Orthognathic (Jaw) Surgery

Orthognathic surgery is an operation that repositions one or both jaws to correct the way they meet, align, and function.

During the procedure, an oral and maxillofacial surgeon (a specialist trained in the bones and soft tissues of the face, mouth, and jaw) cuts the jawbones and moves them into a new position, then holds them in place with small titanium plates and screws. The bones heal in this corrected position over the following months. The goal is to restore a balanced bite — the way the upper and lower teeth meet — and to improve breathing, chewing, speaking, and the overall shape of the face.

Orthognathic surgery is considered when jaw problems are severe enough that orthodontic treatment (braces or aligners) alone cannot fully correct them. It is usually planned together with an orthodontist over a period of months or years.

• Skeletal class III malocclusion (underbite) — where the lower jaw protrudes significantly in front of the upper jaw
• Skeletal class II malocclusion (severe overbite) — where the upper jaw sits far forward relative to the lower jaw
• Open bite — where the upper and lower front teeth do not meet even when the back teeth are closed
• Crossbite — where upper and lower teeth do not meet symmetrically on one or both sides
• Facial asymmetry — noticeable unevenness of the face caused by unequal jaw growth
• Obstructive sleep apnoea (OSA) — a condition where the airway repeatedly collapses during sleep, in part due to jaw structure
• Difficulty chewing, biting, or swallowing caused by the jaw relationship
• Speech difficulties linked to jaw position
• Jaw joint (temporomandibular joint, or TMJ) pain that arises from a poor bite

This surgery is generally not suitable in certain situations. Your surgeon and orthodontist will discuss these with you.

• Patients whose jaws are still growing — surgery is usually deferred until bone growth is complete, typically in the late teens or early twenties
• Patients whose bite problems can be fully corrected with braces or other non-surgical methods
• Patients with uncontrolled systemic conditions (such as unmanaged diabetes or severe heart disease) that make general anaesthesia unsafe
• Patients with active bone infections in the jaw area

Like all major surgical procedures performed under general anaesthesia (being fully asleep), orthognathic surgery carries recognised risks; your surgical team will explain which of these are most relevant to your specific plan.

• Swelling and bruising of the face and jaw, which is expected and usually peaks in the first few days
• Pain and discomfort in the jaw and face during recovery
• Temporary numbness or altered sensation (tingling, pins and needles) in the lips, chin, cheeks, or teeth, caused by stretching of nearby nerves
• Permanent numbness in a small area of the face — rare, but possible if a nerve is injured during bone cuts
• Bleeding during or after surgery, occasionally requiring a blood transfusion
• Infection at the surgical site, sometimes requiring antibiotics or further treatment
• Relapse — partial movement of the jaw back toward its original position during healing
• Jaw joint (TMJ) pain or clicking after surgery
• Bite not settling as planned, sometimes requiring further orthodontic adjustment or, rarely, a second surgery
• Risks related to general anaesthesia, including breathing difficulties or reactions to anaesthetic drugs — your anaesthetist will assess these before surgery
• In very rare cases, injury to blood vessels near the jaw

Preparation for orthognathic surgery typically unfolds over many months and involves both your orthodontist and your surgeon working closely together. Your surgeon and care team will give you specific instructions; the information below describes what is commonly done.

In the weeks before surgery, patients are usually advised to stop smoking, as smoking slows bone healing and increases infection risk. Alcohol should also be avoided in the days leading up to surgery. Certain medications — including blood thinners, some anti-inflammatory painkillers, and herbal supplements — are commonly paused before surgery, as directed by the surgical team. Always inform your doctor about every medication and supplement you take.

Fasting is required before general anaesthesia. In most hospitals, this means no food for a set number of hours before surgery, and no plain water for a shorter period. Your team will give you the exact times to follow.

Tests and assessments commonly carried out before surgery include:

• Full dental and facial X-rays, including a panoramic jaw X-ray (OPG) and a cephalometric X-ray (a side-view X-ray of the skull and jaw relationship)
• CT scan (a detailed three-dimensional image of the jaw bones), used in most cases to plan the exact movements
• Dental impressions or digital scans of the teeth, used to make surgical splints (custom-fitted bite guides worn during and after surgery)
• Photographs of the face and teeth from multiple angles
• Blood tests to check general health and clotting
• A heart tracing (EKG) and sometimes a chest X-ray if required for anaesthesia clearance
• A consultation with the anaesthetist to review your medical history and plan the type of anaesthesia

On the day of surgery, the procedure itself generally follows these steps:

• You change into a hospital gown and have a drip (intravenous line) placed in your arm
• The anaesthetist gives you general anaesthesia so you are fully asleep throughout
• The surgeon makes incisions (cuts) inside the mouth, so there are usually no visible scars on the skin
• The jawbone or bones are carefully cut using precise instruments
• The jaw is moved into the planned new position, guided by the surgical splint
• Small titanium plates and screws are fixed to hold the bones securely in their new position
• The incisions inside the mouth are closed with dissolvable stitches
• You are woken from anaesthesia and moved to a recovery area for close monitoring

Recovery from orthognathic surgery takes place in stages. Most patients spend at least one night in hospital after surgery, and some stay for several days depending on how extensive the procedure was and how they respond. Swelling of the face is significant in the first week and continues to reduce gradually over several weeks; the final facial appearance may not be fully visible for many months. Full bone healing typically takes several months, and orthodontic treatment usually continues after surgery to fine-tune the bite.

• Diet: a liquid or soft-food diet is required for a period of weeks after surgery — the length of time varies by patient and by the complexity of the procedure; your team will guide you on when and how to progress to normal foods
• Jaw movement: the degree to which jaw movement is restricted after surgery depends on the surgeon's technique and your individual healing; some patients have their jaws guided with elastics (rubber bands), while others are able to open their mouths more freely
• Oral hygiene: keeping the mouth clean is important; the team will advise on gentle rinsing and careful brushing around surgical sites
• Swelling and bruising management: applying cold compresses (ice packs) in the first day or two, and keeping the head elevated, usually helps reduce swelling
• Pain management: your team will prescribe appropriate pain relief for the early recovery period
• Activity restrictions: strenuous physical activity and contact sports are usually avoided for several weeks to months; your surgeon will advise on a safe timeline for returning to normal activities
• Work and school: many patients take several weeks off, though the exact time depends on the nature of their work and how quickly they recover
• Smoking and alcohol: continuing to avoid smoking after surgery supports better bone healing; alcohol may interact with medications and should be discussed with your team
• Follow-up appointments: regular check-ups with both the surgeon and the orthodontist are essential in the months after surgery to monitor healing and adjust the bite
• Hardware (plates and screws): in most cases the titanium plates and screws remain in place permanently; removal is only considered if they cause problems, which is uncommon