© Institute of Stomatology, Riga Stradins University


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Orthognathic surgery

Orthognathic surgeries are carried out in order to correct skeletal and dental nonconformities in the facial skeleton. In the result of the treatment the patients are able to breathe, eat and talk better, and the aesthetics of the face also improve.

You should consult with specialists if you have one of the following problems:

  • breathing problems at night, snore, apnoea;
  • loose occlusion;
  • difficulties with eating, biting and swallowing;
  • excessive teeth wear;
  • teeth compression due to lack of space;
  • defects of the soft or hard tissues of the face;
  • chronic pain in the temporal joint, crackling during movement, difficulties with opening the mouth;
  • clearly prominent or sunken chin;
  • the face is not harmonious;
  • you usually breathe through your mouth etc.

Orthognthic treatment is carried out by a team of specialists: orthodontists, oral and maxillofacial surgeons, prosthetists, dental technicians, support personnel).

The orthodontic treatment is usually started during the period before the jaws stop growing – at the age of 16-18. There are exceptions involving large skeletal nonconformities; in such cases the age is determined individually.

Diagnostics (x-ray, photo, dental impressions, sometimes detailed examinations carried out by other profile specialists have to be done) has to be carried out before the treatment.

The treatment lasts for several years. It can be divided into three phases: orthodontic preparation of the teeth and jaws before the surgery, surgery, stabilisation of the occlusion after surgery. The preparation phase lasts for 6-24 months. During this phase the orthodontist corrects the teeth location, the angle of the teeth in relation to the base of the jaws, and the occlusion planes. Different apparatuses (braces, other fixed or removable apparatuses, orthodontic implants and plates etc.) can be used during the orthodontic treatment. During this time the occlusion will become “supposedly” worse than in the beginning, but this is needed in order to achieve the right proportions during surgery.

When the patient is orthodontically prepared for the surgery, the pre-surgery diagnostics and surgery planning has to be carried out. The stages of the surgery are planned digitally, as well as a model surgery is carried out during which the jaw transfer is simulated and occlusal guards are prepared in the laboratory.

Depending on the severity of the occlusion anomaly a correction surgery of one or both jaws is carried out. The surgery is performed with intubation (general) anaesthesia. The duration of the surgery may vary from approx. 2 to 3.5 hours for the transfer of one jaw and from 4 to 6 hours for the transfer of both jaws.

After the surgery the patient is placed into an intensive care unit. One has to stay at the hospital for 2-5 days.

The surgeries of the following types are applied:

  • osteotomy of the upper jaw in accordance with Le-Fort I type;
  • vertical osteotomy of the lower jaw branch or bilateral sagittal split osteotomy of the lower jaw.

They can be supplemented or combined with other surgeries, e.g. chin plastic. Usually the intraoral approach (from the mouth) is used, therefore there are no scars on the face.

The bone fragments are fixed with special plates and screws that do not have to be removed after surgery. If medical indications occur later on or the patient wishes to do so, the plates may be removed by carrying out a small surgery.

After surgery the patients receive antibacterial, analgesic, anti-oedema and detoxification therapy, and they have to wear intermaxillary ligatures in order to maintain the stability of the occlusion.

Just as after any surgical intervention one has to consider the possible risks, e.g. inflammation, bleeding, oedema, sensory interferences, sickness, vomiting etc. In order to decrease the possibility of these risks, the patient has to get examined by his or her family physician and other specialists before the surgery.

Orthodontic treatment continues after the surgery and it lasts for about a year. Then the braces are taken off and we get the final result that is being controlled for 2 more years by taking photographs and x-rays.

The patients are sent to the orthognathic council by an orthodontist or dentist that has carried out the main diagnostics (models, x-rays). The councils take place on Mondays from 11:00 to 13:00 with prior application on the phone: 67455586.