San Diego Center for Oral and Facial Surgery

Face and Jaw Reconstruction

Oral and maxillofacial surgeons treat a wide variety of congenital, pathologic, and trauma-induced facial deformities. Modern surgical techniques and materials allow oral and maxillofacial surgeons to optimize function and esthetics of the face and jaws.

Modern surgical techniques of the face and jaws were developed during World War II, the Korean War, and the Vietnam War. It was during this period of time that oral surgeons and plastic surgeons were called upon to treat the devastating facial injuries of our war heroes. During the often desperate attempts to reassemble or reconstruct these injuries to the face and jaws, new surgical techniques were born.

Surgeons can now disassemble the bones of the face and skull and place them in their normal anatomic positions. The advent of titanium plates and screws allows rigid fixation of the newly positioned bones allowing surgeons to achieve greater anatomic movements that were not possible prior to the advent of these devices.

The most common reconstructive procedure of the face performed by oral and maxillofacial surgeons falls under the category of orthognathic surgery. Orthognathic surgery is designed to properly align the jaws relative to each other and to the skull. 

In most cases, discrepancies in the alignment of the dental arches can be treated with orthodontics (braces). However, in some cases surgery is needed to correct these discrepancies. These discrepancies are usually inherited. The following table illustrates problems with jaw growth that require surgical correction.

Diagnosis	Surgical Correction	Before	After
Maxillary hypoplasia with anterior-posterior discrepancy: the upper jaw has not grown far enough forward resulting in an underbite.	Lefort I osteotomy with anterior advancement: a horizontal bone cut is made above the roots of the upper teeth and the upper jaw is moved forward. Movements greater than 6 mm often need additional bone grafting.
Maxillary hyperplasia (vertical maxillary excess): the upper jaw has grown down too far resulting in a "gummy" smile.	Lefort I osteotomy with superior repositioning: a horizontal bone cut is made above the roots of the upper teeth and a horizontal segment of bone is removed. The upper jaw is then repositioning upwardly and held with titanium plates and screws.
Maxillary transverse discrepancy: the arch form of the upper jaw is constricted relative to the lower jaw.	Multiple segment Lefort I osteotomy: a standard Lefort I osteotomy is performed and additional cuts are made in between the teeth and in the palate to widen the upper jaw. Sometimes the application of an orthodontic palatal expander is necessary to achieve the desired amount of widening.
Mandibular hypoplasia with anterior-posterior discrepancy: the lower jaw has not grown far enough forward leading to an overbite.	Sagittal split osteotomy: an oblique bone cut is made through the vertical portion of the lower jaw (ramus) allowing forward advancement of the lower jaw. The bones are then held together using titanium screws.
Mandibular hyperplasia: the lower jaw has grown too far forward resulting in an underbite.	Sagittal split or vertical ramus osteotomy: bone cuts are made in the vertical portion of the lower jaw allowing posterior repositioning of the lower jaw.
Combination facial growth discrepancy.	Discrepancy between upper and lower jaw is too great to be corrected with single jaw surgery alone. Upper and lower jaw surgery is necessary using methods described above.
Microgenia: the chin had not grown far enough forward.	A horizontal bone cut is made below the roots of the front teeth of the lower jaw allowing the chin portion of the lower jaw to be separated and moved forward. The chin bone is then held forward using a specially designed titanium plate.

One question that patients have when undergoing jaw surgery is whether or not they will have to be wired shut. Wiring patients shut after orthognathic surgery is infrequent due to the application of rigid internal fixation using titanium plates and screws.

Oral and maxillofacial surgeons will also participate in varying degrees to correct skull deformities (craniofacial surgery) and to repair congenital deformities such as cleft lip and cleft palate. The degree of participation by the oral and maxillofacial surgeon in these types of surgery will depend on their own level of experience and training.