Orthognathic (Jaw) Surgery in Singapore: Costs, Risks, Recovery

Orthognathic surgery is a specialized procedure that corrects abnormalities of the jaw bones and facial skeleton.

If you’ve been referred to an oral and maxillofacial surgeon for jaw issues, this comprehensive guide will help you understand what orthognathic surgery entails, who needs it, and what to expect throughout the treatment journey.

What is Orthognathic Surgery?

The term “orthognathic” derives from the Greek words “ortho” meaning straight and “gnathic” referring to the jaws. Orthognathic surgery refers to corrective jaw surgery that aims to realign or reposition the upper jaw (maxilla), lower jaw (mandible), or both, to achieve proper function and facial balance.

This surgery is typically performed in conjunction with orthodontic treatment (braces) and requires a multidisciplinary approach involving:

An orthodontist who specializes in correcting teeth positioning
An oral and maxillofacial surgeon who performs the actual jaw surgery
Allied health professionals such as dieticians and speech therapists who assist in recovery

Why is Orthognathic Surgery Necessary?

While orthodontic treatment can correct dental abnormalities like crooked teeth, some bite problems stem from underlying issues with the jaw bones themselves. When there’s a significant disharmony in jaw position or size, orthognathic surgery becomes necessary to:

Improve function: Enhance chewing efficiency, speaking ability, and breathing
Correct aesthetic concerns: Restore balance to facial proportions
Establish proper bite alignment: Create a stable occlusion (how the teeth meet)
Address health issues: Treat conditions like sleep apnea that may result from jaw abnormalities

Common Jaw Problems That May Require Orthognathic Surgery

Long Lower Jaw (Mandibular Prognathism)

People with a long lower jaw often experience:

Difficulty chewing with front teeth as upper and lower teeth don’t properly contact
Speech difficulties, particularly with sounds containing ‘s’, ‘f’, and ‘v’
A pronounced chin and protruding lower lip compared to the upper lip

Asymmetric Jaw

An asymmetric jaw occurs when the lower jaw is slanted to one side, creating an imbalance in the bite (crossbite). This condition can range from mild to severe and is often detectable by visual inspection.

When viewing someone with a crossbite, you’ll notice their chin is not aligned with their nose, and sometimes their lips appear slanted.

Short Lower Jaw (Mandibular Retrognathism)

Individuals with a short lower jaw typically have:

Protruding upper front teeth due to increased distance between upper and lower dentition
A small chin when viewed from the side
Appearance of a double chin despite being at a healthy weight (due to insufficient jaw length for proper tissue distribution)
Increased risk of obstructive sleep apnea due to a narrowed airway when the tongue falls back during sleep

Skeletal Open Bite

A skeletal open bite occurs when the upper and lower jaws diverge from each other, preventing the front teeth from making contact. This means chewing occurs only with the back teeth, giving a longer facial appearance.

Gummy Smile (Vertical Maxillary Excess)

This condition is characterized by:

Excessive gum display when smiling
A longer and lower upper jaw than normal
Difficulty closing the lips comfortably

How to Determine if You Need Orthognathic Surgery

If you suspect you have any of the conditions mentioned above, consider consulting with an orthodontist who can assess your situation. The evaluation process typically involves:

Facial examination
Dental impressions
X-rays of your jaws
Photographs to document your condition

An orthodontist works in collaboration with an oral and maxillofacial surgeon to determine whether orthognathic surgery is necessary or suitable for your specific case. They’ll evaluate the degree of disharmony between your jaws and create an individualized treatment plan.

The Orthognathic Surgery Treatment Process

Orthognathic surgery is not a single procedure but a comprehensive treatment plan that spans several months to years. There are two possible treatment sequences:

Braces first, then surgery
Surgery first, then braces

Your orthodontist and oral surgeon will jointly determine which sequence is most appropriate based on your specific jaw and teeth alignment issues. Let’s look at the typical treatment phases:

Phase 1: Treatment Planning

This initial phase involves:

Consultations with both the orthodontist and oral surgeon
Taking records, X-rays, and 3D scans
Creating a customized treatment plan
Discussing the risks, benefits, and alternatives

Phase 2: Pre-Surgical Orthodontics

If following the more common “braces first” approach:

Braces are placed to align your teeth properly
This phase typically lasts 9-18 months depending on complexity
You’ll have appointments every 4-6 weeks to adjust your braces
The goal is to position your teeth optimally for surgery, even if this temporarily worsens your bite

Phase 3: The Surgery

Once your teeth are properly aligned, the surgical phase begins:

You’ll be admitted to the hospital (typically for 2-3 days)
The surgery is performed under general anesthesia
The surgeon makes cuts in the jaw bones and repositions them into the correct alignment
Titanium plates and screws secure the bones in their new position
Most patients are monitored in a high-dependency unit or intensive care unit overnight after surgery

Phase 4: Post-Surgical Orthodontics

After surgery:

Your braces remain in place and are used to finalize tooth alignment
Elastics (rubber bands) may be used to guide your bite into its final position
This phase typically lasts 6-9 months
Once complete, your braces will be removed, and retainers will be provided

What to Expect After Orthognathic Surgery

Immediate Post-Operative Phase

Intermaxillary fixation: Your jaws may be temporarily secured together with elastics for up to 2 weeks to ensure proper healing.
Diet restrictions: You’ll start with a liquid diet for about 2 weeks, then progress to pureed foods, soft foods, and eventually return to a normal diet after about 6 months.
Facial swelling: Significant swelling around the cheeks, face, and lips is normal and typically resolves within 2-3 weeks.
Bruising: Some temporary bruising around the lower jaw is expected.
Limited mouth opening: Initially, your ability to open your mouth will be restricted.

Recovery Period

Hospitalization leave: You’ll typically require 4-6 weeks of leave for recovery.
Physical activity: While you’ll be encouraged to move around, strenuous physical activity should be avoided for at least 6 weeks.
Long-term precautions: Contact sports and activities that might result in facial trauma should be avoided for at least 6 months while the bones fully heal.

Post-Operative Care After Orthognathic Surgery

Medications

You’ll be prescribed various medications to aid your recovery:

Oral antibiotics to prevent infection
Pain relievers and anti-fever medications
Nasal drops for decongestion (for upper jaw surgery)
Lip creams for swelling and dryness

Feeding and Hydration

Use syringes and feeding tubes provided for liquid intake initially
Maintain adequate hydration (1500-2000ml daily)
Gradually transition from liquid to pureed to soft diet as advised

Oral Hygiene

Maintaining excellent oral hygiene is crucial to prevent infection:

Use a small-headed toothbrush with gentle antiseptic mouthwash
Carefully clean around braces, elastics, and any surgical splints
Rinse with prescribed antiseptic mouthwash after meals

Physical Activity Restrictions

Avoid vigorous exercise for at least 2 weeks
No swimming for at least 3 months
Avoid contact sports for 6 months
Prevent any trauma to the face during the healing period

Nutrition After Orthognathic Surgery

Proper nutrition is essential for healing after jaw surgery, and a diet rich in protein is recommended. Your diet will progress through several stages:

1. Full Liquid Diet (Weeks 1-2)

During the first two weeks, you’ll need to consume only liquids that:

Have a smooth, runny consistency
Contain no lumps or sediments
Require no chewing

Suitable options include:

Water, juice, milk, tea, coffee
Strained soups
Nutritional supplement drinks
Milkshakes

2. Pureed Diet (Weeks 3-6)

As healing progresses, you’ll advance to foods that are:

Blended to a smooth consistency
Free from lumps or pieces
Easy to swallow without chewing

Examples include:

Pureed rice porridge, mashed potatoes
Blended meat, fish, eggs
Pureed fruits and vegetables

3. Soft Diet (Weeks 7-12)

In this phase, you can introduce foods that:

Are soft and moist
Require minimal chewing
Can be cut into small pieces

4. Regular Diet (From Week 13)

After about 3 months, you can gradually return to your normal diet, though it’s advisable to continue avoiding very hard foods until 6 months post-surgery.

Potential Risks and Complications

Like any surgical procedure, orthognathic surgery carries certain risks:

Common Risks

Bleeding that may require intervention
Infection at the surgical site
Discomfort at the jaw joints
Injury to adjacent teeth
Temporary or permanent numbness in the lips, chin, or tongue due to nerve disruption
Relapse (the jaw reverting to its original position)

Rare Complications

Poor healing of the jaw bones
Loss of blood supply to bone segments
Changes in voice quality or airway
Injury to facial nerves causing muscle weakness
Vision problems (extremely rare)

Can Surgery Be Avoided?

In some cases, particularly for growing children and adolescents, early orthodontic intervention can help modify bone growth and potentially eliminate the need for surgery. Special orthodontic appliances can guide jaw development when used at the appropriate age.

However, for adults whose facial bones are no longer growing, significant jaw discrepancies typically can’t be corrected with braces alone. In these cases, combining orthodontics with surgery provides the best functional and aesthetic outcomes.

Alternatives to Traditional Braces

While traditional metal braces are commonly used in orthognathic surgery cases, some patients may be candidates for alternative options:

Clear Aligners (e.g., Invisalign)

Clear aligners may be suitable for some orthognathic surgery patients, depending on the specific teeth movements required. Your orthodontist will determine if you’re a candidate for this treatment approach.

Ceramic Braces

Ceramic braces function similarly to metal braces but are less visible, making them a more aesthetic option for some patients.

For surgery stabilization, traditional braces offer the advantage of built-in hooks that surgeons can use to secure the jaws after surgery. With clear aligners, the surgeon may need to use alternative methods like fabricated arch bars to stabilize the jaws post-operatively.

Frequently Asked Questions

How long does the entire treatment process take?

The complete treatment, including pre-surgical orthodontics, surgery, and post-surgical orthodontics, typically takes 18-24 months, though this varies based on individual circumstances.

Will there be visible scars after surgery?

Most orthognathic surgeries are performed through incisions inside the mouth, resulting in no visible external scars.

How painful is orthognathic surgery?

Pain management is a priority after surgery. You’ll receive appropriate pain medications during hospitalization and for home use. Most patients describe the experience as involving pressure and discomfort rather than acute pain.

Will my face look different after surgery?

Yes, orthognathic surgery will change your facial appearance, often in ways that enhance balance and proportion. Your surgeon will discuss expected changes during the treatment planning phase.

Do the titanium plates and screws need to be removed?

Generally, the titanium hardware used to secure your jaw bones remains permanently in place. It rarely causes problems and won’t set off metal detectors. Removal is only necessary if complications like infection or hardware exposure occur.

What are the success rates for orthognathic surgery?

Orthognathic surgery has high success rates, with most patients experiencing significant improvements in function and aesthetics. Your surgical team will discuss specific expectations based on your case.

Is orthognathic surgery covered by insurance?

Coverage varies by insurance provider and policy. Some plans may cover orthognathic surgery when deemed medically necessary (for functional problems rather than purely cosmetic concerns). In Singapore, some costs may be covered under Medisave, with deductible amounts depending on whether it’s a single or double jaw surgery.

How long will I need to be off work/school?

Most patients require 4-6 weeks of leave for initial recovery, though some may return to light duties earlier depending on their healing and the nature of their work.

Will I lose weight after surgery?

Some weight loss is common due to the liquid diet restrictions in the early recovery phase. Your surgical team and dietician will help ensure you maintain adequate nutrition.

Can I still have orthognathic surgery if I have existing dental work like crowns or implants?

Yes, existing dental work doesn’t usually prevent orthognathic surgery, though it may influence the treatment plan. Discuss any dental restorations with your orthodontist and surgeon during the planning phase.

Conclusion

Orthognathic surgery is a predictable, multidisciplinary treatment option for conditions where bite problems stem from jaw position rather than teeth alignment alone.

While the prospect of surgery can be intimidating, the procedure offers life-changing benefits for those with significant jaw discrepancies.

If you believe you might benefit from orthognathic surgery, consult with an orthodontist who can assess your condition and refer you to an oral and maxillofacial surgeon if appropriate.

Together, they can develop a customized treatment plan to address your specific needs and help you achieve improved function, aesthetics, and quality of life.