Loading article content
Jaw surgery stands out as one of the most effective procedures for transforming facial structure. It can dramatically alter the appearance of cleft lip and palate as the face develops over time. While simple orthodontic corrections and arch expansions can normalize the bite, they fall short in addressing deeper issues like the concave midface or protruding chin bones shaped by natural growth patterns.
As the name implies, jaw surgery corrects the bite through surgical intervention. It involves osteotomy on the upper and lower jaws, allowing them to shift forward or backward for optimal alignment, followed by securing the bones with fixation. This flexibility not only improves occlusion but also reshapes the entire face. Preoperative computer simulations help plan movements based on ideal facial proportions, though they provide only an approximate preview of soft tissue changes.
Jaw surgery is necessary when orthodontic treatments alone cannot resolve issues. This includes severe jaw protrusion, retrusion, asymmetry, or related occlusal problems. For individuals with cleft lip and palate, early surgeries can lead to developmental issues, resulting in a recessed midface or prominent chin in adolescence. Statistics show that about 20% of cleft lip and palate patients may require jaw surgery in adulthood to correct their bite, enhance midface fullness, and address chin prominence.
The principles of orthognathic surgery for cleft lip and palate patients mirror those for the general population, involving similar osteotomies. However, complete cleft cases present unique challenges due to palatal clefts. These patients often exhibit slower growth, thicker palatal tissue, and scarring from prior procedures, making surgery more complex. Post-operative changes may continue for six months to a year due to scar tissue tension. Additionally, clefts at the nasal base increase the risk of bleeding from the affected nostril. An advantage is the potential to perform simultaneous repairs of the oronasal fistula and gingiva without bone grafting, as past attempts at concurrent grafting have shown high failure rates. Associated nasal septal deviations can also be corrected during surgery to alleviate nasal obstruction on the affected side.
In cleft cases, advancing the maxilla enhances midface fullness but enlarges the space behind the soft palate, potentially causing velopharyngeal insufficiency and increased nasal speech. Studies indicate that about one in seven patients experience this issue, with most improving within six months. Persistent cases may require additional speech therapy or surgery.
Complications are similar for all orthognathic surgeries, primarily involving damage to the maxillary nerve. For detailed health education on surgical risks, consult standard medical resources.
Surgery can correct malocclusion, facial asymmetry, and misalignment, improving overall oral function. For cleft lip and palate patients, it addresses midface retrusion, chin protrusion, and related issues like oronasal fistulas and nasal septal deviations.
Orthognathic surgery typically occurs after skeletal maturity, around 18 for males and 15-16 for females. Unlike cosmetic procedures, which may require age 18 or older, cleft-related surgeries can be performed up to ages 50-60. Since the procedure alters appearance and impacts social life, early intervention is advisable when needed. Note that perfect symmetry is unattainable; preoperative simulations aid planning but cannot guarantee 100% accuracy.