The term osteotomy means the surgical cutting of bone, and is also called corrective jaw surgery.  It is an orthognathic (jaw straightening) procedure to correct jaw deformities, where the jaw bone is cut, moved, and realigned to achieve an improved and natural-looking facial appearance. It can be performed on either the upper or lower jaw, and is used to resolve a wide range of maxillofacial problems.

There are just 3 basic osteotomies that can manage most maxillofacial deformities:  1) the mid face with the Le Fort Type I osteotomy, 2) the lower face with the sagittal (vertical plane) split ramal (bony projection) osteotomy of the mandible, and 3) the horizontal osteotomy of the symphysis (bone fusion) of the chin.

Types of dentofacial osteotomies are:

  • Maxillary (upper jaw, treats open bite)
  • Maxillary segmental
  • Mandibular (lower jaw, treats receding chin or open bite)
  • Mandibular body segmental
  • Mandibular symphysis osteotomies.
  • Bilateral sagittal split osteotomy (BSSO) *
  • Genioplasty (moves chin backwards or forwards)
  • Rapid Palatal Expansion (treats a constricted/oval shape maxilla)
  • Le Fort Type I, Type II, & Type III
  • Vertical ramal
  • Inverted L and C

* The most commonly performed jaw surgery, and considered an indispensable tool for correcting dentofacial abnormalities because it can move the jaw on multiple planes.

Deformities are uncomfortable, such as micrognathia — the mandible doesn’t grow far forward enough (over bite), and when the mandible grows too much, causing an under bite.

Some of the symptoms of dentofacial deformities that create challenges for patients, are:

  • Open bites (space between upper and lower teeth when the mouth is closed)
  • TMJ pain, temporomandibular joint disorder
  • Excessive wear on teeth
  • Difficulty swallowing
  • Difficulty chewing
  • Receding or protruding chin
  • Pain in Jaw

Orthodontic treatments may simply not be enough when there are more severe dental alignment problems. Then surgery may be required to correct the problem.  The upper and lower jaws are bases upon which teeth are aligned. Jaw abnormalities may be inherited or acquired from developmental or traumatic events, and may affect not only your facial appearance but also your bite, speech, and/or chewing.  Braces correct dental abnormalities like crooked teeth and poor bites (malocclusion). However, the more extreme irregularities of jaw size or position can only be corrected surgically.  Corrective jaw (orthognathic) surgery may be needed when some of these additional conditions are present:

  • Birth defects such as Cleft Lip & Palate
  • Chronic mouth breathing, airway defects
  • Excessive show of gums (i.e. Gummy smiles)
  • Facial asymmetry (unbalanced facial appearance from the front, or side)
  • Inability to make the lips meet without straining
  • Sleep apnea (breathing problems when sleeping, including snoring)
  • Speech impairment
  • Trauma to head and face

Estimates show that nearly 5% of the population in the UK or USA are suffering with dental or facial deformities that cannot be easily corrected with orthodontic treatment, and will need orthognathic surgery to correct their condition.  However braces may still be needed before and after surgery to stabilize the teeth and jaw, and perhaps retainers after braces are removed.

Dentofacial osteotomies are typically performed by a maxillofacial surgeon, usually on an outpatient basis. The specific procedure used will differ, depending on the specific problem.  Advancements allow surgeons to expand the use of an osteotomy on more parts of the jaws with faster recovery time, less pain, and no hospitalization, making the surgery more effective with respect to time and recovery.

All dentofacial osteotomies require an initial healing time of 2–6 weeks with secondary healing (complete bone fusion and remodeling) taking an additional 2–4 months.  The jaw may be immobilized (movement restricted by wires or elastics) for approximately 1–4 weeks. However, the jaw will still require two to three months for proper healing. The convalescence period is short, and most patients are able to return to work 2–3 days after the surgery, but must follow the specific rules for recovery for 8 weeks.

Some of the main goals of orthognathic surgery are to achieve a correct bite, improve facial appearance, and alleviate breathing problems by enlarging the airway.   These can greatly enhance the patient’s self-esteem and quality of life.

If you are interested in dentofacial osteotomy in Costa Rica, fill out the “Find a Dentist” form on this page.  One of our patient advocates will reply to your needs.