Cleft Orthognathic Surgery

Candidates are typically teenagers or young adults who have completed facial growth and are experiencing bite misalignment, difficulty chewing, speech changes, or facial imbalance related to prior cleft repairs. A detailed evaluation with 3D imaging and orthodontic records helps determine readiness.

The scar tissue and growth differences that occur after early cleft repair can restrict forward growth of the upper jaw. As a result, the upper jaw may sit too far back relative to the lower jaw. Orthognathic surgery repositions the jaws so the teeth can meet properly and establish better harmony in the face.

This procedure is typically performed after skeletal maturity, which means when children stop growing and their bones are fused. This typically occurs between ages 15 and 18.

Yes. In addition to improving function, orthognathic surgery often enhances facial proportion, particularly by bringing the midface forward, improving lip support, and softening a retruded or flattened appearance. Our goal is to create a natural, balanced result that still looks like you, just more proportional.

A CT scan is required for proper diagnosis and evaluation of the bone structure so that jaw surgery can be planned more accurately. There are many different techniques in bone cut patterns that are specific for a patient’s bone structure and other anatomy, which can only be confirmed with proper imaging. It is also needed to rule out any other complicating anatomical factors that would affect decisions regarding your treatment plan.

Because cleft-related jaw discrepancies are functional as well as aesthetic, insurance often provides partial or full coverage. Our office handles preauthorization and all necessary documentation before the surgery to ensure and confirm coverage.

Cleft orthognathic surgery is a team-based process. We collaborate closely with your orthodontist, speech specialists, and restorative dentists to ensure all functional and aesthetic goals align. Each phase from pre-surgical orthodontics to final detailing is coordinated for a seamless, predictable outcome.

Typically it is important for patients to be under the care of an orthodontist before and after jaw surgery. Even if their bite is stable preoperatively, an orthodontist might be involved to 1) establish a better occlusion (bite) that will allow the jaw surgery movements to be more ideal, and 2) stabilize the occlusion after surgery (because it is not uncommon for tiny shifts to occur after surgery). It is important to note that this does not apply to an isolated chin procedure (genioplasty) as those cases do not involve the bite.

Not every jaw surgery requires genioplasty; however, in most cases when the jaws are not ideally developed, the chin is also not ideally developed. Repositioning the chin bone at this time allows for an ideal profile and aesthetic bone structure. Also, many times with asymmetries of the jaw, there is also asymmetry at the chin, which needs to be corrected as well.

Yes. Small titanium plates and screws are used to hold the jaws in their new position as they heal. These are biocompatible and permanent, but can be removed later if desired. Most patients leave the plates and screws in forever and remove them only if they cause problems such as infection or extrusion, which is very rare.

Custom guided jaw surgery can have different meanings. The way it is used in our practice describes a process where the surgery is performed virtually on a CT scan of the patient’s facial bones with soft tissue predictive images and sketches. When the desired facial aesthetic is achieved, the surgeon customizes the precise position of the bone cuts and custom-designs the titanium plates that will be used to fixate the bones into their desired positions. This is a highly accurate and precise method of jaw surgery within 1-2mm of precision, allowing for smaller surgical access points (less invasive), quicker surgical times, more stable plate fixation, and therefore better results overall (aesthetically and functionally) than other methods.

No. For our standard orthognathic and genioplasty procedures, all of the incisions are inside the mouth. These incisions are placed in the deep folds of the mouth and are not visible once healed during speaking and smiling. We typically use sutures that dissolve on their own after a period of 1-2 weeks, which do not require removal. (For some cases, the surgeon will perform additional facial aesthetic procedures, and those procedures may require separate skin incisions.)

Jaw surgery is typically performed in a hospital or accredited surgical center, under general endotracheal anesthesia using a breathing tube to secure the airway. Most patients stay for observation at least one night before going home for comfort, monitoring, and early feeding adjustments.

For standard orthognathic surgery that includes the upper and lower jaws as well as genioplasty, the surgery can take between 2-4 hours including anesthesia prep time and waking up from anesthesia.

Yes, most patients stay for observation at least one night before going home for comfort, monitoring, and early feeding adjustments, though some are able to return home the same day.

Most patients spend one night in the hospital or facility for observation, followed by several weeks of soft foods and gradual return to normal activities. Swelling peaks around day three, then improves steadily. Pain is typically mild and managed with oral medication.

We typically ask patients to remain in town for a period of 1-2 weeks, depending on the surgery, before flying. However, car rides of 2-4 hours are okay the following day in most cases. (We would still like to see you for a post-op visit at the one-week mark.)