Dysgnathic Surgery - Specialists and Information

Dysgnathia surgery involves the surgical correction of a malocclusion. Dysgnathia (Greek: dys- = mis-, gnathos = jaw) refers to a misalignment of the jaw and the resulting misalignment of the teeth and chin.

Depending on the specific nature of the malformation, doctors distinguish between:

• Transverse dysgnathia
• Vertical dysgnathia
• Sagittal dysgnathia

In transverse dysgnathia, the upper or lower jaw is too narrow, which often results in misaligned teeth.

In vertical dysgnathia, the upper jaw is too long. This leads to what is known as long-face syndrome or a gummy smile. The center of the face appears too long, and when smiling, more of the teeth and gums are visible than is usual or considered attractive. If the lips cannot close completely, this is more than just an aesthetic problem.

In sagittal dysgnathia, either the upper or lower jaw is set too far back. If the upper jaw is affected (progenia), the midface appears flattened, the upper lip is narrow and set back behind the lower lip, and the chin appears to protrude. If the lower jaw is affected (prognathism), the typical “retrognathic” chin develops.

In cases of facial asymmetry or facial scoliosis, deformities of the bone tissue cause the tip of the nose and the tip of the chin to be displaced from the midline of the face. In practice, a combination of these various malalignments is often present.

Our appearance plays a major role in how we feel. If we are dissatisfied, this can have a negative impact on our emotional well-being. If the psychological strain is very severe, you should take action.

Apart from the psychological strain, dysgnathia also causes physical impairments:

• Difficulty and pain when biting and chewing
• Pain in the temporomandibular joints, neck, and head
• Snoring
• Increased susceptibility to infections in the sinuses, throat, and upper respiratory tract
• Speech disorders caused by improper tongue position

From an orthodontic perspective, malocclusion is another factor that can lead to problems ranging from poor oral hygiene to premature tooth loss.

The goal of dysgnathia surgery is to correct jaw misalignment through surgical intervention. This improves the functionality of the jaw and the patient’s appearance. Pain and functional problems disappear: chewing, speaking, and breathing through the nose are possible without restrictions.

In prognathism, the lower teeth protrude in front of the upper teeth. @ Marina Demeshko / Adobestock

In most cases, orthodontists, oral surgeons, and facial surgeons will work together to correct dysgnathia.

Dental impressions and X-rays help plan the surgery in advance. All surgical procedures are performed under general anesthesia and require a hospital stay of two to seven days. Incisions are made through the oral cavity and leave no visible scars.

• In cases of mild dysgnathia, the orthodontist can correct the misalignment of the teeth using fixed braces, removable aligners, or splints.
• If the upper jaw is too narrow, it is expanded using a fixed appliance. This procedure, known as palatal suture expansion (PSE), creates space through new bone growth. The expansion phase begins one week after surgery.  During this phase, you turn the appliance yourself. Don’t worry: It’s painless!
• If the lower jaw is too narrow, a similar procedure is performed. In a mandibular mid-split (mandibular distraction), the incision is made at the symphysis, in the center of the chin tip.
• In cases of long-face syndrome, the upper jaw is detached via an incision in the oral cavity, shortened, and fixed in the correct position using tiny plates.
• In maxillary retrusion, an incision through the oral cavity detaches the maxilla on both sides. It can then be slid forward like a drawer and fixed in the correct position with small plates.
• In cases of mandibular retrusion, the lower jaw is separated on both sides via an incision at the level of the wisdom teeth. This allows it to be moved into the correct position and secured with small plates.
• In cases of facial asymmetry, the upper jaw is first detached, repositioned, and fixed. Then the lower jaw is detached, adjusted to the correct position, and fixed.

You will be able to speak, drink, and eat even after the surgery. At first, you should consume only liquid foods. After the first few days, you can switch to soft foods such as pasta dishes. After 6 weeks, you can return to a normal diet. During this time, you should also refrain from smoking and strenuous physical activity. And even while you’re healing, don’t forget to brush your teeth!

Serious complications are extremely rare with this surgery. Risks such as damage to nerves and tooth roots, as well as discomfort in the temporomandibular joints or even misalignment, occur rarely. If problems do arise, they are usually easy to treat.

Common side effects include swelling, bruising, bloody discharge from the nose, and limited mouth opening. These symptoms usually subside quickly with consistent cooling, lymphatic drainage, and physical therapy. You must not blow your nose for the first 14 days.

Surgical treatment of dysgnathia is not always necessary. If it is, however—thanks to modern technology and collaboration among specialists from various fields—it is a procedure with minimal risks.

You should expect an inpatient hospital stay of no more than one week. After about 6 weeks, you will have recovered from the procedure. If medically indicated, the costs are covered by health insurance.