DR. JYOTSNA MURTHY
A perfectly symmetrical face is considered to be the most beautiful and attractive in all ages and all regions. However, not all are fortunate to have a symmetrical face with normal proportions.
In addition to the skull, eye and nose, the upper and lower jaws bones are the most important to provide the framework for the face. The upper jaw (maxilla) and lower jaw (mandible) grows through childhood, but main growth happens during adolescence.
Any growth disturbance leads to facial asymmetry. Some of it manifests during early childhood, but many of them show up during adolescence. Adolescence is a very important period of life and facial difference puts the teenager at risk of psychological disturbance and distorts self-image.
The Orthognathic surgery aims to improve facial appearance by reshaping and repositioning facial bones and the jaws along with the teeth. With present advances in medical field, orthognathic surgeries are safe.
In the case of excess or deficiency of the lower jaw, the protrusion of the lower jaw is very visible from the side. In profile, this is seen as prominence of the lower part of the face and particularly the lower lip. Some individuals may also have asymmetric jaws. Apart from the deformity in the patient’s appearance, there may be problems with chewing and speech in some cases.
Some individuals with mandibular retrusion appear to have a small and/or underdeveloped lower jaw causing gum deformities. The overgrowth bone can be set back and fixed. The small mandible can be advanced or distracted to bring it to normal proportions.
Excess or deficiency of upper jaw is caused by less or restricted growth of the upper jaw. It is more commonly found in cleft lip and palate and following trauma to the upper face.
Due to poor growth and development of the upper jaw, these individuals may appear to have lower jaw protrusion even if mandible growth is normal. Excess of upper jaw will cause a gummy smile or protruding upper teeth. The height of the upper bone can be reduced and fixed which will correct the gummy smile and protruding teeth.
Jawbone deformities are caused by protrusion of both jaws, resulting in a “gummy smile”, with excessive show of front teeth. This often causes difficulty in closing the lips and therefore in concealing the front teeth. These individuals often compensate by trying to hide this with a tight lip closure, making their lips appear small and constricted.
The treatment differs according to age and degree of protrusion. Generally, from the teenage to young adult years, the patient may require orthodontics to correct the condition. However, in the older people and in severe cases the problem needs to be addressed by a combination of orthodontics and surgery to the jawbones.
Though these are major surgeries, the majority will not have any complications. Most incisions are placed inside the mouth and are not visible. In rare cases incisions may need to be placed on the skin but these are camouflaged and not obviously visible to a casual observer.
After surgery, the patient will be on a diet of liquids and semisolids for a few weeks and also need to take care of oral hygiene. Most go back to work within 10 days depending on the extent of surgery.
Occasionally there may be complication following surgery. Some may have sensory disturbances following lower jaw surgery, which are reversible. However this numbness does not affect daily life or the movement of the lower lips.
Other rare complications are bleeding after surgery, infection and exposure of plates.
However, the important feature of this surgery is acceptance of new face by patients. Young patients adapt to the new face quite happily. However, after 30 years, the patients may find difficult to adjust to the new face.