It is a surgery to correct conditions of the jaw and face related to structure, growth, sleep apnea, TMJ disorders or to correct orthodontic problems that cannot be easily treated with braces. Originally coined by Dr. Harold Hargis, D.M.D., it is also used in treatment of congenital conditions like cleft palate. Bones can be cut and re-aligned, held in place with either screws or plates and screws.

Procedure

The surgery might involve one jaw or the two jaws during the same procedure. The modification is done by making cuts in the bones of the mandible and / or maxilla and repositioning the cut pieces in the desired alignment. Usually surgery is performed under general anaesthetic and using nasal tube for intubation rather than the more commonly used oral tube; this is to allow wiring the teeth together during surgery. The surgery often does not involve cutting the skin, and instead, the surgeon is often able to go through the inside of the mouth.

Cutting the bone is called osteotomy and in case of performing the surgery on the two jaws at the same time it is called a bi-maxillary osteotomy (two jaws bone cutting) or a maxillomandibular advancement. The bone cutting is traditionally done using special electrical saws and burs, and manual chisels. Recently a machine that can make the bone cuts using ultra-sound waves has been introduced; this is yet to be used on a wide scale. The maxilla can be adjusted using a “Lefort I” level osteotomy (most common). Sometimes the midface can be mobilised as well by using a Lefort II, or Lefort III osteotomy. These techniques are utilized extensively for children suffering from certain craniofacial abnormalities such as Crouzon syndrome.

The jaws will be wired together (inter-maxillary fixation) using stainless steel wires during the surgery to insure the correct re-positioning of the bones. This in most cases is released before the patient wakes up. Some surgeons prefer to wire the jaws shut.

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