Dentofacial deformities are common in Singapore. In fact, there is not a single day that I can walk around Singapore without seeing someone in the streets who has a face that can be improved aesthetically with corrective jaw surgery. Some people are not bothered by their deformities and can live happily without seeking any kind of correction. To this group, the issue of whether corrective surgery is worthwhile is a non-starter. However, for a much larger group who are bothered, albeit to different degrees, about their dentofacial deformities, the question of whether to undergo surgery is often perplexing.
To answer this question, we need to look at the problem at three levels. Corrective jaw surgery is not a purely cosmetic procedure. It corrects functional deficit due to malalignment of the jaws, improving chewing ability and in some cases, indirectly, speech as well. Decision on elective surgery is best made after weighing the risk versus the benefits. If the benefits outweigh the risk, surgery is worth it. Otherwise, it is better to leave well alone.
Patients with severe dentofacial deformities are unable to chew properly. These are the severe underbite, overbite and open bite cases.
For these patients, the question of whether it is worthwhile undergoing surgery is easily answered. Surgery brings about a definite and tangible improvement in function that can be felt in daily life. While there are risks involve in all surgeries, in the hands of a competent team, orthognathic surgery risks are kept to a minimal. As such, for patients with a functional problem, the benefits of surgical correction justify the risk of surgery.
On the other extreme, there are patients with dentofacial deformities but no functional problems.
Bimaxillary protrusion is one such deformity. The teeth are usually well aligned and biting well. There is a disproportionately excessive development of the tooth bearing part of the jaws in relation to the jaw bases. This result in the teeth being carried into a much more forward position, giving a rather ape-like appearance.
Vertical maxillary excess is another example. This is similar to bimaxillary protrusion except that the excessive growth is usually in the vertical direction rather than the horizontal. Commonly this group of patients complains of gummy smile. In fact, in the more severe form, the gums are showing even without smiling.
For these patients, surgery is worthwhile if they are sufficiently bothered by their looks. Corrective jaw surgery can bring about drastic changes to facial appearance. The magnitude of improvement in facial cosmesis can justify the risk of surgery.
However, many patients do not fall under both categories whereby benefits from the surgery are tangible and obvious. Some have relatively minor deformities but are bothered by it enough to seek treatment. For this group, a longer process of diagnosis and treatment planning is needed to uncover the true needs. When the deformity is minor, function usually does not improve significantly with surgery. For patients with minor discrepancies who complain primarily of being unable to bite properly, it is usually not worth undergoing corrective jaw surgery. When weighing the risk-benefits of surgery, although the risk of surgery for this group of patients is the same, the benefits that can be gained is not sufficient to justify the risks.
Some patients are not concern about the functional deficits but are unhappy about their looks. For this group, treatment planning should be targeted at cosmetic objectives. Beyond the physical findings derived from measurements on the face and radiographs, an in-depth discussion on the patient’s aesthetic taste and preferences is important. Orthognathic surgery corrects disproportions in facial bones and indirectly affects facial appearance by the corresponding contour and shape changes over the skin. If the deformity is minor, alternative less invasive treatment can be considered. For example, minor changes in chin contour can be achieved with chin implants or even injection of dermal fillers, by-passing the need for bone surgery. For this group of patients, the treatment goals must be clearly identified before deciding whether it is worth while undergoing surgery. When in doubt, it is best to defer surgery until there is clarity.
Corrective jaw surgery is fairly invasive and significant downtime is involved. However, for the right cases, the improvement in function and aesthetics is dramatic. Having a definite diagnosis is the key to knowing whether it is worth while going through with surgery.