Treatment Approach

1. Traditional Approach (Orthodontics before surgery)

Steps:

1. Pre-surgical orthodontics

• It takes about 12-24 months to align the teeth into a suitable position for surgery.
• The teeth will be arranged in preparation for jaw repositioning.

2. Surgery

• Surgery is performed under general anesthesia in a hospital, where the jaw is repositioned according to the plan and fixed with metal plates and bone screws.
• The surgery takes about 2-6 hours.

3. Post-surgical orthodontics

• It takes about 6-12 months to adjust the tooth position to fit the new jaw.

Benefits

• Provides high accuracy in the treatment process.
  
• Provides high accuracy in treatment planning

Disadvantages

• Requires a long overall treatment period (2–3 years)
• Aesthetic results are seen only after surgery; during the presurgical orthodontic period, some patients may feel their facial appearance looks worse

2. Surgery-First Approach (performing orthognathic surgery before orthodontic treatment)

Steps:

1. Pre-surgical planning

• Using 3D simulation technology to determine future jaw and dental positions

2. Surgery

• Surgery is performed under general anesthesia in a hospital, where the jaw is repositioned according to the plan and fixed with metal plates and bone screws.
• The surgery takes about 2-6 hours.

3. Orthodontic treatment after surgery.

• Orthodontic treatment starts around 4–6 weeks after surgery and continues for another 6–12 months

Benefits

• Shorter treatment duration (12–18 months)
• Immediate aesthetic and functional results
• Increases patient confidence after surgery

Disadvantages

• Requires complex planning and an experienced specialist team
• Not suitable for cases with severe dental or jaw misalignment complexities

Comparison table: Traditional Approach vs. Surgery-First Approach

Preoperative preparation for orthognathic surgery

1. Consultation and treatment planning

• Undergo examination by an orthodontist and an oral & maxillofacial surgeon
• Joint evaluation and analysis of the patient’s problems and needs
• Collaboratively plan treatment using clinical examination data, photographs, X-rays, and CT scans

2. Pre-surgical oral care

• Undergo scaling, fillings, and maintain oral hygiene to reduce infection risk
• Impacted teeth or unnecessary teeth may need extraction beforehand, or in some cases they can be removed during jaw surgery

3. Planning work schedule and daily activities

• Prepare soft or liquid food for the postoperative recovery period
• The surgeon will explain the surgical process, recovery time, and expected outcomes
• After surgery, avoid heavy physical activities, strenuous exercise, and activities that may impact the jaw , Important social or work activities may require adjustment; patients should modify daily life and scheduling accordingly
  
  

Post-operative care

1. Hospital recovery: patients typically stay 1–3 days for close monitoring and complication prevention
2. Wound care: gentle mouth rinsing with antiseptic and saline once the patient can open the mouth without bleeding
   Avoid hard-bristled toothbrushes; use mouthwash and maintain careful oral hygiene
3. Diet and nutrition

• First 1–2 weeks: liquid diet such as soup, juice, milk, smoothies
• Weeks 3–12: soft foods such as porridge, steamed eggs, rice soup, soft dumplings
  Normal diet can resume after 3 months (excluding hard, crunchy, or chewy foods)

4. Jaw exercises: once swelling and pain decrease, the patient can open their mouth more easily and must perform jaw mobility exercises
5. Follow-up: patients must attend scheduled appointments to assess healing, complications, recovery progress, and orthodontic adjustments

Possible side effects and risks

Short-term side effects

1. Swelling and bruising on the face and neck commonly occur in the first 1–2 weeks and gradually subside within 4–6 weeks
2. Jaw pain and tightness can be relieved with pain medication prescribed by the dentist
3. Limited jaw movement, making it difficult to open the mouth initially; movement improves as swelling and pain decrease
4. Difficulty eating: patients must follow a liquid diet for the first month and soft foods for 3 months after surgery

Surgical risks / Risks associated with surgery

1. Infection, although uncommon, requires excellent oral hygiene, antibiotic use for infection control, and taking all prescribed medication as directed
2. Nerve injury may cause numbness or abnormal sensitivity around the lips, chin, under the eyes, or sides of the nose, which is usually temporary
3. Jaw relapse may occur if postoperative care is inadequate; dentists may recommend jaw-positioning appliances to maintain stability, and strict adherence is required. In some cases, revision surgery may be necessary
4. Temporomandibular joint (TMJ) issues may cause pain or abnormal jaw joint movement
5. Anesthesia-related complications such as nausea, vomiting, fatigue, nosebleeds, and sore throat from intubation

Summary

Orthognathic surgery and orthodontic treatment require detailed planning by a specialist team. The Traditional Approach is suitable for cases with significant presurgical orthodontic needs, while the Surgery-First Approach is ideal for patients who want faster results and shorter treatment time. Both approaches require thorough evaluation and close monitoring to achieve the best long-term outcome