What is it?
Jaw surgery (also called ‘orthognathic surgery‘ or sometimes an ‘osteotomy‘) is a procedure to change the position of your jaws and how they relate to each other.
Why might I be offered jaw surgery?
Some young people and adults with a cleft have an upper jaw (maxilla) which is relatively smaller than their lower jaw (mandible). This can make the upper lip and nose look a bit more flat, and make the top teeth sit behind the bottom teeth (an underbite).
Surgery in combination with orthodontics can bring the top teeth and upper jaw forward to line up better with the lower jaw and teeth. The middle part of the face can be made to come forward and appear less flat. This can change the appearance of the face a lot, especially from the side. It can also help with problems with chewing and eating, as it will change how your teeth fit together. Surgery is usually only performed once you’ve finished growing, which is around 16-18 years old.
This is a serious surgery and happens in several stages:
Planning and Assessment
The specialists in your Cleft Team will work together to gather all the information they need to plan your surgery. This will include taking photographs, special x-rays, models of your teeth, and whatever else is necessary. The Clinical Psychologist will also arrange to meet with you to discuss your hopes and expectations of surgery, support you in deciding whether or not to go through with it, and help prepare you throughout the process if needed.
The cleft specialists will discuss with you your options and make a treatment plan that suits your individual needs. It’s up to you to decide whether or not to go ahead with surgery. This is an important decision and it’s a good idea to take time to think about it carefully and ask as many questions as you need. If you are unsure about anything, it’s important to talk to someone, like the Clinical Psychologist, before the treatment begins.
Braces are put on your teeth to move them into different positions so that when your jaw is moved your teeth will fit together comfortably. This can take months and sometimes even years. Your teeth may have to move into positions that make them fit together less well than they did to start with in order for them to work better after the surgery.
There are a few different ways this surgery is done. Sometimes only the upper or lower jaw needs to be moved. Sometimes the upper jaw is moved forward and the lower jaw is moved backwards so that the teeth meet in a middle position. The two jaws may be moved at the same or different times. Once they are moved, they will be held in place by tiny metal plates and screws. You might also need a device like a frame attached to the inside or outside of your mouth while you heal, and this may need to be adjusted.
The exact procedure is different depending on your needs and your surgeon, so it’s best to ask them directly if you have any questions about what will happen to you.
The surgery itself is done under general anaesthetic when you’re asleep. As it’s all done inside your mouth, you won’t have any visible scars on your skin.
Matilda underwent jaw surgery when she was 18, and shared her journey with the Channel 4 show Embarrassing Bodies. Warning: Please be advised that extremely graphic shots of this surgery are featured between 3:15-5:35 which many viewers will find disturbing. If you’re nervous about surgery, you may find the before and after interviews helpful, but we’d advise you avoid the middle part of the video.
Warning: Please be advised that extremely graphic shots of this surgery are featured between 3:15-5:35 which many viewers will find disturbing.
After the surgery, you can expect some swelling which may take a while to go down. Your lips will be numb at first, which may make the swelling feel worse than it actually is. You may have some tubes in your nose or skin to help reduce the swelling and make breathing easier, but these will be removed as soon as possible. You will be given painkillers if you need them as well as antibiotics to prevent infections.
In some cases, your jaws will be wired shut to hold them in place while the bones heal.
You’ll need to be on a liquid-only diet for some time after the surgery, followed by soft foods until your jaws have fully healed.
Once the position of the jaws is stable, the orthodontist can adjust the teeth into a final position to make the top and bottom teeth fit together so they work properly and help to keep the jaws in their new place.
Sometimes, once you’re healed you may want or need further surgery, including:
Closure of fistulae: A ‘fistula’ is a small hole in the palate which can get bigger after jaw surgery and may need to be closed.
Speech surgery: Sometimes jaw surgery can result in a gap between your palate and the back wall of your throat during speech, so your speech will sound nasal. There is surgery to help with this, and you will automatically see the Speech and Language Therapist after jaw surgery so they can see how, if at all, your speech has changed.
Rhinoplasty: This is surgery to change the appearance of the nose. You may want this depending on how your appearance has changed after jaw surgery.
Should I have the surgery?
It’s your decision! This may be the first major surgery decision you’ve had to make, so it’s okay to not be 100% sure about it right away. It’s important to take the time to listen and ask questions until you have all the information you need before making decisions.
The Great Ormond Street Hospital Branch of CLAPA held a Patient/Professional Forum about Jaw Surgery in April 2017. They invited 4 young adults who previously had the surgery to answer questions about their experiences.
Danielle was 17 when she had her jaw surgery and wrote about her experiences. Read her story here.