Orthognathic surgery, from the Greek words "ortho" (straight or properly aligned) and "gnathos" (jaw), refers to a procedure in which the jaw bones are cut and repositioned in an optimal alignment with one another. Maxillary surgery refers to surgery performed on the upper jaw only, mandibular surgery to that performed on the lower jaw only, and maxillomandibular surgery to that performed on both jaws. Common reasons for choosing to undertake this surgery are clicking sounds or pain in the jaw joint, an open bite, and unhappiness with one's appearance.
Several months prior to surgery, the patient consults with an orthodontist, who will be working with the orthognathic surgeon as a team during the entire process. Cranial X-rays will be taken to map out the location of the teeth and bones. If the patient still has his or her wisdom teeth, they are removed, and as soon as the wounds are healed, braces are installed in order to prepare the position of the teeth for surgery, since in many cases of an open bite, teeth shift so that they can meet as well as possible when biting down on something.
Once the teeth have reached their desired alignment, the patient visits the hospital in which the surgery will be performed--under general anesthesia, of course. In most cases, the surgery will be performed entirely from inside the mouth in order to ensure a minimum of scarring. If a jawbone is being lengthened, bone grafts will be taken from the patient's hip to use in the procedure. Older or anemic patients will have drawn blood prior to the procedure in order for it to be used in the event that a transfusion is required. After the procedure, the patient remains in the hospital for as long as the immediate effects of the anesthetic need to wear off; this can mean that the patient leaves as soon as the same day of the procedure or the day following.
Depending on the procedure, after surgery the patient's jaws may be wired together and immobilized until the initial healing has taken place (usually six to eight weeks). During this period, of course, the patient would have to adapt to a high-protein and high-calorie liquid diet. However, a relatively new technique of post-operative mandibular stabilization involves the use of titanium screws holding the separated parts of the jaw together, two screws to each side of the jaw. This technique has the benefit of allowing the patient to speak normally within hours after the procedure and avoids the problem of jaw muscles cramping and losing their mobility after being locked into the same position for weeks at a time. In fact, patients are encouraged to use certain gentle exercises to help the jaw muscles become accustomed to their new position. Also, instead of needing to be kept on a liquid diet for two months, the patient can begin on semisolid foods within a few days and graduate to solid foods within a couple of weeks, depending on their health and healing status.
Regardless of whether the jaws are wired shut or pinned together, however, patients should avoid heavy activity until the wounds are closed. Also, contact sports should be avoided until the bone has healed properly, which can be any time from six months to a year after surgery, depending on the patient's metabolism.