One of the more involved things that I do as an orthodontist is to give parents guidance and advice if we have identified something in the cranial facial growth of their child that indicates that they may benefit from a surgical procedure in addition to traditional orthodontics. Some parents are familiar with these procedures if they (or a family member) has had surgery to help correct their own jaw relationships in the past, or can clearly visually recognize that there is a significant jaw imbalance. The purpose of this article is to act as a starting point to help parents and patients understand why they may be a candidate for jaw surgery, how it may benefit them, what the potential risks are.
Hearing that a child’s jaw growth has, or may progress to the point where surgery is needed to achieve an acceptable bite or facial aesthetics is usually a cause of great stress to the parents of the child. Having had this conversation with hundreds of families, and having a daughter of my own that is a possible candidate for a surgical jaw correction, I can empathize with the worry, uncertainty, and parental concern that naturally accompanies such a decision. Here are some of the most common questions about orthognathic (jaw) surgery that I commonly address.
” Why might my child need jaw surgery?” Jaw surgery (orthognathic surgery) is most often an option when the upper jaw (maxilla) or lower jaw (mandible) has grown disproportionately in size to the other. Other indications for surgery may stem from issues due to jaw asymmetry, congenital defects or syndromes. Most commonly though, I guide people through making decisions about surgery due to a lower jaw that is growing too much, a lower jaw that has not grown enough, or an upper jaw or midface that is not growing enough.
“What are signs that my child’s jaws are not growing in proportion?” If the lower jaw is not growing enough, there is often the appearance of a “weak chin” that is set far back, or upper teeth that appear excessively forward of the lower teeth. If the lower jaw is growing too much, or the upper jaw not enough, the chin often appears to protrude too far or to be too large. The front teeth will also often be in a crossbite (lower teeth ahead of the upper teeth), even at an early age. An upper jaw that is too narrow will often cause a posterior crossbite (back teeth that are on the wrong side off one another).
“Cant crossbites, overbites, underbites, and jaw issues be corrected by orthodontics?” Most often these issues can be corrected with orthodontics, but there are two main factors that must be considered. The first is the magnitude of these conditions. If the jaw imbalances are severe enough, no amount of orthodontic treatment will obtain a result that is within normal limits. The second factor is the age that these issues are treated. Certain relatively severe issues, such as crossbites and some underbites can be corrected or greatly improved if treated early enough. It is important for an orthodontist to identify these imbalances early, as there are age appropriate times for these conditions to be treated most effectively (for example, many crossbites cannot be fixed after the maxillary suture fuses during the mid-teen years). However, it is just as important for an orthodontist to have discussions with the family if it appears that orthodontics and braces alone cannot result in a satisfactory outcome. This is when the option of a surgical correction comes into the equation, and the sooner it is discussed, the better prepared the family will be.
In several weeks, I will continue this article with more information regarding surgical orthodontics in the second half of this blog.
Dr. Dan Rejman has two orthodontic specialty offices located in Castle Rock, CO. He is happy to have complementary consultations with families or patients that are looking for advice regarding dental or oral-facial developmental concerns.