Plate 05 · Procedures
Corrective jaw surgery
This is the longest commitment we ask of anybody. Two to three years, most of it in braces, with a hospital stay in the middle and a face that changes. It is also the only way to correct a skeletal discrepancy in an adult. We spend the first consultation making sure the patient understands the timeline before we discuss the surgery.
For the referring practice
Orthognathic surgery — Le Fort I, bilateral sagittal split osteotomy, genioplasty and SARPE — planned virtually and phased with orthodontic decompensation.
In plain language
Surgery to move the upper jaw, the lower jaw or both, so the teeth meet properly and the face is balanced. It runs alongside two to three years of braces.
Both are always on this page. The switch in the header decides the order everything else is presented in, not whether you are allowed to read it.
01
When we would operate
And, just as importantly, when we would not. A referral that ends in a recommendation to do nothing is a good outcome, not a wasted appointment.
- Skeletal Class II or III discrepancy beyond orthodontic camouflage
- Anterior open bite with a skeletal cause
- Facial asymmetry with a skeletal component
- Vertical maxillary excess or deficiency
- Transverse maxillary deficiency in a skeletally mature patient — SARPE
- Obstructive sleep apnoea considered for maxillomandibular advancement after failed or declined CPAP
- Cleft-related maxillary hypoplasia
02
How it is done
Phase one — orthodontic decompensation
Typically 12–18 months. The orthodontist deliberately moves the teeth back over their own bases, which makes the bite look worse before surgery. Patients need warning about this or they lose faith halfway through.
Virtual surgical planning
CBCT merged with an intraoral scan, movements planned in software, and printed splints or patient-specific plates produced from the plan. We share the planned movements with the orthodontist before the theatre date.
Le Fort I osteotomy
Down-fracture of the maxilla, allowing advancement, impaction, expansion in segments, and correction of cant. Rigid fixation with plates.
Bilateral sagittal split osteotomy
Splitting the mandibular ramus to advance or set back the tooth-bearing segment. The inferior alveolar nerve runs through this field, which is the source of the risk below.
Genioplasty
An osteotomy of the chin point, moved in any of three planes. Often the change patients notice most in the mirror.
Phase three — orthodontic detailing
6–12 months of finishing, then retention. Elastics from the first post-operative weeks.
- CBCT covering the whole facial skeleton, plus a lateral cephalogram.
- Intraoral scan of both arches, and a bite registration in centric relation.
- Standardised clinical photographs: frontal at rest, frontal smiling, profile, three-quarter, and an occlusal series.
- The orthodontist’s treatment plan and expected decompensation endpoint.
A note back to you
Refer early, before decompensation begins, so the surgical plan and the orthodontic plan agree from the start. We are happy to see a patient jointly with the orthodontist for the first consultation, and we will produce the virtual plan for review before we fix a theatre date.
04 · Consent
Risks, stated rather than softened.
Every figure below is a published-literature range and is labelled as one. None of them is a claim about this practice's results, and there are no success rates anywhere on this site. You should hear all of this out loud before you consent to anything, not only read it.
Inferior alveolar nerve altered sensation
After a sagittal split, altered sensation of the lower lip and chin is close to universal in the immediate period. Most recovers over months. A meaningful minority are left with some permanent change, and the risk rises with age and with the size of the movement. This is the risk patients most consistently under-estimate, so we state it first.
Literature: permanent altered sensation after BSSO widely reported in the ~10–35% range
Unfavourable split ("bad split")
The mandible fractures along an unplanned line during the split. Managed at the time with additional fixation; occasionally changes the plan.
Relapse
Skeletal movement partially reverses over the first year, most notably with large advancements, open-bite correction and mandibular setbacks. Some cases need revision.
Condylar resorption
Progressive loss of condylar height after surgery, causing late open bite. Uncommon, more often described in young women with high mandibular plane angles and pre-existing joint symptoms.
TMJ symptoms
Joint symptoms may improve, stay the same, or get worse. We will not promise that jaw surgery will fix jaw pain, because the evidence does not support that promise.
Bleeding
Significant haemorrhage in a Le Fort I is uncommon but recognised, from the descending palatine or maxillary vessels. Transfusion is rare and is discussed as part of consent.
Infection and plate exposure
Plates occasionally need removal later, usually for palpability, discomfort or exposure rather than infection.
Change in appearance
Your face will look different. The nose widens slightly with maxillary advancement unless an alar cinch is used; the lips redrape; the chin projects differently. Simulations are useful but they are a guide, not a promise.
05
What the timeline looks like
Recovery varies between people. The general recovery instructions — bleeding, swelling, diet, medication timing and dry socket — are on the after-your-surgery page.
06 · For patients
The questions people actually ask us in the chair.
Why does my bite look worse before surgery?
Because your teeth have been quietly compensating for the position of your jaws for years — tilting to meet each other. The orthodontist has to undo that tilting so the jaws can be moved to the right place. It looks alarming around a year in. It is the plan working.
Will my jaws be wired shut?
Almost never these days. Rigid plates hold the bones, and we use guiding elastics instead. You will be on liquids then soft food for weeks, but you will be able to open your mouth.
The numbness question
Your lower lip and chin will almost certainly feel numb or tingly after lower jaw surgery. For most people that improves over weeks to months. For some, a degree of altered feeling is permanent. If that would be unacceptable to you, tell us at the first appointment — it is the single most important thing to be sure about before starting.
07
More on this procedure
Next
Send us this case with the imaging listed above, or call the referral line on (612) 555-0150 if it needs to be seen sooner than a form allows.
If your dentist has already referred you, we will contact you to book. If you would like a second opinion, you can come to us directly.