People who can potentially benefit from orthognathic surgery include those with an improper bite and those with jaws that are positioned incorrectly. Jaw growth is a slow and gradual process, and in some instances, the upper and lower jaws may grow at different rates. 

The result can be a host of problems that can affect chewing function, speech, long-term oral health, and appearance. Injury to the jaw and birth defects can also affect jaw alignment. While orthodontics alone can correct many "bite" problems if only the teeth are involved, orthognathic surgery may be required if the jaws also need repositioning.

The following are some of the conditions that may indicate a need for orthognathic surgery:

•  difficulty chewing or biting food
• difficulty swallowing
• speech problem
• chronic jaw pain
• excessive wearing of teeth
• open bite (space between upper and lower front or back teeth when mouth is closed)
• unbalanced facial appearance
• receding chin
• protruding jaw
• inability to make lips meet without effort
• chronic mouth breathing with dry mouth
• sleep apnea (breathing problems when sleeping such as snoring, difficulty breathing, etc.

Before any treatment begins, an initial consultation will be held to get acquainted and answer any preliminary questions you may have. It is important to understand that your treatment, including pre-surgical orthodontics, orthognathic surgery, and post-surgery healing, may take from several months to two years or more to complete. You should be prepared to make a long-term commitment in order to derive the benefits of orthognathic surgery, and in some cases psychological counseling may be an important part of the treatment process.

After the initial consultation, a thorough examination with facial measurements, photographs, x-rays and dental impressions will be made. A medical history will also be taken to ensure that there are no health problems that would interfere with surgery or the administration of anesthesia. If input from other specialists is needed, you will be referred for additional consultations as appropriate.

Some people may consider having cosmetic procedures to enhance their new appearance, such as surgery on the eyes, nose, chin or neck. You may wish to discuss these options with your surgeon including if and when these procedures should be performed.

As your pre-surgical orthodontic treatment nears completion, the oral and maxillofacial surgeon will make final preparations for the surgical procedure. Additional records will be taken, similar to the previous ones. Your surgeon may use new x-rays and models of your teeth and jaws to "simulate" surgery in order to finalize the surgical movements of your jaws and anticipate the results of the procedure. From these models a plastic bite wafer can be made to serve as a guide for proper tooth realignment.

Orthognathic surgery is performed in a hospital or ambulatory surgical center under general anesthesia. Prior to surgery you will have a physical examination to ensure that you are in good overall health. You may be advised to donate blood in the event you need a transfusion during surgery Certain dietary supplements and exercise may be prescribed to achieve optimum health, so that healing after surgery will be as rapid and uneventful as possible. Any required lab tests will also be done prior to surgery.

Orthognathic surgical procedures last anywhere from one to several hours, depending on the amount and type of surgery needed. In lower jaw surgery the rear portion of the jawbone behind the teeth is separated and the tooth-bearing portion is moved forward or backward, as appropriate. In upper jaw surgery the jaw can be repositioned forward or backward, or the jaw can be raised or lowered.

Certain movements may require the jaws to be separated into several parts, with bone added or removed to achieve the proper alignment and stability Other facial bones that contribute to the imbalance may also be repositioned, augmented, or reduced in size.

Immediately after surgery you will be moved to the recovery room until the general anesthesia has worn off. Your family may not be allowed in the recovery room, but they should be able to visit you shortly thereafter. An intravenous apparatus attached to your arm can provide required medications and nutrients until you are able to take sufficient liquids by mouth. Medications may be administered to control post-surgical discomfort or pain.

The length of stay can be one or more days. You can expect temporary swelling, especially of the lips and cheeks, and perhaps bruising, but this is a normal healing response and should disappear over time.

For the first few days after surgery you may experience nasal congestion or sore throat due to the nasal tubes used for anesthesia. Post-operative discomfort is usually not significant and can be controlled with medications.

To aid in healing, your jaws may be prevented from moving with the use of fixation appliances. In many cases the jaw sections are held together during the healing period by small screws placed by the surgeon. In other cases wires are used to hold the bones together and keep the jaws from moving. Wiring the jaws together may not be necessary after surgery, may be required for a few days, or for the entire healing period, depending on the techniques used.

While your jaws are fixed and healing, you may consume a liquid diet. During this time period you may lose weight, but this can be regained after the fixation period is over. During the first week after surgery your dietary intake is very important, and you may be advised to supplement your diet with liquid vitamins and minerals. A blender can be used to liquify almost any food to provide a balanced diet.

Smoking is highly discouraged as it can retard the healing process. Strenuous activities should be avoided during the first postoperative weeks.

You will see the oral and maxillofacial surgeon and the orthodontist for regular evaluation visits, and it is very important that you keep these appointments. The surgeon will monitor your healing, and at the appropriate time, remove fixation devices if they were used.

The initial healing phase will take approximately 6 weeks, but completion of the healing process will take 9 to 12 months. During the entire healing phase it is critical that you practice the best possible oral hygiene. Your surgeon and orthodontist can assist you in this area, and may recommend the use of some special oral care devices.

Because orthognathic surgery requires a team approach involving an oral and maxillofacial surgeon and orthodontist, obtain cost estimates from each one prior to treatment. Their fees are your responsibility regardless of how much your insurance may cover.

1. Swelling is a normal reaction to any surgical procedure, and the amount varies with the individual and the procedure. Swelling will likely increase for approximately 24 to 72 hours following surgery, typically remains unchanged for approximately one week, then usually subsides by the third to fourth week.

2. Nausea and vomiting are complications of general anesthesia but occur infrequently. Because you are on a liquid diet, anything that "comes up" will be liquid and can escape from between and behind your teeth. Medications can be given to control any nausea that might occur.

3. Pain following orthognathic surgery is usually moderate and can be controlled by medication. If symptoms persist that cannot be relieved by prescribed medication, contact your surgeon.

4. Minor bleeding may be experienced after surgery, and if upper jaw surgery has been performed, there may be some oozing of blood from the nose. This bleeding is easily controlled in the hospital setting. In the rare event excessive or prolonged bleeding occurs after you return home, contact your surgeon immediately.

5. Loss or alteration of nerve sensation, resulting in numbness or a tingling sensation in the face, jaw, teeth or tongue may occur as nerve fibers are regenerating and mending. As healing takes place, you may have sensations of warmth and tingling in the affected areas. It is infrequent that these remain longer than six months. However, some individuals may experience permanent altered sensations, particularly in lower jaw operations.

6. Infection is a potential risk following any surgical procedure, and if an infection does occur, it is usually treated with antibiotics. If fever, persistent swelling/pain or pus develops following surgery, contact your surgeon immediately.

7. Sinus complications, such as drainage or pain (sinusitis), may occur in some cases involving surgery of the upper jaw. This may or may not require further treatment, but any symptoms of sinus trouble should be reported to your surgeon.

8. Injuries to adjacent teeth and roots, fillings or bridgework can occur during orthognathic surgery, which may later require appropriate dental treatment.

9. Relapse of the new jaw position or unpredicted shifting of jaw structures is uncommon following orthognathic surgery, but can occur. If it does, further treatment may be necessary.

10. Persistent limited range of movement of the jaw or impaired chewing or speech function can occur following orthognathic surgery Special jaw exercises can usually help to improve this condition.

11. TMJ (Jaw Joint) pain or abnormal function happens in rare instances following orthognathic surgery. Surgery may aggravate pre-existing jaw joint problems. If these conditions persist, further treatment may be necessary.

12. Prolonged recovery or pneumonia are rare, but are potential risks of general anesthesia associated with any procedure, including orthognathic surgery.