orthognathic surgery: Definition, Uses, and Clinical Overview

Definition (What it is) of orthognathic surgery

orthognathic surgery is a surgical procedure that repositions the upper jaw, lower jaw, or both.
It is used to correct jaw alignment problems that affect bite, facial balance, and airway-related function.
It is performed for reconstructive goals, functional improvement, and, in some cases, aesthetic refinement.
It is commonly planned in coordination with orthodontic treatment.

Why orthognathic surgery used (Purpose / benefits)

The purpose of orthognathic surgery is to improve the relationship between the jaws (maxilla and mandible) so that the teeth meet more appropriately and the facial skeleton is better balanced. Many patients seek care because jaw misalignment can affect everyday functions such as chewing and speech, and it can also influence facial symmetry and profile.

From a functional standpoint, repositioning the jaws can help address malocclusion (a misaligned bite), improve how forces are distributed across teeth, and reduce compensatory strain in the jaw joints and muscles for some patients. From an aesthetic standpoint, changing jaw position can alter facial proportions—such as the prominence of the chin, the midface projection, and the appearance of facial asymmetry—although aesthetic changes are secondary to skeletal correction in many treatment plans.

In reconstructive settings, orthognathic surgery may be used when the facial bones did not develop in typical alignment, after trauma, or as part of coordinated care for congenital or syndromic craniofacial differences. In all contexts, benefits and trade-offs vary by anatomy, technique, and clinician.

Indications (When clinicians use it)

Typical situations where clinicians may consider orthognathic surgery include:

• Significant overbite or underbite caused by jaw position (skeletal malocclusion)
• Open bite (front teeth do not meet) related to jaw growth pattern
• Crossbite or midline discrepancy associated with skeletal asymmetry
• Facial asymmetry due to uneven jaw development or positioning
• Difficulty chewing or biting effectively that is linked to jaw alignment
• Speech articulation issues where jaw structure is a contributing factor
• Obstructive sleep apnea management as part of selected airway-focused plans (case-dependent)
• Post-traumatic jaw deformity or malunion affecting function and symmetry
• Cleft-related or congenital craniofacial conditions requiring skeletal repositioning
• When orthodontics alone cannot realistically align the bite without skeletal correction

Contraindications / when it’s NOT ideal

Orthognathic surgery may be less suitable, delayed, or avoided in situations such as:

• Medical conditions that increase surgical or anesthesia risk (varies by clinician and case)
• Uncontrolled bleeding disorders or use of medications that significantly affect clotting (case-dependent)
• Active oral infections or untreated dental disease that need management first
• Poor bone health or healing capacity that could compromise fixation and bone union (varies by clinician and case)
• Ongoing facial growth in younger patients when growth could change results (timing varies by individual)
• Severe untreated periodontal (gum) disease affecting tooth support
• Inability to participate in coordinated orthodontic planning and follow-up when it is required
• Primary concern is minor cosmetic contouring that may be better addressed with less invasive options (varies by clinician and case)
• Expectations that are not aligned with what skeletal surgery can and cannot change (for example, soft-tissue response can be less predictable)

How orthognathic surgery works (Technique / mechanism)

Orthognathic surgery is a surgical procedure, not a minimally invasive or non-surgical treatment. It works by repositioning sections of the jaw bones to a planned alignment, then stabilizing them so the bones can heal in the new position.

At a high level, the mechanism involves:

• Osteotomy: controlled surgical cuts in the maxilla and/or mandible.
• Repositioning: moving the bone segments forward, backward, upward, downward, rotating, or correcting asymmetry.
• Fixation: stabilizing the new position using small plates and screws (commonly titanium; material choice varies by clinician and case).
• Occlusal guidance: aligning the jaws to a planned bite, often using surgical splints or guides created during planning.

Typical tools and modalities include:

• Intraoral incisions (cuts inside the mouth) to reduce visible scarring; external incisions are uncommon and case-dependent.
• Surgical saws and instruments designed for bone work.
• Rigid fixation hardware (plates/screws) and sometimes temporary elastics to help guide the bite during early healing.
• Imaging and planning tools such as cephalometric analysis and 3D imaging/virtual surgical planning (use varies by clinic and case).

Energy-based devices (like lasers or radiofrequency) and injectables (fillers/neuromodulators) are not mechanisms for orthognathic surgery, though they may be discussed separately for complementary aesthetic goals in some treatment plans.

orthognathic surgery Procedure overview (How it’s performed)

A general workflow for orthognathic surgery often follows these stages. Exact steps vary by clinician and case.

1. Consultation – Review concerns (function, bite, symmetry, airway) and medical/dental history. – Discussion of goals, expected ranges of change, and the role of orthodontics.

2. Assessment and planning – Clinical exam of bite, facial proportions, and jaw movement. – Dental records and imaging (commonly X-rays; sometimes 3D scans) to plan jaw movements. – Coordination between surgeon and orthodontist; creation of a surgical plan and, in some cases, splints/guides.

3. Preparation and anesthesia – Preoperative instructions, medication review, and safety clearance as needed. – Orthognathic surgery is commonly performed under general anesthesia; anesthesia approach varies by clinician and facility.

4. Procedure – Incisions are commonly made inside the mouth. – Bone cuts are made, jaw segments are repositioned according to plan, and fixation hardware is placed. – Bite alignment is checked during the procedure.

5. Closure / dressing – Incisions are closed with sutures; external dressings are limited in many cases. – Some patients may have temporary elastics or other supports based on the plan.

6. Recovery – Immediate recovery monitoring, then staged follow-up. – Diet progression, oral hygiene routines, and return-to-activity timing vary by clinician and case. – Orthodontic finishing (when applicable) continues after surgical healing progresses.

Types / variations

Orthognathic surgery is an umbrella term covering different jaw procedures and planning pathways. Common variations include:

• Single-jaw surgery
• Maxillary (upper jaw) surgery: often described as Le Fort I osteotomy in many treatment plans.

• Mandibular (lower jaw) surgery: commonly performed via bilateral sagittal split osteotomy (BSSO) in many settings.

• Double-jaw (bimaxillary) surgery

• Both upper and lower jaws are repositioned to correct complex bite issues and facial balance concerns.

• Genioplasty (chin surgery)

• A chin bone procedure that can be added to adjust chin projection or symmetry.

• This is distinct from a chin implant; it uses the patient’s own bone repositioning.

• Segmental osteotomies

• The jaw is divided into segments to address localized problems (for example, specific bite relationships). Use varies by clinician and case.

• Transverse widening approaches

• In selected cases, surgical approaches can address upper jaw narrowness; technique selection varies widely by age, anatomy, and orthodontic plan.

• Distraction osteogenesis

• Gradual bone movement using a device over time; used in selected reconstructive or complex cases (varies by clinician and case).

• Fixation choices

• Most modern approaches use rigid internal fixation (plates/screws).

• Hardware material and design vary by manufacturer and clinician preference.

• Anesthesia and setting

• Most cases use general anesthesia in an operating room setting.
• Inpatient vs outpatient management varies by case complexity, facility protocols, and patient factors.

Non-surgical “orthognathic” options do not exist in the literal sense; non-surgical care may address related appearance concerns or dental alignment, but it does not reposition the jaw bones.

Pros and cons of orthognathic surgery

Pros:

• Can address the underlying skeletal cause of a misaligned bite rather than only dental compensation
• May improve chewing efficiency and bite mechanics when jaw position is the primary driver
• Can reduce visible facial asymmetry in selected cases (soft-tissue response varies)
• Allows coordinated correction across multiple planes (forward/back, vertical, rotational)
• Often planned with orthodontics for a comprehensive bite and facial skeleton approach
• Can be part of reconstructive care after trauma or in congenital craniofacial conditions

Cons:

• Involves major surgery with anesthesia and a meaningful recovery period
• Swelling, bruising, and temporary functional limitations are common during early healing
• Numbness or altered sensation can occur, sometimes lasting longer than expected (risk varies by procedure and individual anatomy)
• Bite may feel unfamiliar during adaptation, and orthodontic finishing can be time-intensive
• Infection, bleeding, and healing complications are possible with any surgery (rates vary by clinician and case)
• Aesthetic changes are not perfectly predictable because soft tissue adapts differently across individuals
• Cost and time commitment can be significant and vary by region, facility, and complexity

Aftercare & longevity

Orthognathic surgery aims for durable skeletal change because the jaws heal in the new position. Longevity is influenced by factors such as surgical planning accuracy, fixation stability, bone healing, orthodontic finishing, and how the bite settles over time. Some relapse (partial movement back toward the original position) can occur in certain directions of movement and in certain anatomies; the likelihood and degree vary by clinician and case.

Recovery is typically staged. Early healing focuses on swelling control, comfort, oral hygiene, and protecting the surgical sites. Later phases involve gradual return of normal chewing and continued orthodontic adjustments when part of the plan. Follow-up schedules and restrictions vary by clinician and facility.

Durability and satisfaction may also be influenced by:

• Pre-existing jaw joint and muscle patterns
• Dental health and periodontal support
• Smoking status and overall health factors that affect wound and bone healing
• Adherence to follow-up and orthodontic coordination (when applicable)
• Individual soft-tissue thickness and elasticity, which affects how facial contours “drape” over the repositioned bones

Alternatives / comparisons

Alternatives depend on the primary goal—bite correction, facial aesthetics, or reconstruction.

• Orthodontics alone (braces/aligners)
• Can align teeth effectively when the jaw bones are reasonably positioned.

• May be limited for significant skeletal discrepancies; in those cases, it can “camouflage” the bite rather than correct the jaw relationship.

• Tooth extractions and orthodontic camouflage

• Sometimes used to reduce dental protrusion or crowding.

• Does not reposition jaw bones; facial profile changes may be limited and vary by case.

• Chin implant vs sliding genioplasty

• A chin implant can change chin projection without cutting jaw bones, but it does not correct bite relationships.

• Genioplasty changes chin position using bone and can be combined with jaw surgery for balance; suitability varies by anatomy and goals.

• Facial fillers

• Can add volume to the chin, jawline, or midface to improve perceived balance.

• Do not change occlusion (how teeth fit) and require maintenance over time; product longevity varies by material and manufacturer.

• Energy-based skin tightening or contouring

• May modestly improve soft-tissue laxity around the jawline in some patients.

• Does not correct skeletal misalignment and is not a substitute for jaw repositioning.

• Sleep apnea treatments (for airway-related goals)

• Non-surgical management (such as CPAP or oral appliances) targets airflow rather than facial skeletal alignment.
• Surgical airway approaches may overlap with orthognathic movements in selected cases, but candidacy and goals are individualized.

Common questions (FAQ) of orthognathic surgery

Q: Is orthognathic surgery considered cosmetic or medically necessary?
It can be cosmetic, reconstructive, functional, or a combination. Some patients pursue it primarily for bite function, others for facial balance, and many for both. How it is classified can vary by clinician documentation and payer policies.

Q: How painful is recovery?
Discomfort is expected after major jaw surgery, especially in the first days to weeks, but the experience varies widely. Pain control strategies differ by clinician and patient factors. Sensations like tightness, swelling pressure, and fatigue are commonly discussed in recovery counseling.

Q: Will there be visible scars?
Many orthognathic surgery approaches use incisions inside the mouth, which can minimize visible external scarring. In certain complex or reconstructive cases, additional incisions may be used; this is case-dependent. Scar appearance varies by healing, skin type, and surgical technique.

Q: What type of anesthesia is used?
Orthognathic surgery is most commonly performed under general anesthesia. The anesthesia plan depends on procedure complexity, medical history, and facility protocols. Your surgical team typically coordinates anesthesia evaluation as part of preoperative planning.

Q: How long is the downtime?
Downtime varies by the extent of surgery, whether one or both jaws are treated, and individual healing response. Most patients expect an initial period of swelling and activity limitation, followed by gradual return to work/school and normal eating over time. Exact timelines differ significantly by clinician and case.

Q: How long do results last?
Because the bone heals in a new position, changes are generally intended to be long-lasting. However, bite settling and some degree of relapse can occur in certain movements or anatomies, and soft-tissue appearance can evolve with aging. Longevity depends on planning, healing, and orthodontic follow-through.

Q: Is orthognathic surgery safe?
All surgery involves risks, and jaw surgery includes specific considerations such as nerve sensation changes, infection, bleeding, and healing issues. Overall safety depends on patient health, clinician experience, facility standards, and the complexity of the movements. A personalized risk discussion is a standard part of informed consent.

Q: Will I need braces or aligners?
Many treatment plans involve orthodontics before and after surgery to align teeth with the new jaw relationship. Some modern pathways reduce pre-surgical orthodontic time in selected cases, but coordination is still common. Whether orthodontics is required depends on your bite and treatment goals.

Q: Can orthognathic surgery change my face significantly?
It can change facial proportions because it repositions the underlying skeleton. The degree and visibility of change depend on the amount and direction of movement, preoperative anatomy, and how soft tissues adapt. Some changes are subtle; others are more noticeable, and predictability varies by clinician and case.

Q: How much does orthognathic surgery cost?
Costs vary widely based on region, facility fees, anesthesia, imaging/planning, surgeon fees, and whether orthodontics is included. Insurance coverage (when applicable) also varies depending on diagnosis and documentation requirements. A detailed cost estimate typically requires an individualized evaluation.