Is orthognathic surgery plastic surgery?

 "Ortho" means straight, and "gnathic" means jaw. Together, orthognathic surgery refers to “straightening” of the jaws, ie correcting any “crookedness” or deformity of the jaws. "Plastic", refers to changing or moulding shape, and plastic surgery then refers to surgery that changes the shape or form. It can be further subdivided into aesthetic plastic surgery, where the objective is primarily improving the cosmesis of a body structure which is not diseased, and reconstructive plastic surgery, which as the name suggests, rebuilds diseased or defective body parts. So, in the strict sense of the word, orthognathic surgery is a form of reconstructive plastic surgery. However, it is not aesthetic plastic surgery, which is the plastic surgery that most people know of.

The first plastic surgery organization in the world was formed at the Chicago Athletic Club on August 8, 1921 and was called the American Association of Oral Surgeons. The name was soon changed to the American Association of Oral and Plastic Surgeons and eventually in 1942, became the American Association of Plastic Surgeons. Concurrently, also in 1921, an organization known as the American Society of Exodontists, which was formed in 1918, changed their name to the American Society of Oral Surgeons and Exodontists and eventually in 1946, changed again to become the American Society of Oral Surgeons. This organization changed its current name, the American Association of Oral and Maxillofacial Surgeons, in 1946. (source: Journal of Plastic & Reconstructive Surgery, Vol 91, No 7, pg 1334-1336)

Today, in Singapore, as in most parts of the world, orthognathic surgery is mostly done by oral and maxillofacial surgeons though some plastic surgeons do perform some orthognathic surgery as well. Regardless of whether who does the surgery, it is not considered a cosmetic procedure because there is a quantifiable deformity that requires treatment. Although a dentofacial deformity presents cosmetic challenges and orthognathic surgery which corrects it achieves an improvement in cosmesis, the primary objective is to correct the dysfunction that comes with the deformity.

In recognition that it is not cosmetic in nature, Medisave can be used for payment of such corrective jaw surgery. For patients who are covered under an Integrated Shield Plan, the insurance company will also cover the cost of surgery up to the prescribed limits.

However, there are some insurance companies that dispute the non-cosmetic nature of the surgery due to misconception as the cosmetic improvement after surgery is the most dramatic. Indeed some patients’ motivation for surgery may be more cosmetically driven than functional. However, that does not detract from the fact that there is a functional deficit.

Some orthognathic surgery, however, has greater cosmetic elements than others. For example, correction of facial asymmetry without occlusal discrepancy may be deemed by some insurance company as cosmetic surgery. In some cases of surgical correction of short lower jaw, an additional procedure of chin advancement to improve the cosmetic results may be render the whole surgery as cosmetic. In such situations, the surgery may need to be done in two stages. The jaw advancement surgery is done first and the chin surgery is done several months later. Insurance will pay for the first surgery but not the second. Sometimes, it may be possible to negotiate with the insurance company to pay a part of the surgery, deducting the cost ascribed to the chin surgery, so as not to undergo surgery twice.

Orthognathic surgery, like many procedures in dentistry, invariably has a cosmetic nature simply because the face is such an prominent part of the body. Nobody will accept an amalgam filling for a front tooth that has decayed. An amalgam filling can do the job of filling the cavity but the patient will walk around with the blackish patch on his tooth! Using tooth coloured filling materials such as composite does not remove the functional nature of the treatment. Likewise, improving facial aesthetics while correcting a dentofacial deformity with orthognathic surgery does not make it a cosmetic procedure.