Bilateral Sagittal Split Osteotomy (BSSO)
- Short term: 24 to 48 hours swelling and discomfort are at a maximum, teeth may (but not as likely as in a two-jaw operation) be held tightly together using elastic bands or less commonly wires. A splint may be in place. Steroids used to reduce swelling produce an initial sense of euphoria. During this period this wears off and the first day or two after all orthognathic operations is quite difficult. An operation undertaken to make you bite and look better seems to have done the opposite! Sit tight.
- Medium term: over the next 2 to 3 weeks the gloom, swelling and discomfort improve and there is more a sense of frustration, wanting to get rid of the elastic bands and clean your mouth properly. A lingering odd feeling in the lower lip should improve. The sutures inside the mouth all dissolve. If any are on the skin, they are removed about 5 days later.
- Long term: there is less likely to be a need for completion orthodontics in a single-jaw operation but if there is, this usually takes far less time (the teeth move faster after surgery than before) than pre-operative orthodontic arch alignment, levelling and decompensation.
Vertical Sub-Sigmoid Osteotomy (VSSO)
- Short term: having intermaxillary wires or elastics are even more likely, as the internal fixation process while possible is more difficult than for the sagittal split procedure (see above).
- Medium term: more likely to have frustrations over the elastics or wires, less likely to have sensory problems with the lip.
- Long term: similar to above, but the risk of relapse may be higher than in a BSSO.
Inverted L osteotomy – many similarities to the above but this operation is now used so rarely that we would advise seeking advice from the surgeon who choses to use it.
Anterior subapical osteotomy – again not an operation currently in vogue.
Posterior subapical – even more so. In the event of being likely to undergo this operation we would recommend asking questions of your surgeon.
A relatively common operation which is done by other surgical disciplines although this is usually by way of implants. The timeline here describes the more usual maxillofacial version which is a true osteotomy of the chin.
- Short term: discomfort more than pain as the osteotomised segment is fixed internally, some minor sensory disturbance might be noticed. An odd dressing is usually the most frustrating aspect.
- Medium term: getting used to a slightly different appearance.
- Long term: relapse is the main issue.
Le Fort I osteotomy
- Short term: swelling and discomfort are the main issues. Bruising around the eyes can be quite obvious. It is difficult to breathe through the nose as there are often small blood clots present. If elastic bands, splints or wires are used, then the same issue as with BSSO (see above). If part of a two-jaw operation (Le Fort I and BSSO is by far the most common bimaxillary orthognathic operation), then lip sensation alterations, limited mouth opening, difficulty in cleaning teeth and all the issues around steroids and swelling are magnified.
- Medium term: If only a Le Fort I procedure and the bite is correct immediately, then the recovery from this operation is often very quick and the result dramatic. More frequently it is part of a bimaxillary procedure and the overlapping issues with the mandible and maxilla tend to prolong this recovery period as swelling settles over a 10 to14 day period and there is usually a period of postoperative orthodontics.
- Long term: these are life changing operations and have often been preceded by a lengthy period in orthodontic preparation. The final 6 to12 months of orthodontic finishing can be frustrating but there are usually no other issues except a small incidence of long term altered sensation to the lips and gums (the latter often not noticed at all).
Rarely used now, as a modification of the Le Fort I is more commonly used.
Surgically Assisted Rapid Palatal Expansion (SARPE)
- Short term: a short (overnight) stay in hospital, although this can be done as a day case. Stitches dissolve and discomfort rather than pain is the norm. The rapid maxillary expansion appliance is usually fitted as part of the procedure.
- Medium term: wound healing is usually uneventful. Turning the screw in the appliance is the major challenge but you will be taught how to do this.
- Long term: this is usually a successful procedure with little relapse. Removing the appliance may be the only long-term issue.