Orthognathic jaw surgery in Costa Rica: the plan comes first

When the bite doesn't close because the bones — not the teeth — are out of place, braces alone can't fix it. Orthognathic surgery moves the upper jaw, the lower jaw or both into a position measured beforehand, together with your orthodontist. Before operating I measure every movement in millimeters, check the airway and the jaw joints, and explain what you can and can't expect.

Anesthesia

General, in hospital

Planning

Cephalometry, CT scan and models

Teamwork

With your orthodontist, before and after

Hospital stay

Set in your plan, case by case

When it's indicated

• A lower jaw that sits too far forward (underbite) or too far back, when the difference is in the bone and braces can't compensate.
• Open bite: the front teeth don't touch when you close.
• Facial asymmetry caused by the bones, or a chin that sits off-center.
• Trouble chewing, closing the lips or speaking because of the size or position of the jaws.

Before surgery

• Pre-surgical orthodontics: the bite can look worse, and studies indicate quality of life tends to dip before it improves (the evidence is limited). That's expected.
• Wisdom teeth and smoking: they are among the most-cited risk factors in lower-jaw surgery. We decide early whether the wisdom teeth should come out, and I'll ask you to quit smoking.
• Healthy gums and any cavities treated.
• Blood tests and an anesthesia evaluation. If you snore or stop breathing in your sleep, tell me: you may need a sleep study.

How I plan it

How I do it

1. 01ConsultationI look at your bite, your face and your imaging, and we talk about what bothers you. If surgery isn't what you need, I'll tell you.
2. 02Pre-surgical orthodonticsYour orthodontist prepares the teeth over several months; together we decide when to operate.
3. 03PlanningWith recent imaging I set how many millimeters each bone moves and in which direction, and the splints are made.
4. 04SurgeryIn hospital, under general anesthesia and from inside the mouth. I cut the bone in a controlled way (osteotomies), bring it to the planned position with the splint and fix it with titanium plates and screws. I use medication to help prevent nausea and reduce swelling.
5. 05Check-ups and final orthodonticsFrequent check-ups at first; then your orthodontist fine-tunes the bite.

Recovery

• Swelling peaks between 48 and 72 hours, then goes down.
• For the first two weeks the mouth doesn't open much: a liquid, then soft, diet.
• Lip and chin numbness is the most bothersome and longest-lasting symptom; for most people it improves over the months.
• At 5 weeks, in 378 patients after two-jaw surgery, the most common complaint was nasal congestion (55.6%).
• Mouth opening keeps improving steadily over three months.
• Going back to school or the office is gradual and depends on the case; there's no number I can promise you.

Risks and how I prevent them

Lip and chin numbness

The most common effect of lower-jaw surgery. Across 47 studies, 1 in 5 people (21%) still had some altered sensation at one year; change that doesn't resolve is reported from 3.4%, because each study measures it differently. In the 47-study review, risk was higher with large advancements and nerve manipulation, so I locate the nerve on the CT and plan the cut away from it. The tongue is rarely affected (0.1% to 0.7%).

Infection and plate removal

Infection: from 3.55% in two-jaw surgery to 9.6% in lower-jaw series. Removal of a plate: from 4.21% to 11.2%. To lower the risk: antibiotics per protocol, good hygiene and not smoking (smoking and age are among the most-cited risk factors); a plate that bothers you can be removed later.

Unplanned fracture

When the lower jaw is split, the bone can break where it wasn't planned (2.3% of operated sides). It's generally handled during the same surgery.

Relapse

The bone can partly drift back. In retruded lower jaws followed for 5 to 13 years there was some relapse, generally within clinically acceptable limits. Orthodontics, stable fixation and follow-up help hold the result.

Airway and sleep

In one review, 12.25% of people who had two-jaw surgery for a deformity developed sleep apnea afterwards: a signal to assess sleep before and after, not an individual risk.

Sinusitis and facial nerve

After upper-jaw surgery, sinusitis occurred in 3.3% of cases; I watch for it at check-ups. Facial-nerve weakness is rare (0.04% to 0.77%), and 79.6% of reported cases recovered completely with conservative care.

Other options

Orthodontic camouflage

In mild cases, braces compensate by tilting the teeth. It improves the bite but doesn't change jaw position or your profile.

Surgery first

In selected cases surgery comes before orthodontics. In a review of 12 studies it was somewhat less stable than the traditional order.

Not operating

A valid choice if the problem is mild, there's no functional issue, or you'd rather not take on the risks. The decision is yours.

If the reason is sleep apnea

In randomized trials CPAP outperformed the other options, and the guideline suggests trying it first; a mandibular advancement device is another option if you can't tolerate it.

Frequently asked questions