The shape of the face is largely determined by the structure of the upper and lower jaw. There are many congenital and acquired problems that can distort the appearance of a person. The jaw is too narrow or wide, too long or short, protruding forward. To correct these flaws and give the person the desired appearance, an operation of the osteotomy of the upper jaw is performed.
Briefly about the operation
An osteotomy is a type of surgical intervention performed by a dentist. Most often, it is prescribed for serious occlusion pathologies, congenital malformations of the jaw, after an unsuccessful correction of the cleft palate ("cleft palate"). Osteotomy of both the upper and lower jaw is possible . An operation on the lower jaw is often performed after its traumatic fracture.
Types of interventions on the upper jaw
Two main types of osteotomy are distinguished: general and segmental.
The total, in turn, is subdivided into another three subtypes. They got their name by the name of the author who invented them: osteotomy of the upper jaw according to Le Fort 1, 2, 3.
Three subtypes of segmental operations are distinguished separately:
- Premaxillary osteotomy.
- Posterior osteotomy of the upper jaw.
- Operation on the lower labial segment.
Each of the types of segmental osteotomy of the upper jaw has its own characteristics. The first type consists in moving the incisal bone, the second method is in changing the placement of the posterior alveolar segments, and the operation on the lower segment is in repositioning the lower front teeth.
Indications for surgery
Osteotomy of the upper jaw is performed in the following cases:
- with severe malocclusion and non-closure of the dentition, which is not eliminated by wearing braces or other orthodontic methods;
- pathological growth of the bones of the upper jaw;
- a pronounced violation of the proportions of the face, which gives a person inconvenience on the aesthetic side.
But the operation is not only aimed at making the face more beautiful. Sometimes these defects can contribute to the development of serious life-threatening conditions:
- respiratory failure;
- joint diseases of the jaw ;
- inflammatory processes in the gastrointestinal tract.
An osteotomy can prevent the development of these consequences and even save the life of the patient.
Contraindications for surgery
Sometimes the patient’s desire alone is not enough to intervene. The presence of some conditions completely excludes the possibility of osteotomy of the upper jaw:
- minority, since bone tissue continues to form in children and adolescents;
- periodontal disease in the active stage or advanced chronic course;
- bleeding disorder;
- systemic diseases of the connective tissue (systemic lupus erythematosus, rheumatoid arthritis and others);
- the presence of diabetes;
- unprepared dentition.
Preparation for surgery
If the doctor decided to make the patient an osteotomy of the upper jaw, first of all he appoints an X-ray examination of the dentition. The discussion of surgical intervention should be carried out comprehensively by the maxillofacial surgeon and the orthodontist. They analyze the x-ray in detail and make the final decision about the operation.
An osteotomy per se is not able to change the wrong arrangement of teeth. It only corrects bone deformation. Therefore, often before the operation, the patient needs to undergo orthodontic treatment - wearing braces. Sometimes they resort to the help of surgical dentistry: the installation of dentures, tooth extraction.
Before the operation, the patient visits the orthodontist again. If braces were prescribed, the doctor will change their location so that an osteotomy can be done.
Only after alignment of the dentition and consultation with the orthodontist does the patient once again go to the maxillofacial surgeon. If the alignment results suit the surgeon, he discusses with the patient a plan for osteotomy of the upper jaw.
Operation progress
An osteotomy is performed under general anesthesia. An anesthetic is injected through the tube into the trachea. The patient plunges into a deep sleep and feels absolutely nothing. All stages of the operation are done on the inside of the face, so there will be no defects on the skin.
First, the gingival mucosa and periosteum are cut above the attachment of the upper teeth. Thus, the surgeon gets access to the bone.
Marks for cuts are placed on the bones on both sides. A special surgical saw cuts the bone of the upper jaw. Most often, cuts are performed according to the method of osteotomy of the upper jaw according to Le Fort.
The resulting fragment is moved to a new location. It is fixed by screws and plates. All fasteners are made of titanium, which is completely safe for the body.
Sometimes patients need a bone graft. Usually take a portion of the femur. This is done at the same time as the operation on the jaw when the patient is under general anesthesia.
Sometimes there is a need for splinting. This procedure is a combination of several teeth. This method helps to consolidate the dentition with the help of special equipment. This is a temporary procedure. After a certain time after the operation, the threads are removed.
The duration of surgery is about two hours.
Complications
Most often, the osteotomy of the upper jaw passes safely, without any undesirable reactions. But sometimes they do occur, therefore, both the patient and the doctor should be aware of possible complications. Key issues include:
- Nose bleed. Slight leakage of blood from the nose is normal and does not require additional measures. But if there is a large amount of blood during and after surgery, it is necessary to pinch the nasal passages for at least 10 minutes.
- Numbness of the upper lip after surgery. This is rather not a complication, but an adverse reaction to anesthesia. An unpleasant sensation can last for weeks.
- The penetration of microorganisms. It occurs in case of violation of sterilization of screws and plates, insufficient processing of the surgical field.
- Exacerbations of chronic pulmonary diseases. It occurs in patients with bronchial asthma and smokers with great experience.
- Incorrect bite. Bite changes are possible after surgery. Sometimes there is a need for repeated orthodontic treatment.
- Fusion of bone too slow.
Rehabilitation period
During the operation, the patient does not feel anything. But after surgery, minor pain in the upper jaw may disturb him. Therefore, the doctor prescribes painkillers for him.
While the patient is in the hospital, he is given intravenous antibiotics. This is a necessary measure to prevent infectious complications.
After the operation, the patient will encounter some inconveniences:
- violation of nasal breathing, because of which he will have to breathe through his mouth;
- discomfort due to edema;
- difficulty opening the mouth due to hematomas over the lip;
- sore throat and trouble swallowing due to an anesthetic tube.
Facial edema is reduced with cold compresses and an elevated head position during sleep.
The first two days after surgery, the patient can eat only liquid food. After a few days, the diet expands to a soft consistency. In just a few weeks, normal nutrition is possible.
Full working capacity returns to the person three to four weeks after the operation.
In the first month, the patient will have to face some difficulties, however, it is all worth it. Osteotomy of the upper jaw gives excellent results. She really changes the lives of people. Changes in the photo before and after the osteotomy of the upper jaw are visible to the naked eye.
Operation Reviews
Osteotomy is quite expensive. The price depends on the qualifications of the doctor, the status of the medical institution, and the technique of surgical intervention. The cost starts from 80 - 100 thousand rubles and reaches 300 thousand or more.
But even despite the high prices, most reviews of osteotomy of the upper jaw are positive. However, patients are worried about severe edema after surgery. Many do not look in the mirror for another month after the intervention.
Patients claim that the attitude to the operation and their appearance is largely determined by the rate of wound healing and edema subsidence. The more positive the mood, the faster the recovery.
But the end result affects almost everyone. Those who have gone through the osteotomy of the upper jaw say that all these inconveniences are definitely worth it.