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Virtual Hospital: Dentistry: Surgical Treatment to Correct the Faulty Jaw
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Iowa Health Book: Dentistry
Surgical Treatment to Correct the Faulty Jaw: Frequently Asked
Questions
Kirk L. Fridrich, D.D.S.
Division of Oral and Maxillofacial Surgery
University of Iowa Hospitals and Clinics
Creation Date: May 2000
Last Revision Date: May 2000
Peer Review Status: Internally Peer Reviewed
What does "faulty jaw" actually mean?
The faulty jaw can be either congenital or developmental in nature, or from a traumatic injury. Faulty
jaw is another word for malposition of the jaw or jaws.
What kind of problems can arise by having a misaligned jaw cause?
When we talk about problems that the malaligned jaw can cause, we should mention difficulty with
chewing and speech, and some people think problems with the temporomandibular joint, or TMJ. Faulty
jaw position can also create problems with sleep apnea and we in fact advance the lower jaw and
sometimes the upper jaw to aid with obstructive sleep apnea symptoms.
Can braces do damage to the jaw?
In general it is felt that orthodontic therapy is not specifically related to damage or problems with the
jaw.
What is TMD?
TMD is "temporomandibular joint dysfunction". Like all joint problems, the causes are multifactorial
and some people believe malposition of the jaw is one of these causes.
I grind my teeth at night, is this cause by a problem with my jaw?
Bruxism or grinding teeth at night or during the day for that matter can be associated with malposition of
the jaw. Occasionally when the teeth do not meet correctly, it can facilitate or encourage grinding of the
teeth. This of course can create muscle spasm or a "tired jaw."
What are other options, non-surgical for TMJ, TMD??
Non-surgical treatment for TMJ or TMD include physical therapy, the use of medicinal therapy
including non-steroidal anti-inflammatories such as ibuprofen, the use of muscle relaxants, and
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occasionally in severe problems, the use of narcotics on a temporary basis.
I was in an accident and broke my jaw. Will it heal properly? What should I be concerned about?
With respect to a broken jaw, this certainly can be a cause of a faulty jaw position. I am assuming the
broken jaw was in the lower jaw, or the mandible. In general, mandibular fractures are treated by closed
or open reduction. A closed reduction involves wiring the teeth together for approximately 6 weeks.
This acts as a "cast" to keep the jaw from moving. The other way to treat a mandibular fracture would be
to utilize an open reduction and internal fixation. Fixation would involve the use of small titanium plates
and screws to reduce the fracture and to minimize the time the patient is wired together. One of the more
important aspects of mandibular reduction is to seat the occlusion or bite, as it existed before the
accident. If these things are accomplished, it is very likely the mandibular fracture will heal.
Occasionally when a malaligned jaw occurs from a traumatic incident, meaning did not heal correctly,
we go back secondarily and perform an osteotomy or bone cut, to allow realignment of the jaw.
What types of materials are used in jaw joint surgery?
With respect to temporomandibular joint surgery and materials utilized during surgery, we have become
very conservative with our approach. Many autogenous (or materials that come from the patient) can be
utilized. These might include cartilage, muscle, or fascia lata. In severe cases, alloplastic or artificial
joint replacement is undertaken. But I must emphasize this would be for a severe case.
What is TMJ? What causes it? Are there any ways to correct it?
The temporomandibular joint is the articulation between the mandible and the skull. The actual joint is
immediately in front of the ear. You can feel your TMJ by placing your index finger in front of your ear
and opening the jaw. What you are feeling is the condyle of the lower jaw. When people speak of
problems with the temporomandibular joint (TMJ), there are many potential causes that lead to
difficulties. One contributing factor is stress, others include muscle imbalance, severe jaw malposition,
and displacement of the normal anatomy or cartilage that lies between the mandible and the skull.
Are there any synthetic material used in jaw surgery? Is it possible for people to be allergic to
these materials?
There are synthetic materials used in jaw surgery. Typically in an osteotomy we will reposition the
bones using titanium screws and plates, which eliminates the need for wiring the teeth together. In
general, people are not allergic to surgical-grade titanium. That is not to say, however, that one could not
be allergic to titanium. Titanium has generally replaced surgical-grade stainless steel.
Is chewing gum bad for your jaw?
Gum chewing is not necessarily bad for your jaw. However, like most joints, overuse can eventually
lead to problems. Since the jaw joint, or the mandible, moves each time we swallow, speak or eat, it
obviously is used to a great extent. Thus, if you are prone to sore jaw joints or have TMD, I would
recommend against parafunctional habits including gum-chewing, fingernail chewing, chewing on pens
and pencils, and opening your jaw excessively wide to "dislocate."
What is the typical recovery time?
Following a jaw osteotomy, the recovery time varies depending on the desired activity. A jaw surgery
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patient is usually hospitalized overnight. They are typically restricted from heavy activity or lifting over
30 pounds for approximately 1 month, and then they are restricted to non-contact sports for 3 months.
We would allow our young patients to return to full contact sports in 12 weeks. Any surgery of the jaw
also requires a change in diet. The diet is typically liquids for several days followed by no-chew food for
approximately 1 month with a gradual return to a normal diet starting at 6 weeks. If the surgery requires
the jaw to be wired together, then the diet would be liquids for the full 6 weeks.
Does a cleft palate have anything to do with the jaw?
A cleft palate is often associated with a cleft lip and alveolus. The patient usually undergoes several
surgeries in the area of the cleft at an early age. Because of this early surgery, the normal growth pattern
of the upper jaw is restricted. Thus, it is often necessary to advance the upper jaw when the patient is in
the mid to late teens.
How do you wire a jaw shut?
The teeth are wired together utilizing horizontal wires that go around the teeth. This is done in both the
upper and lower jaws, and then vertical wires are used to connect the horizontal wires. We also utilize
arch bars, which are wired to the teeth, and then they are connected utilizing vertical wires between
upper and lower jaws. We ask patients who are wired together to carry wire cutters with them in case
they are involved in an accident. It is usually not necessary for patients to cut their own wires.
Can a toothache indicate a problem with the jaw?
A toothache certainly can indicate a problem within the jaw. Whenever a toothache occurs, it should be
evaluated to prevent any potential infection from spreading into the jaw or surrounding soft tissues.
Why would you wire the jaw shut -- can't you surgically advance the jaw without wiring?
With most osteotomies or major jaw surgery to move the jaws, it is not necessary to wire the teeth
together. Instead, we use titanium plates and screws to secure the jaw into the new position.
Isn't wiring a jaw shut painful?
The use of wires to close the upper and lower jaws together is not painful because of the use of local
anesthetics, conscious sedation, and occasionally general anesthesia
With jaw surgery, are any scars visible?
There are generally not any visible scars when major jaw osteotomies or cuts and movements are
accomplished. The majority of incisions are intraoral or inside the mouth. The oral mucosa or tissue has
an amazing capacity to heal and even intraoral scarring is minimal.
I have a severe underbite and would like to get it fixed. Should I consult a surgeon like you, or a
plastic surgeon?
With respect to a patient with a severe underbite, first and foremost, one should visit an orthodontist.
Correction of a malaligned or an underdeveloped jaw requires a combined effort, usually including an
orthodontist and an oral and maxillofacial surgeon. Plastic surgeons also do osteotomies. I would
recommend relying on your orthodontist for ultimate referral.
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What is JRA?
JRA is "juvenile rheumatoid arthritis". This condition will involve both temporomandibular joints.
Fortunately, unlike adult rheumatoid arthritis, this process tends to "burn out" as the child reaches their
late teens. The ultimate diagnosis of JRA does not come specifically from the observation of TMJ
changes.
There is a new trend for moving facial bones called distraction osteogenesis. This is essentially moving
the bone very slowly after making a corticotomy or bone cut, that movement being approximately 1 mm
per day. This can be accomplished with an intraoral or extraoral device. Distraction osteogenesis is not a
replacement for routine orthognathic or jaw surgery, but has been an exciting addition to our surgical
options for treatment of assymetries and the severely underdeveloped jaw.
What kinds of pain medications are normally prescribed to a patient after jaw surgery? Does
welling often occur?
Following jaw surgery, we typically prescribe a mild analgesic. It is not usually necessary to give
antibiotics beyond the final dose give intravenously in the recovery room. With upper jaw surgery, we
often give a nasal decongestant to decrease swelling of the nasal mucosa. Otherwise, no other
medications are generally prescribed. With respect to swelling, we utilize peri-operative high-dose
steroids. This limits the amount of swelling that occurs from surgery and facilitates patient comfort.
Patients are not swollen to a great extent; however, the amount of swelling varies from patient to patient.
what is the percentage of people who will experience an infection after surgery?
The incidence of infection following orthognathic or jaw surgery is very low. In the literature, the
incidence is reported to be between 6 and 15 percent. These figures are high, in my opinion. When it
occurs, the infection is easily treated with antibiotics and drainage with minimal discomfort and no longterm se< uelae.
Is there any long term follow up needed?
Following a jaw osteotomy, we have patients return for numerous postoperative visits. We see patients
typically at 1 week, = weeks, 6 weeks, and 12 weeks following surgery. We also see the patient back at
the 6-month and 12-month intervals. This is to assure that the proper jaw correction has been obtained,
is stable, and that there is not an infection or any other postoperative complications.
What can be done to prevent infection?
During jaw surgery, we utilize high-dose perioperative intravenous antibiotics for prophylaxis to prevent
infection. Meticulous surgical techni< ue and accomplishing the surgery in an efficient manner will also
reduce infection rates. Occasionally, if bone graft is utilized during osteotomy, we will continue the
antibiotic therapy for > -10 days orally after discharge.
Like the Ilizarov leg lengthening procedure?
Jaw distraction osteogenesis is based on the Ilizarov leg lengthening procedure. In many ways, it is more
successful and reliable in the head and neck region versus the extremities because of the ample blood
supply found in the head and neck.
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How often is this jaw distraction performed?
The distraction osteogenesis procedures are somewhat new, and are being utilized for the more severe
deformities. It is also being utilized very early in life to advance the lower jaw and prevent the need for a
tracheostomy in children with microgenia or micrognathia.
I have two bumps on my lip. How do I get rid of them?
With regard to bumps on the lip, I would advise seeking the opinion of a physician or dentist. Many
bumps on the lip can be related to the minor salivary glands. There are, of course, many other causes.
Over what period of time is the distraction completed, and what kind of followup?
Let8 s look specifically at mandibular or lower jaw distraction osteogenesis: once the bony corticotomy or
cut is made, and the distraction device is placed, the distraction rate is approximately 1 mm per day.
Thus it is possible to advance the lower jaw approximately 19 mm in 2 weeks8 time. This obviously is a
large advancement. Once the jaw has been advanced, it is necessary to "lock up" the distraction device
with the jaw in the advanced position. This allows the newly formed bone to calcify and heal. One other
advantage of distraction osteogenesis is that the soft tissue envelope meaning muscle and skin readily,
follow the bone.
What is the likelihood that you would lose sensation in your mouth after surgery?
Following orthognathic or upper/lower jaw surgery, there will be neurosensory changes. The nerves
involved with jaw surgery are not motor, meaning surgery will not affect how your face looks or moves.
In the lower jaw, the numbness will include the lower lip, chin and gum tissue, and in general, this
should resolve in about 3 months. Sometimes neurosensory changes take up to 1; months in an adult to
resolve. Occasionally, minor neurosensory changes of the lower lip and chin can be permanent.
Permanent numbness following an upper jaw (maxilla) procedure is less common.
Is there a great chance of infection at the pin sites?
These pin sites are remarkably free of infection> however, one complication with the pin sites is
stretching of the skin and scarring. Thus, there is a great push to develop smaller and more efficient
intraoral distraction devices to eliminate this problem.
How is it locked up?
When one is using distraction osteogenesis, it is the patient8 s caregiver or the parent who will activate
the appliance either once or twice per day. The device specifically clicks, indicating a 1-mm
advancement, and after achieving the desired movement, there is a locking mechanism to keep the
device in its final position during healing. Some devices have different measurements> meaning 1 click
might equal 0.5 mm.
Is it dangerous to nerves in jaw?
Distraction osteogenesis can also affect the sensory nerves within the bone> however, patients are
generally young and neurosensory recovery is good. The distraction device is usually left in place for
approximately 6 weeks following the last distraction movement or after it is "locked up." If the device is
an extraoral appliance, it is usually quite easy to remove the pins and often does not require a general
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