This webpage has been designed to improve understanding of Mandibular Osteotomy and contains answers to the most commonly asked questions about this treatment. If you have any other questions that the website does not answer or would like further explanation please ask a member of our medical staff.

The problem
It has not been possible to correct the teeth and how they bite together with orthodontics alone. This is because the bones of the face and jaws are out of balance with one another. Surgery will change the relationship between the lower jaw and upper jaw and will correct these problems. The surgery will take place under a general anaesthetic, ie the patient is going to be put to sleep completely.

What does the operation involve?
The operation is almost entirely carried out from the inside of the mouth to minimise visible scars on the skin of the face. A cut is made through the gum behind the back teeth to gain access to the jawbone. The lower jaw is then cut with a small saw to allow it to be separated in a controlled manner. It is then moved into its new position and held in place with small metal plates and screws.

Occasionally it is necessary to make a small “stab” incision on the skin of the face to allow the screws to be inserted. This incision is a few millimetres long and usually only requires a single stitch to hold it back together. The gum inside the mouth is stitched back into place with dissolvable stitches that can take a fortnight or even longer to fall out.

What can be expected after the operation?
Perhaps surprisingly it is not a particularly painful operation but it is still likely to be sore and regular painkillers will be arranged. The discomfort is usually worse for the first few days although it may take a couple of weeks to completely disappear. It is also necessary to make sure that the area heals without any infection and so the patient will be given antibiotics through a vein in their arm whilst in hospital. Patients are sent home with painkillers and a course of antibiotics.

Immediately after the operation the face will be swollen and feel tight, jaws will be stiff and patients find that they cannot open their mouth widely. The throat may also be uncomfortable and swallowing can be difficult to begin with.

Swelling and bruising is variable but is generally worst on the second or third day after the operation. The swelling can be reduced by using cold compresses and sleeping propped upright for a few days. Most of the swelling has disappeared after a fortnight but there is often some subtle swelling that can take several months to disappear although only the patient and their family are likely to notice this.

Can patients eat normally after surgery?
To begin with, no. For the first day or two patients will only want liquids, but very quickly they should be able to manage a soft diet and then gradually build up to normal food over a few weeks.

How long will the hospital stay be?
This obviously varies from person to person but most patients spend one or sometimes two nights in hospital after this operation. The position of the chin will be checked with X-rays before the patient is allowed home.

Does this procedure require any time off work?
This varies enormously from person to person and depends on what kind of work they do. We recommend that most people have around a week off work if they are having just a genioplasty carried out. It is important to remember that patients will not be able to drive or operate machinery for 48 hours after general anaesthetic.

What are the possible problems?
There are potential complications with any operation. Fortunately with this type of surgery complications are rare and may not happen. However it is important that patients are aware of some of them and have the opportunity to discuss them with their surgeon.

		Bleeding - some oozing from the cuts inside the mouth on the night of operation is normal and to be expected. Significant bleeding is very unusual but should it occur it can usually be stopped by applying pressure over the area for at least 10 minutes with a rolled up handkerchief or swab.
		Numbness - the bottom lip will be numb and tingly after the operation, similar to the sensation after having an injection at the dentist. This numbness may take several months to disappear and in a minority of patients may last forever.
		Infection - the small plates and screws that hold the jaw in its new position are usually left in place permanently. Occasionally they can become infected and need to be removed but if this happens it is not normally a problem until several months after surgery. The metal that is used is titanium, which does not set off metal detectors in airports etc.
		Adjustment of the bite - in the weeks following surgery it is often necessary to put elastic bands on orthodontic braces to guide the bite into its new position. Rarely a second small operation may be required to reposition the fixing plates and screws if the new bite is not quite right.

Will further appointments be required?
A review appointment will be arranged before the patient leaves hospital to see the surgeon and orthodontist.

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