osteotomy site until new bone is formed. Once the desired reconstruction is achieved, the device is left in place until the bone is healed and then the device is removed. This enables a surgeon to elongate a facial bone and the adjacent soft tissue envelope.

Patients with deficient bone tissue may require grafts from their ribs, hips or skull. Alloplastic replacement of missing bone may also be required. The preparation of a donor site and the harvesting of the patient’s own bone requires additional cognitive effort and surgical time on the part of the physician.

Orthognathic surgery is usually performed under general anesthesia as an inpatient procedure, although some adjunctive procedures may be done on an outpatient basis.

Indications for Orthognathic Surgery:

Excess mandibular bone causes protrusion of the lower jaw beyond the normal alignment with the upper jaw. This can prevent effective biting and chewing of food and hastens periodontal disease. Temporomandibular joint function and speech may be impaired. Excessive chin hyperplasia or malposition may require a reduction or sliding genioplasty.

Retrognathia or micrognathism is a deficiency of the mandibular bone. This does not allow the upper and lower teeth to come together when chewing food and may affect speech. Sleep apnea (ICD-9: 786.09) may also be produced by a retruded or deficient lower jaw. A deficiency of bone supporting the chin may require surgery (genioplasty) to build up the tissue and provide a normal framework for the chin.

In this condition, also called hypoplasia, the growth of the maxilla does not match that of the lower jaw. There is a collapse of the normal mid-face supporting structures. In addition to causing difficulties with eating and speech, this deficiency may be associated with anomalies of the supporting structures of the nose and cheeks. 

Dr. Richard O'Donnell specializes in Maxillofacial Surgery with a dual degree in Dentistry and Plastic Surgery, as well as many years of experience in the field of Maxillofacial Surgery.