Dr. Neil Agnihotri is very passionate about Orthognathic Surgery (Jaw Surgery). He is uniquely trained in Craniofacial Surgery (surgery of the face/skull) and has performed hundreds of cases. Jaw surgery provides a permanent solution to not only enhance facial aesthetics, but also to prevent pain and other defects down the road. Facial implants (chin/cheek) along with jaw surgery create a well-rounded facial and profile enhancement.

 

The ACS Difference

Dr. Agnihotri uses the latest in virtual planning technology to plan, perfect and execute your surgery. Each surgery is different like each patient is different. We custom make each part and piece involved using VSP Orthognathics and 3D imaging systems. These systems are among the greatest in the industry and allow for the most accurate surgery and natural-looking results.

Want to research more? Check our Dr. A’s blog post >>

What is It?

A definitive treatment for open bites, under bites or people with jaw discrepancies.

Cost: $$$$

Downtime:

2 weeks of initial healing, 5 weeks of complete healing.

Anesthesia: General anesthesia

Who is it for?

Teenagers / adults with jaw discrepancies.

Frequently Asked Questions

Why should I fix my bite?

  • This depends on the extent of your bite problem. You may have already experienced problems with your bite while other issues may not become apparent for several years. Tooth wear, gum recession, loss of fillings/crowns, and eventual tooth loss are all possible in the future.

Why can’t braces alone fix my problem?

  • Your bite problem is extensive.
  • Your upper and lower jaws are not properly aligned.
  • Your bite is “off” because of both crooked teeth and crooked jaws.
  • While braces can straighten crooked teeth they cannot straighten crooked jaws.
  • Attempting to straighten crooked jaws with braces alone doesn’t work and can injure your teeth/gums.

What are the options for correcting my bite?

  • The overall possible options to consider include:
    • Braces only
    • Braces and lower jaw surgery only
    • Braces and upper jaw surgery only
    • Braces and surgery on both jaws

What determines which of the four options is best to treat my bite problem?

  • The evaluation of “complete” facial and dental records and assessment by specialists (surgeon and orthodontist) is necessary. Complete records likely include:
    • Molds of your teeth
    • Special x-rays (Cephalometric and Panorex)
    • Bite registration
    • Facial and occlusal photographs
  • Consultation with an experienced Orthodontist and Surgeon who are both familiar with the needed orthodontic treatment and surgical care for someone with both a bite and jaw problem is essential.
  • The treatment option recommended will be the one that is overall best for your function (bite, speech articulation, breathing and lip closure) and facial appearance In general the two (function and aesthetics) go hand in hand.

What if the wrong treatment option for my bite/jaw problem is chosen?

  • The bite may not be corrected despite years of orthodontic treatment
  • An initial satisfactory orthodontic bite correction may tend to “relapse” over time. This can result in bone loss around the teeth with gum recession and loosening of the teeth.
  • Your facial appearance may also be negatively affected.

Why would a clinician (Orthodontist or Surgeon) recommend a treatment different from the one that you are recommending if it might not solve my problems and may cause complications?

  • There are differences in the training and experience level of the different surgeons/orthodontists that you will see. Some have more or less experience with the type of problem that you present with. 
  • It will be up to you or your family to discern discrepancies/ differences in opinions given.

Why have the opinions that I have received been so different?

  • The most common reason has to do with differences in doctors training and experience. Not all of the dentists/surgeons that you will see have an equal level of experience with your specific problem. 
  • It will be up to you or your family to discern discrepancies/ differences in opinions given.

Can orthognathic surgery be carried out without orthodontic braces?

  • The optimal result can only be achieved through a combination of orthodontic treatment and jaw straightening surgery.
  • If “surgical” braces are used rather than “orthodontic” braces, injury to the “gums” may occur. In addition, detailing of the bite for the best occlusion would not be possible without simultaneous orthodontic treatment.

How long will I have to wear braces before and after surgery?

  • I can estimate of the amount of time pre-surgical orthodontic treatment will be required, but a specific answer can only be given once you have been seen by an experienced orthodontist.

Is the jaw straightening surgery considered cosmetic?

  • Jaw surgery which improves function including (bite, speech articulation, breathing, lip closure and relief from myofascial pain) is usually considered as medically necessary- However many patients are pleased to have better facial balance and aesthetics. 

Does insurance generally cover this type of surgery?

  • The insurance to consider would be your medical insurance not your dental insurance.
  • If the planned surgery is expected to improve your function there is a reasonable chance that your “medical” insurance will provide coverage.
  • A Financial Coordinator in my office can assist with the “pre-authorization” process to determine whether or not the procedures discussed are covered by your medical insurance company.

How much will the surgery cost?

  • A financial coordinator in our office can discuss anticipated fees with you prior to your leaving the consultation.

When do I need to return to your office for further visits?

  • This depends on your ongoing orthodontic and dental needs.
  • I will work with your orthodontist and dental specialists to help achieve your objectives while minimizing the number of visits required.

When do I schedule my actual date for surgery?

  • I will work closely with your orthodontist and dental specialists. We will estimate a date for your surgery well in advance of the actual date.  The actual “orthodontic” ready date will depend on your specific needs as well as your availability for appointments and school/job requirements.

Where is the surgery performed? How long will I be in the hospital?

  • I generally perform surgery at our accredited surgery center or at Parham Doctors Hospital. Usually you are out of the hospital within 23 to 48 hours after surgery, depending on what your insurance provider allows.

How much time will I miss from work or school?

  • Generally, I will ask that you remain at home with no specific school or work responsibilities for the initial two weeks after surgery.
  • In general, I will recommend that you refrain from driving a motorized vehicle for the initial four weeks after surgery.
  • In general, I will request that you refrain from any sports or gym like activities for five weeks after surgery.
  • In general, I will ask that you remain on a liquid (blenderized) diet for the initial five weeks after surgery.

Is the surgery painful?

  • As a rule, excessive pain is not experienced.
  • Pain medications are given to address any pain level that occurs.
  • Pain medications are generally not required after five to seven days.

How much swelling occurs after surgery?

  • The extent of swelling and the duration of the swelling is variable.
  • In general, 80% of the swelling is gone within two to three weeks.
  • Limited, but residual swelling may last up to twelve months.

Will my jaws be wired shut?

  • No, standard orthodontic rubber bands are used between your upper and lower braces to help provide support to the jaws and limit the need for your using the muscles that open and close your mouth. By doing so, there will be limited pain after surgery.
  • The standard orthodontic rubber bands may be removed at anytime should it be necessary or if you feel the need to do so.
  • The rubber bands will be changed out at least every week if not more frequently as you wish.

How and what will I eat?

  • A liquid – blenderized type of diet will be used for the initial five weeks after surgery.
  • A return towards normal food will begin after the initial five weeks of healing.
  • Achieving a well balanced diet through a blenderized diet these days is easy to do with pre-packaged foods or according to your taste preferences.

Will I be able to exercise after surgery?

  • We ask that you refrain from sports activities and/or gym classes during the initial five weeks after surgery.
  • In general, after 5 weeks of healing you may return towards your normal sports/gym activities.

 

 

For information on what Orthognathic Surgery (Jaw Surgery) entails, check out this video:

Having Orthognathic Surgery from AAOMS.org on Vimeo.

The Results

Treatment Information

Post-treatment Instructions for Jaw Reconstructive Surgery

 

The following information is provided to ensure that many of the details of postoperative care are covered prior to your surgical procedure. This ensures a smooth and uneventful recovery. It has been our experience that the more information and preparation patients have prior to their surgery, the more easily they are able to manage their postoperative care.

 

There are several aspects of your postoperative care which will require special attention. These areas of concern are listed below in the sequence with which you will have to manage them after your surgery.

 

Swelling

It is difficult to predict what you will remember immediately following surgery. You may remember waking up in the recovery room or you may not recall this event and only remember waking up in your room. Regardless, be assured that there will be experienced and caring nurses and staff to attend to your needs. When you awake, you may have some concerns. You will likely have a small oxygen mask lightly over your face; this is routine. If you have some fluids in your mouth or stuffiness in your nose, this will be removed with a small suction tube. Remember – your jaws will be held together with some elastics-not wires. Many of these things can cause you to feel uncomfortable or even panicky. Remember to relax and listen to the staff – you are in no danger. Your jaws are not wired together and usually you will be able to open the jaws against the force of the elastics. We would prefer that you don’t. This resting of the jaw will help minimize swelling.

 

You will be positioned with your head up. This will help minimize swelling. This “head up” position should be used for the first 7-10 days to help reduce swelling. Expect the peak of your swelling to occur 48 hours after surgery and most should be gone by 7-10 days. In the hospital, the bed will be flexed in the middle to prevent you from sliding to the foot of the bed. At home, propping up your mattress at the head of the bed and under the foot of the bed will help also. Spending a lot of time in a “Lazy Boy” type chair is an excellent alternative. Remember, keeping your head above the level of your heart is what helps reduce and minimize swelling. How much swelling you will actually have varies significantly from patient to patient.

 

In the hospital, several additional aids will be used to help minimize your swelling. Medications will be administered to help decrease swelling. Ice packs will also be used. Constant use for the first 12 -24 hours is most effective. The nurses will assist you with ice packs which should be applied for 20 minutes and removed for 10 minutes.

 

Nasal swelling and stuffiness can also be a problem after upper jaw surgery. This will tend to be worse 48 hours after surgery and will then begin to decrease.

 

Warm packs to the face after the first 48 hours will help increase blood supply and reduce swelling, speeding the resolution of discoloration associated with bruising. If bruising occurs it will be evident 4-5 days after surgery.

 

Just a final word regarding your jaw surgery and safety. First, the elastics can be easily removed by you. In the unlikely even vomiting occurs, it is most important to position yourself properly rather than to try to take the elastics off. If you are sick, position yourself over a basin or toilet bowl and let the fluids pass between the spaces in your teeth and out your nose. You will not choke. There is no need for you to take wire cutters home with you.

 

Drinking

Following jaw surgery there is frequently some numbness in the upper or lower lip, or both. When this is combined with facial swelling and soreness due to incisions inside the mouth, a task as basic as drinking may present difficulties. There are several tips which may help you:

  • You should be drinking a fair amount of fluid after jaw surgery. Daily amounts should be between 2 -3 liters. Fruit juices are an excellent source of fluid, especially apple juice. This is a major goal after surgery. The most frequent cause for a delay in discharge from the hospital is a lack of adequate fluid intake. Always have some fluids in front of you and drink frequently to consume 2-3 liters in 24 hours. The nurses will be encouraging you to drink early.
  • Attempt to drink from a cup if possible. While some fluids may be spilled when drinking in this manner, this is still the most effective way of taking fluids.
  • Place a small towel under your chin if necessary and place a small amount of fluid in your cup. Tip your head back slightly while pouring in the fluid slowly, a little at a time. Close the lips together and swallow. If you have difficulty with this, then try doing it in front of the bathroom mirror over the sink. You will find this gets easier the more times you drink.

 

REMEMBER: TAKING ADEQUATE AMOUNTS OF FLUIDS IS ESSENTIAL FOLLOWING SURGERY

 

Medications

Several medications will be used around the time of your surgery. Antibiotics will be given during your hospital stay through the intravenous. Upon your discharge from the hospital, these antibiotics will be given in liquid form.

 

Pain medication will also be given after your surgery. In the first 24 hours following your surgery, the pain medication will be administered through intravenous. You will regulate the amount of pain medication you are given. It must be emphasized that this route of administration is only used while you have the intravenous, which is approximately 24 hours. We always encourage you to use oral pain medication as soon as possible as this will expedite your discharge from the hospital and allow for a smoother transition. Upon your discharge from the hospital, your pain medication will be in liquid form. In general, there is less pain than most would anticipate with this surgery. This is due to the dysfunction of the sensory nerve in the areas of surgery which minimizes your ability to feel discomfort.

 

Plastic Splint

This is an important part of your surgery. This will help balance your bite and train your muscles to function in the new jaw position. It has indentations on it that fit the teeth on the top and bottom and thus will only fit one way.

Generally, the splint will be worn continuously for the first 3-5 weeks following surgery. Your orthodontist may continue to use the splint for a short period of time to assist treatment. Failure to wear the splint may cause pain or may result in significant change of the bite! The splint will also help reduce jaw joint pain.

 

Jaw Joint Pain

It is possible to experience some pain or pressure in or around your jaw joint after jaw surgery. This may feel somewhat like an earache. This pain or pressure will usually disappear within 2 to 3 weeks. If the pain medication is not taking the pain away, let us know and an anti- inflammatory medication may be prescribed. The new position of your jaw is the cause of pressure in the jaw joint area.

 

Dietary Intake

Please see the links below for helpful information and sample menus:

https://healthcare.utah.edu/ent/docs/jaw-surgery-cookbook.pdf

https://www.gwh.nhs.uk/media/140776/help_yourself_to_eat_well_after_jaw_surgery.pdf

Start looking the age you feel, today!