Modern medicine offers ample opportunities to eliminate or correct the annoying natural anomalies of the maxillofacial region. Sometimes, to obtain the desired result, only a small correction is necessary with the help of orthodontic devices - braces, cap, etc. But often the matter is much more serious, and we are talking not only about cosmetic problems, but also about the violation of the most important body functions - chewing, breathing, diction . In such cases, the patient is recommended orthognathic surgery.
Definition
Surgery of this kind involves the correction of the shape, size, position and ratio of the upper and lower jaws. This plastic implies significant correction of the bite, as well as restoration of facial proportions. For many, orthognathic surgery is the only chance to make life easier and find a pleasant appearance.
The procedure is included in the section of maxillofacial and plastic surgery, fifteen years ago such treatment was prescribed only when abnormalities in the structure of the skeleton interfered with a person's daily life: the function of chewing, speaking, etc. was disrupted. Today, aesthetic is gaining more and more popularity. surgery, when orthognathic surgery and rhinoplasty together eliminate facial defects that prevent a person from leading a full life.
Features
In general, orthodontology and orthognathic treatment are aimed at performing similar tasks, but in the latter case there are more opportunities to eliminate serious problems when it comes to changing the position of the bones.
Orthognathic surgery is a full-fledged surgical intervention, therefore it is not recommended for every patient. Only after a thorough examination and diagnosis can we speak with confidence about such a treatment. Contraindications may be the patient’s age, unprepared dentition, serious diseases, such as heart disease, diabetes, acute infection, etc.
Indications for surgery
Improper location of the upper and lower jaws, malocclusion can be either congenital or acquired, that is, the consequences of injuries or improperly performed operations. During the growing up of a person, all these problems begin to adversely affect his psyche, leading to the development of a variety of complexes. In order not to bring the matter to a neglected state, people with similar anomalies must be prescribed an orthognathic operation. Patient reviews, as well as numerous photographs with the result confirm the positive results of such surgery.
Treatment involves an integrated approach and begins with an examination by an orthodontist, if the problems of the maxillofacial system cannot be corrected with braces, then the orthodontist and specialist in orthognathic surgery are already working together. Indications for surgery may be the following reasons.
Cosmetic:
- asymmetry of facial proportion;
- open bite;
- gummy smile ;
- protruding lower jaw;
- chin slope.
Physiological:
- problems with chewing food;
- respiratory failure;
- various speech defects;
- chronic pathology of the temporomandibular joint.
Treatment involves several stages, where the longest is preparation for surgery, it can take a year or more. Surgical intervention is possible only after the patient is 18 years old, when the process of bone growth has already been stopped, the ideal age is 20 or 30 years. The reason for refusing surgery may be individual characteristics of a person - an allergy, a reaction to anesthesia or intolerance to some drugs.
Advantages: patient opinion
Behind the frightening word "operation" is the solution to a large list of problems that can only be resolved surgically. Treatment has the following advantages, according to patients:
- A person has confidence in his appearance, and therefore in himself.
- As a result, self-esteem rises, before and after photographs speak best of all of the cardinal changes that occur with the patient.
- An incorrect bite or displacement of the jaws relative to each other causes not only aesthetic discomfort, but also affects important body functions; the person chews incorrectly and gets a constant upset stomach, diction deteriorates, difficulties arise when breathing; Orthognathic surgery eliminates such problems.
In addition, the results of treatment, according to people, with rare exceptions, are well preserved for a long time. But, as in any procedure, there are also drawbacks. For example, the fact that the preparatory period, the operation itself and rehabilitation is a complex process that is difficult for a person to tolerate. In addition, many comers are stopped by the high cost of treatment and the duration of all actions.
Preparation
A patient who has decided on a surgical procedure to correct anomalies of the maxillofacial bone system should be prepared for the duration and complexity of such treatment. Doctors always work in conjunction, especially if changes of a cosmetic nature are coming, in this case, it is necessary to immediately connect a plastic surgeon so that after the main operation, the nose, lips and other soft tissues can be corrected. The preparatory phase includes the following actions:
- Monitoring the problems of the oral cavity and their elimination, at this stage, the dentist can remove plaque, conduct a comprehensive dental treatment, remove excess roots, etc.
- The second preparatory period involves orthodontic treatment. Specialists jointly develop a model of action and draw up a work plan that must be carried out with the help of braces. This stage can last from several months to a year and a half, it all depends on the complexity of the anomaly and the extent of the correction.
- Only after orthodontic treatment does the patient transfer to the surgeon's group, where he will undergo various kinds of diagnostics.
- Casts of the jaws are performed; using a computer program, 3D-modeling of the initial and final result; profilometry; X-ray examination anthropometry of the face.
As necessary, the surgeon can prescribe additional examinations, as well as involve specialists from other areas.
Right before the operation, doctors recommend not to eat or drink anything for twelve hours, if the patient takes any medications or if he feels a slight malaise, it is necessary to notify the surgeon about this.
Types of operation
Such surgical intervention involves a combination of several techniques and is a rather complex and responsible operation. Depending on the specifics of a particular case, it can last from one to six hours. The doctor makes all the incisions inside the oral cavity, so that no external scars remain.
After all the diagnostics and analyzes, compilation of a computer model of the patient's jaw, an orthognathic operation is performed. How it is done depends on the type of violation and how to eliminate it:
- Orthognathic surgery on the upper jaw implies the following manipulations: through the openings behind the orbits, the surgeon moves the skeletal system, palate and teeth, including in the right direction, and fixes them using a special tire.
- Mandibular osteotomy - here the incision is made behind the molars, the jaw is installed in the desired position, which is fixed using titanium plates. After bone growth, the plates are removed.
- Aesthetic orthognathic surgery is about the cosmetic correction of the defects of the maxillofacial system. Here the face symmetry is corrected due to the correct installation of the chin part.
- Segmental osteotomy, when bite is normalized by moving one or more teeth.
In some cases, for fixing the jaw in the required position, arcs for orthognathic surgery may be needed, in difficult cases they are also used at the preparatory stage. Typically, patients spend 2-3 days in the hospital and, if there are no complications, the no less significant stage of treatment — rehabilitation.
Postoperative period
As with any surgical intervention, a person may experience pain, discomfort, swelling on the face, slight weight loss, nausea, nasal congestion and a feeling of numbness are observed, the occurrence of all these effects depends on individual characteristics, usually they disappear within 15– 20 days.
After an orthognathic operation is performed, a person still has a whole range of measures to prevent complications and to consolidate the result. The next day, the patient is prescribed a course of antibiotics, and an elastic bandage is applied to the problem area, which is removed after a day.
The most unpleasant moment for the patient becomes the compelled need to wear special elastic bands that are located between the teeth. With them you can not open your mouth wide, chew and blow your nose. Postoperative sutures are usually removed after 10-14 days, and after another three months, internal bolts are removed from the gums.
Rehabilitation
The rest of the healing process, after an orthognathic operation is performed, is on the conscience of the person himself. The doctor is obliged to instruct the patient on how to eat, brush your teeth, as well as other nuances of rehabilitation. For a while, you will have to abandon physical activity, not take vitamins and some medications.
Do not hope for a quick result, to detect a noticeable difference, it is necessary several days or months after the orthognathic operation was performed. Photos before and after will show the desired appearance only when all the swelling has come off and the bones have finally returned to their new position.
Possible complications
As in any section of surgery, there are several unpleasant consequences that an orthognathic operation can lead to. Complications are extremely rare, but still patients should have an idea about them:
- possible nerve rupture in the lower jaw;
- damage to the facial nerve, which can cause numbness of the lips;
- in some cases, scars form, but usually they are easily removed with special creams;
- lack of professionalism of a doctor can lead to tooth damage, in which case there is only one way out - restoration;
- infraorbital nerve damage;
- blood loss during surgery;
- deformation and asymmetry may temporarily form;
- with insufficient oral disinfection, inflammation occurs;
- jaw fracture.
All of these cases are a rare exception rather than a rule. Typically, surgeons performing such operations are highly qualified specialists who do not allow negligence or accidents. Already thousands of people in Russia have learned what an orthognathic operation is. Patient reviews are almost always positive and grateful, because the doctor, in fact, gave the person a new life.
Best Clinics
A few years ago, Russians were scared by the mere thought of the possibility of surgical correction of the maxillofacial system. In our country, a culture of maintaining beauty and health has recently begun to take shape, and there is a need to look good and presentable. Today, there are already hundreds of clinics offering these services, and the procedure can be done in public hospitals.
So, in Moscow on the Volokolamsk highway for many years, the Federal Scientific Center of Otorhinolaryngology of the FMBA of Russia has been operating, where the best specialists in this field work. A team of highly qualified doctors not only carries out operations and appropriate treatment, but actively implements global technologies and is developing its own.
In addition, dozens of private clinics operate in the capital and in each region of the country, the number of services of which includes orthognathic surgery. Reviews of former and current patients can greatly help with the final choice. The decision should be made after a personal visit, the treatment is long, and a change of specialist is undesirable.
Orthognathic surgery before and after it raises many questions, the answers to which in full cannot be obtained. Each case is unique, all the nuances of treatment can be voiced only with direct treatment.
Cost
To make accurate calculations of orthognathic treatment is almost impossible. The whole process involves several important, sometimes lengthy stages, as well as the participation of specialists from different fields, so the patient must be prepared for very large costs. Even in government clinics will have to purchase braces, arcs, special bolts and other equipment.
The cost of the operation itself varies from 100 thousand to 200 thousand, depending on the complexity of the operation. The orthodontic treatment that precedes the surgical correction will also depend on the degree of necessary correction of the teeth. Despite the complexity and cost of the process, such operations are quite in demand in Russia, because the result is worth this expectation, and the money spent.