 Good evening everyone. I am Dr. Nisha Shetty, an oral and maxillofacial surgeon consultant with Manipal Hospital. I am here to debunk the myths of orthognathic surgeries also known as jaw-corrective surgeries. Corrective jaw surgeries go a long way. They have been performed for more than 150 years by various surgeons now. These are designed to correct conditions in the upper jaw, in the lower jaw to improve the airway of the patients to correct disorders of the joint that is the jaw bone joints and also to correct mal occlusions. Problems primarily because of the skeletal deformity that persists because of the growth disorders that persists as an individual attains complete growth. Dental deformities alone can be corrected by orthodontic treatment where an orthodontist who is a specialist in aligning the teeth corrects it when the child is growing, generally starts by the age of 11-12 and finishes it within two to three years. But when there is a skeletal as well as a dental deformity meaning the size of the jaw bone is very big, very small or the airway is very constricted or speech is an issue or the child or the adult is suffering from some kind of sleep disorder these are the conditions any kind of disharmony in the upper and the lower jaw is when these jaw corrective surgeries are warranted. A lot of people ask me when are these surgeries required is it really important to do these surgeries? I would say it is not a purely aesthetic correction or a cosmetic surgery it is privately done to correct the functions for the individual functions meaning ability to chew better, ability to breathe better to improve the airway of the patient and also medical conditions such as obstructive sleep apnea. The most common reason why these corrective jaw surgeries are done is because of dental and skeletal disharmonies. It is usually the patient has severe overbite, an underbite, a deep bite, a cross bite that is when the lower jaw is really protruded, the upper jaw is really protruded or the opposite of it or the chin is very small or the oral cavity per se has a very less volume. In these conditions it is warranted it cannot be just corrected dentally it's when a surgical intervention is needed to improve the function. Also some sort of childhood injuries can lead to a deformed development of a particular bone especially the lower jaw bone or the upper jaw bone. In such situations once the growth and development of the individual is completed it may warrant for these jaw corrective surgeries. In certain situations there are these chronic TM joint pains that the patient has. This condition is called as TMD, Tempromandibular Disorder which is treated by conservative means most of the time or with certain arthroscopic procedures but in certain situations it may warrant or require jaw corrective surgeries. So this is also one of the indications of orthognathic surgeries. Orthognathic means straight jaw. Orthognathic doesn't literally mean that we make the jaw straight but we make the jaw you know we achieve a harmonious balance between the upper and lower jaw and in the process a good airway, good function is also achieved and also life-changing aesthetic changes the way the cosmetic changes the way the patient appears also is achieved. These surgeries are needed in conditions when the teeth don't meet at all. In certain individuals it is seen that only 20% of the back teeth only meet and they have opened by they are not able to bite on well which leads to various other problems because they are not able to digest the food that they are eating well and you know there is a lot of functional issue they are unable to close their lip the competence of the lip is lost where they develop upper respiratory tract infections in such situations just by dental correction with braces it is not possible to correct these conditions in such situations corrective jaw surgery is generally you know looked upon as in that is the only way by which we can achieve the functional loss which the patient has another large area that I want to highlight is obstructive sleep apnea this is a branch of medicine that is really not given that much of importance but now it is really a people are very aware of what obstructive sleep apnea is so generally in people who snore a lot there is a lot of apnea hypapnea A H I index what is called that is altered meaning their heart and their brain and their vital organs are receiving less blood supply in sleep that's because of a compromised airway there is a specialty called a sleep medicine which deals with it so generally it is treated using these conditions are treated using CPAP machines these are machines which help the patient ventilate positively when they are sleeping so that the amount of distress to these vital organs is reduced but in certain situations despite of that the patient's A H I apnea hypapnea index doesn't improve then also a lot of weight loss programs the patients are put in or dentists give maxillary mandibular advancement splint these are devices that are worn in the mouth when worn in the mouth when the patient sleeps and despite of all this in certain situation if the there is no improvement there are certain non-invasive surgical procedures like the a soft palate repair to improve airway is done and still if it fails then the last resort is generally a maxillary mandibular advancement meaning moving of the entire upper jaw that is along with the dental segment and the skeletal bone moved forward and the lower jaw advanced forward brought forward thereby improving the volume of the oropharyngeal airway has shown considerable results in treating these conditions as well so it's not generally only for cosmetic reasons that orthognathic surgeries are done it is done for various other reasons generally we wonder what is the right time to do the surgery when a child hits puberty growth spot that's when the parent starts noticing that oh the lower jaw is very protruded the upper face is very protruded meaning very small or the patient the child always keeps the mouth open and breathes through the mouth he's unable to close his mouth properly usually most of these conditions correct because the rate at which the lower jaw and the upper jaw may vary differently in different individuals usually it gets corrected so we ideally wait for a time where the growth and development has stopped after which only the patients are generally taken for orthognathic surgery this is a very debatable topic it's of course on the surgeon's preference as well but generally patients younger than 15 years of age especially girls younger than 15 years of age or boys younger than 18 years of age are not taken up for corrective jaw surgeries so what is the outcome that you are look the parent looks at is an instant improvement in the bite the moment the bite improves the the ability to digest food is better the patient starts enjoying eating his food better because he's able to chew and experience the joy of chewing and also in the bargain there is also a lot of facial appearance improvement meaning when the jaw is very protruded and we are recruiting it there is a drastic change that the patient and you know his peers and people around them will know that there has been something drastic that has happened because it is quite a life changing aesthetic changes that that can be achieved with these surgeries with somebody who has a very protruded upper jaw and we are bringing it out or we are setting it back even in such situation there's a huge profiles change the simplest of corrective jaw surgery is a chin surgery which is called as genoplasty so where only it's a very it's the most simplest of jaw corrective surgeries so in when we do these surgeries it's just the profile that changes so which is also very drastic and noticeable by people and peers around them so there's a lot of other issues that you know the patient comes with along with a beyond the skeletal deformity that is there is the psychosocial baggage that they come with generally as the child is growing in school they are given certain tags or names you know wherein they are bullied by their peers that they're always wearing certain growth develop growth and development appliances and this kind of creates a stigma in them they so they come with a lot of baggage so it is very important for us we understand they are the psychological issues and they are also put through a good psychological counseling before and after the procedure because sometimes the results can be really overwhelming even accepting the new look becomes a challenge for the individual so this is very relative depending on the individual patient but the team generally treating these conditions always takes care that the psychological aspect of the patient is also taken care of so generally what will this treatment involve is what what is asked like from the parent or the individual himself if he's coming much later in life let me broadly divide the patients who come to us into three segments one is patients who who are brought in during their growing phase by the parent when they are very young meaning the parent notices that they have a very long lower jaw or they have a retarded lower jaw there is an airway shoe or they have some thumb sucking habit which has been so severe that has led to you know a very high arched jaw so in such situations when we catch the child very young or when we diagnose the children very young it is easier to correct it with non-invasive methods where the there is a preventive a pediatric dentist and an interceptive orthodontist who looks into this and helps them overcome these habits and correct it conservatively with dental appliances but after a while in certain situations it is not able to we are not able to correct everything non-surgically certain cases it is a surgery is definitely warranted to improve the function and aesthetics of the growing child so we usually see catch these patients very young so they undergo orthodontics from around 14 15 years of age before the surgery so the this this whole jaw corrective surgery is a huge team work where a pediatric dentist an orthodontist that is somebody who aligns the teeth an oral and maxillofacial surgeon a psychologist you know who is you know an expert in dealing with child psychology as well as a dietician play a very important role so it's like a multidisciplinary approach so the orthodontist plays a very very important role in this because he or she will work on the patients before surgery and create a platform for the surgeon where he can precisely do what he needs to do there are a lot of photographs which are taken documented studied using various software with the advent of 3d printing life has become very easy for us in the last three four years we we make multiple CT scans of the face and we 3d print it we do mock surgeries literally virtual surgeries and we show the patient the outcome of the surgery even before we do the soft tissue as well as the heart tissue changes that we are we are planning to achieve is discussed with the patient or the parent and then it is planned so the orthodontist works for about two third of the entire treatment happens before the surgery and then the surgery happens following which again the orthodontist comes in and they completely settle the bite for us and we stabilize what we have achieved and the patient is then a free to go this is generally in the younger patients this is the scenario so what we also do is lot of mock drills on casts and models we make impressions of the mouth and around area and we do a lot of mock exercises before the surgery so that the predictions of our surgery is very very precise so it's all in millimeters everything is calculated there's lot of mathematics that goes lot of tracings that are done of the skeleton of the soft tissue and then this planning is done by the team which is treating the patient so generally after the surgery is done and after surgery orthodontics is done we also put the patient on retainers for a long time and stabilize the bite and then the patient is free to go so in these corrective jaw surgery is what happens is that a particular jaw bone is intentionally broken in I mean that we make osteotomies that is we break the bone and move it forward backward upward downward depending on whether we are dealing with the upper jaw the lower jaw or both jaws together and then they are stabilized in the new position the new position is verified using certain you know like a splint we use it and then we verify that the outcome is correct and then the new position is maintained by using mini screws and plates made out of titanium to fix and stabilize these bones in this position all these procedures all these extensive jaw corrective procedures are done from inside the mouth we don't really cause any scar from outside it is mostly all the stitches or whatever the sutures are placed inside the mouth and so the oral hygiene of the individual is supposed to be very very good and optimal and it has to be maintained before during as well as after the surgery just to warrant no other infections or complications as such so that is about primarily how the pre intra and postoperative course of this procedure takes so very rarely or very often we also have to correct the position of the nose so a bit of change in the shape of the nose is what the patient will see in the whole process or sometimes a rhinoplasty is also done along with this if if that is a concern or if a dns correction is needed then it is done along with these surgeries as well so that is about the course of the surgery what are the risks associated with this corrective jaw surgeries the most common problems or rather in any extensive surgery which goes beyond a two hours or three hours is swelling in the lips the patient sees a lot of swelling after the surgery in the face the swelling may last for as long as up to three weeks to completely resolve but there is still 10 swelling which remains for up to six months so we normally counsel and tell the patients that the true outcome of this whole procedure is should i mean we generally assess the outcome the soft tissue outcome that is how the face or the profile looks like only six months after the procedure but the functional outcomes meaning ability to chew well ability to breathe well improvement of the all this is is literally instant after of two three weeks once all the edema subsides the patient is very comfortable and you know ready to go numbness is something that yes could happen especially in lower jaw surgery where we do a lot of advancement of a lot of setback so in which the lower jaw including the entire teeth section is sliced up and there is an important nerve which is which is a sensory nerve which supplies your feeling of touch and pressure which supplies your lower lip and you know the lower part of your face may undergo a bit of stretching trauma so they might be a bit of swelling around the nerve so the patient might have some neurologic symptoms for sometimes after surgery which is generally explained well in advance before the surgery to the patient but otherwise it usually resolves in two to three weeks and the patient is back to normal in extensive surgeries we generally ask the patient to refrain from going to work or college or school for at least 10 14 10 to 14 days but if the swelling lasts for longer it's maximum up to three weeks that we ask the patient to refrain from you know exposing themselves because of the it's a bit of a stigma to walk around with that much of swelling around now infection of the plates beneath the gums is another common issue so hence a lot of counseling happens on the oral hygiene and how they are going to maintain the oral cavity because with so many stitches inside in the mouth it's a little difficult and they have braces on so it may be a little difficult but we also use certain devices like a water flosser which aids them in maintaining the hygiene of the oral cavity and it makes life easy for them another important constraint that is there up to these surgeries they are diet you're literally on smoothies or you know soups smoothies or soft diet mushy food for up to three weeks because we are literally fracturing the bone and then rejoining it the jaw is jaws are the areas of your headache or part of your body which cannot be splinted like when when you have a fracture in your hand or an osteotomy you can splint it with a cast but your mouth is one area where you are constantly using it when you're talking when you're eating so hence to avoid any strong impact on the healing bone the patient is advised to be on a completely soft diet for up to three weeks or little longer sometimes and once the bones heal the osteotomies heal then the patient slowly graduates to eating slightly solid food and then hard food whatever appeals them once the wounds have healed well in certain situations we may achieve an ideal bite during surgery and immediately post-op we might lose that bite in such situations the orthodontist again comes to our rescue and gives the patient certain kinds of elastics to wear on the braces to settle the bite so that there is an ideal perfect bite that the patient achieves in the post-course relax after surgery is also very unusual however there may be a relapse in the position of the jaws and the teeth which may require in certain but this is very very rare due to some reason they could be a relapse unforeseen reasons they could be a relapse but very very unlikely because we monitor the patients constantly the patients are monitored of course they are in-house generally if we are doing a bi-jaw surgery at least for five days four to five days the patient is in the hospital so they are monitored on a daily basis followed following which on a weekly basis they are seen the hygienist is constantly watching on the oral hygiene of the patient the nutritionist takes care of the post-op nutrition of the patient and the orthodontist and the surgeon are on constant vigil so that the surgical outcome is maintained and the wound healing happens uneventfully so generally if the procedure is very small wherein only a small segmental surgery only the anterior small part of the jaw is osteotomized or and moved front back or a chin job is done the patient requires to stay in the hospital for just about two days 48 hours or maybe three days 72 hours they are discharged and they resume their work very quickly and care after surgery again is very important a lot of psychological as I said earlier psychosomatic changes they come with the psychosomatic psychosocial baggage so we work constantly along with the parent relative pairs to you know heal them faster so they they turn out to be much more confident much more respectful about they they start loving their own self so it is quite a life-changing process for a lot of patients depending on what kind of procedure we do on them when I suggest when I see a skeletal deformity and I counsel the patient or the parent that you know you might require this procedure to achieve this then they ask me is it cosmetic most of the time the aesthetics of course is very very important we are there to provide the ideal aesthetics but also it is primarily because of function inability to eat properly having constant headaches inability to close the mouth properly inability to breathe through the nostril properly obstructive sleep apnea these are the various other functional reasons for which these corrective jaw surgeries are done so hence I would you know I always choose to disagree that it's purely cost it's done for purely cosmetic reasons in certain situations when there is a childhood injury then in such situations also suppose there is a injury or to the chin or something like that in such situation the child's jaw stops growing due to the injury to the bone and they have a lot of difficulty in opening the mouth and they may have a very protruded chin so in such situations we also do something called as distraction osteogenesis where the bone is grown back to its original position so this also is classified under orthognathic it's an advanced orthognathic surgery where we do distraction osteogenesis to grow and achieve the ideal height of the of whatever we are we are trying to achieve there's a huge profile change that happens so now with the advent of 3d technology the there is no uncertainty here the patient will clearly have an idea of what we are going to achieve and we are able to physically show it in the form of you know we have softwares to show the outcome to the patient meaning how the new bite is going to be how their profile is going to change and even you know how the photograph is going to be you know we can morph the photographs and show them as to what outcomes we are looking at to to achieve in such situations and since it is a multidisciplinary procedure where multiple specialists are involved and in which the orthodontist plays a much longer relationship role with the patient it's a literally a journey of getting to where they are that we go along with the patient because anyway between one and a half to three years is what it takes to complete the entire treatment in certain situations you have a young adult who's about say 24 25 years coming into us and saying that you know they're getting married in three months four months generally it's like quick fixed jobs are not recommended because there is a way systematic way where if we decompensate do the decompensate the bite do the surgery and then settle the bite is when we will achieve optimal results but in certain situations we do instant procedures but I always encourage patients to do it the right way that is go through the orthodontist and the team assesses we see what needs to be done and then we help them a lot of parents of come with concern that will my child need surgery do you think so in such situations I always tell them it's very I mean in certain situations very easy for us to know that sure shot this child will require surgery when they grow up you know studying the pattern of growth a facial growth that they come to us with but in certain certain situations as they grow their lower jaw which might be growing at a very fast pace at a certain age might just you know the upper jaw might just pace up with it and it might just get corrected and just with orthodontic treatment that is treatment of the orthodontic purely is dental correction with minimal skeletal corrections which can be done when we start very young with children we can achieve what we need to achieve but in certain situations where there's a severely compromised airway or you know in such situations a jaw corrective jaw surgery is 100% warranted another important situation is birth defects children born with cleft lip and palate who undergo these surgery correction corrective surgeries of cleft lip and palate very young when they are like less than one year or you know lesser and as they grow up they invariably have some sort of skeletal deformity which may require jaw corrective surgeries so again here the orthodontist plays a very important role where they do the pre surgical workup which takes away two-third of the time of the entire treatment and then a surgical correction is done followed by a maintenance phase again by the orthodontist so here the speech therapist also plays a very important role and along with the speech therapist we deliver what needs to be delivered to the patients with who have a congenital anomaly or what is called as a birth defect so I think I pretty much covered most of the things in corrective jaw surgeries which a common person who's looking for it would want to know and these surgeries have very very very predictable outcome with better function better mastication that is better chewing of food better airway better sleep better appearance better psychosocial life you know and overall it is truly a gratifying surgery for us unlike you know when it's trauma and all that it's a very focused here it's a journey with the patients so we kind of grow with the patients seeing them transform and it's truly gratifying for us max vac surgeons to look up these cases and help them out and help them achieve a better quality of life someone's asking me how long is the process of these surgeries now again I understand you're trying to ask me how long does this surgery take that is how long is the operation so generally it depends on what we are trying to do if it's a simple chin job it will be done within an less than an hour's time but if it is extensive by job procedures where both upper and lower jaws are involved then it can go up to five six hours as well or longer in certain situations so but generally the hospital stay varies anyway between 72 hours for longer procedures between seven up generally not more than five days five six days we keep the patients in house in some situations immediately after surgery if the swelling is very very large meaning the tongue can swell up a lot because we are literally playing around the floor of the mouth which is very important so because of the so much of maneuvering of the lower jaw we see a lot of edema in the tongue in such situations we keep the patient in intensive care for about a night after surgery and once the swelling reduces we move them out to the post-operative to the room or the ward so that is the thing are there any questions let me look up yeah so i think i pretty much covered let me look up for questions can snoring be reduced without surgery yes it can be there is a special specialty called a sleep medicine you can reach out to the sleep physician and there is a sleep study which is performed and we see what is your AHI index based on that the doctor will prescribe either a machine or a splint or a device to be worn and it can be corrected non-surgically most of the time it is corrected non-surgically or there are sleep medicine dentists who will give you a splint to wear after you've seen the physician so you wear something on in the mouth like a like a sports card which looks similar to a sports card but it is a sleep device and that reduces your snoring your snoring considerably but here it's not just reduction of the snow snoring it is certain parameters that we look at if how much damage it is causing to your vital organs so in such situations there is airway surgeries which are done the simplest surgeries which is least invasive is a soft palate surgery where we you know stitch up the soft palate and thereby increase the volume of your oropharynx only in situations after doing all of these where the patient has improved his BMI has lost a lot of weight done everything yet is not able to overcome these problems so obstructive sleep apnea by itself is a big science and there are specialists who can help you with this and if need be they will refer you out to us for jaw corrective surgeries but most of the times it can be corrected non-surgically for sure our corrective surgery is reversible to a certain extent yes they are they can be reversed but it is quite an exercise there hasn't been a situation wherein we have had to reverse it but it can be reversed in most situations so yeah I think pretty much covered most of it thank you for hearing me out and it has been a pleasure coming live on facebook thank you so much