ORTHODONTIC SURGERY

The patient’s health insurance provider must be able to meet the total cost, which will be estimated by the maxillofacial surgeon and must be approved by the insurance provider in advance.

Approximately fourteen days before the planned date of surgery, impressions of the dental arches are taken, the position of the upper jaw relative to the skull is carefully analyzed, and the initial bite registration is recorded. In the dental laboratory, plaster models are used to simulate the three-dimensional repositioning of the jaw(s) and the splints are made. This allows the doctor to precisely plan out the surgical procedure. The doctor will then explain the procedure to the patient orally, as well as provide a detailed written description thereof.

Provided the patient has adequate health insurance coverage, he or she is generally admitted to the hospital on the day before the operation in order to test the fit of the pre-made splints and for the consultation with the anesthesiologist, who will explain the form of anesthesia that will administered and what the patient can expect from it.

For upper- and/or lower-jaw repositioning, the surgical techniques are the same in all highly developed nations. The area is accessed exclusively via the mouth so as to avoid visible scars. The upper jaw is detached along a certain line (named after Le Fort) and repositioned according to the preoperative plan. Individual segments of the upper jaw can also be repositioned during the operation.

The patient is generally hospitalized for 3 days for a single-jaw operation or 4 days for surgery on both jaws. The hospital stay can be shortened if the patient recovers well and can receive adequate care at home.

In the postoperative phase, the patient is hindered less by the pain, which can effectively be controlled with medication, than by the pronounced soft-tissue swelling, which lasts for about three days and then gradually subsides.

Like any surgical procedure, surgical orthodontic adjustments are associated with the following general risks:

• Infection
  (Perioperative antibiotic therapy used as prophylaxis)
• Thrombosis
  (Heparin administered as a precaution)
• Anesthetic risk
  (Almost no chance for young, healthy patients)

Whether the surgery is performed on the upper or lower jaw, it may be the case that the optimal bite cannot be achieved as planned, due to the complexity of the three-dimensional repositioning and the patient's muscle tone in the postoperative phase. The orthodontist can generally correct these discrepancies during follow-up treatment. If orthodontics cannot solve the problem, an additional surgical procedure may be necessary. The need for such a second operation arises in roughly one of every one hundred cases at this practice.

Due to possible anatomical variances, upper jaw adjustments are associated with the risk of hemorrhaging from the blood vessels running behind the upper jaw. In the past, patients would often donate blood prior to surgery, but this practice has been discontinued because the risk of hemorrhaging is minimal and because there can actually be negative effects when one’s own blood is reintroduced into the body. In the history of this practice thus far, a blood transfusion has never been required.

Surgical adjustments of the lower jaw are associated with the risk of permanent impairment of sensation in the lower lip. This risk is minimized by the use of less invasive surgical techniques (see “Operation and Postoperative Phase”). The severity of this impairment of sensation, which may be nonexistent or may be manifested as tingling or more rarely burning, depends on the level of experience of the operating surgeon, as well as the mandibular anatomy, which varies greatly from patient to patient.

Prior to surgery, a three-dimensional volume-tomographic representation of the nerve (see 3D Volume Tomography) provides the surgeon with valuable information and minimizes the risk of nerve damage, while the patient is exposed to only a low dose of radiation.

Patients with unfavorable anatomical conditions, e.g. fine-boned individuals with an overbite, have an increased risk of a “bad split,” where the lower jaw fractures in the wrong place. If this is the case, the operation must be interrupted and completed at a later time.

Havelklinik
Gatower Straße 191
13595 Berlin
Phone 030 - 362 06 0
www.havelklinik.de

the following orthodontic partners:

ADENTICS - Die Kieferorthopäden
in Berlin und Brandenburg (Mahlow)
Woo-Ttum Bittner und Partner
www.adentics.de

Dr. C. Djamchidi
www.123zahnspange.de

Dr. Hatto Loidl
www.westendKFO.de
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