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  • Q&A with Australian Health Practitioners

    What is the risk & margin of improvement if I have jaw surgery a second time?

    Related Topic
    I had a bimaxillary jaw surgery done 5 years ago. The procedure has improved my profile and bite significantly, but I still have a slight overbite, joint clicking, and when I move lower teeth backward I still have a a noticeable overbite (apparently not a lot of people can move their lower teeth backward as much as I could). I would like to go through the jaw surgery procedure again to 1. improve my profile appearance and 2. further improve my bite.

    May I ask what is the risk of cutting up and realign the upper jaw the second time? is it common to have such a surgery done the second time round? Why some online literature claims that it is more common to Le Forte I osteotomy move the maxilla upward, downward, forward, but not commonly backward? what is the risk with moving backward? Why choose braces before the operation? And why in some countries patients only have braces after surgery?
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    Thanks

    Dr Walter Flapper

    Plastic Surgeon (Reconstructive & Cosmetic)

    Dr Flapper is a craniofacial surgeon in Adelaide. Following the completion of his training as a plastic and reconstructive surgeon, Dr Flapper completed a post … View Profile

    Redoing orthognathic surgery is possible, The scarring from the previous surgery can make it technically more challenging but the risks are essentially the same as the first time. Having orthognathic surgery a second time, although not common, is able to be done safely and with good results.

    The key to success with orthognathic surgery lies in careful planning and preparation. This relies on a close cooperation between the surgeon and the orthodontist to ensure that the proposed movements are stable and result in a favourable outcome.

    Moving the maxilla backwards is not done as it results in a loss of the normal facial contour, and the skin and soft tissue envelope around the jaws is too big and will sag. In short, it looks terrible.

    Pre and postoperative orthodontics are essential to prepare for the surgery. The aim of this is to ensure the teeth are appropriately positioned over the base bone, and also to ensure that when the jaws are repositioned that the teeth then meet appropriately. Postoperatively orthodontics are required for a variable length of time to maintain the occlusion and to do any final 'finishing' that may be required.

    Some centres have started doing surgery first orthognathic surgery, claiming a shorter period of orthodontics is required. However, those that do this even admit that it is only suitable for a small select group of patients. Our view is that doing this does not allow for careful and accurate planning and would lead to inferior results.

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