Single Jaw vs Double Jaw Surgery

Disharmonies in jaw development is quite a common problem. They can come in the form of disproportionate horizontal growth of one jaw compared with the other or it can manifest as asymmetry, which is disproportionate growth of one side of the jaws compare to the other side, ie a left-right disharmony.

Yet others may have excessive or deficient growth of the jaws in the vertical dimension, resulting in a long face or short face. To complicate things further, there is often a combination of the above proportional discrepancies.

As such, a proper diagnosis is of paramount importance as that determines what kind of operation is needed. However, one of the common questions that patients ask is whether they need a single or double jaw operation.

I often pause for a moment before I answer that question, trying to understand what the real question is. Some are concern about the morbidity of surgery, assuming that a double jaw surgery is doubly more traumatic. Others are concern about cost, thinking that double jaw means double the cost. While these are real concerns, we need to always remember what is the motivation to seek surgery in the first place. 

Double Jaw Surgery Case Study 

Some years ago, a young girl, about 18 years old, came in with her mother for a consultation. The girl has a long lower jaw and a flat midface. Her concern is primarily aesthetic in nature even though her function can be improved with surgical correction of the jaw position.

What she needed was a double jaw surgery to move her upper jaw and midface forward and her lower jaw backward. However, her mother was understandably concern about the morbidity of the surgery. She wanted to keep things simple and in her mind, that meant a single jaw surgery.

So she requested to have only the lower jaw shifted back to get a good bite. I told her that aesthetically, the results would not be good as the degree of setback of the lower jaw will be too great and that will result in a flat face with no jaw line.

However, she was unable to overcome her concern about the invasiveness of a two-jaw operation. The patient herself understood and was prepared to do the proper surgery but we needed her mother’s consent. In the end, I advised her to seek a second opinion as I was not going to do an operation that changes one form of deformity to another. Furthermore, if she does not like the look after a one –jaw surgery, it will be even more difficult to reverse that and do a double jaw surgery.

Double Jaw Surgery Costs 

And then there was this patient who was concern with cost. A single jaw surgery is cheaper than a double jaw surgery. But what’s the point of having a surgery that does not solve your problem. I told him that it is far better to save up for the right surgery then to proceed with just any surgery that can only address some of the problems. Doing a single jaw surgery when a double jaw surgery is needed is effectively substituting one form of deformity for another.

Single Jaw Surgery Applications 

So what kind of deformity qualifies for a single jaw operation? In my practice, there are very few single jaw surgeries. This is because patients who are bothered enough about their looks to seek surgery often have a significant skeletal discrepancy that cannot be satisfactorily corrected by correcting only one jaw. Conditions that are best corrected with single jaw operations are usually minor deformities that cannot be corrected by orthodontic treatment alone. Typically, this group of patients has a slightly protruding lower jaw whereby the upper and lower front teeth can still bite together.

Most patients with a significant “underbite” thinks that it is their lower jaw that is excessive. However, sometimes, the lower jaw is normal but the upper jaw is deficient in growth. In such cases, a single jaw surgery that repositions the upper jaw in a more forward position is needed, instead of shifting the lower jaw backwards.

Ultimately, the most important thing to do is to do the surgery that will correct the chief concern of the patient. If a single jaw operation cannot do that and you cannot or do not accept a double jaw operation, it is best not to do anything.

Good Candidates for Jaw Surgery

Not everyone is a good candidate for jaw surgery. Below are the characteristics of good candidates for jaw surgery:

Severe Overbite or Underbite

One of the most common reasons for jaw surgery is a severe overbite or underbite. This condition occurs when the upper or lower jaw is misaligned, causing the teeth to not fit together properly. This can lead to difficulty chewing, biting, or speaking, as well as jaw pain or headaches. Good candidates for jaw surgery are those who have a severe overbite or underbite that cannot be corrected with orthodontic treatment alone.

Difficulty Chewing, Biting, or Speaking

Patients who have difficulty chewing, biting, or speaking due to jaw misalignment may be good candidates for jaw surgery. This condition can be caused by a variety of factors, including a misaligned jaw, a small or narrow jaw, or a cleft palate. Jaw surgery can help to correct these issues and improve the patient's ability to eat, speak, and perform other daily activities.

Chronic Jaw Pain or Headaches

Chronic jaw pain or headaches can be a sign of a more serious condition, such as TMJ disorder or a misaligned jaw. Good candidates for jaw surgery are those who have tried other treatments, such as medication or physical therapy, but have not found relief from their symptoms. Jaw surgery can help to correct the underlying issue and alleviate chronic pain or headaches.

Sleep Apnea or Other Breathing Problems

Sleep apnea is a condition that causes a person to stop breathing temporarily during sleep. This can be caused by a variety of factors, including a misaligned jaw or narrow airway. Good candidates for jaw surgery are those who have been diagnosed with sleep apnea or other breathing problems and have not found relief from other treatments.

Facial Asymmetry or Imbalance

Facial asymmetry or imbalance can be caused by a variety of factors, including a misaligned jaw, congenital defects, or facial trauma. Good candidates for jaw surgery are those who have a noticeable difference in the size or shape of their jaw, which can affect their facial appearance and self-esteem. Jaw surgery can help to correct these issues and improve facial symmetry and balance.

Congenital Defects or Facial Trauma

Some patients may be born with congenital defects that affect the development of their jaw. Others may experience facial trauma, such as a broken jaw, that requires surgical intervention. Good candidates for jaw surgery are those who have congenital defects or have experienced facial trauma that has affected the alignment or function of their jaw.

Temporomandibular Joint (TMJ) Disorder

The temporomandibular joint (TMJ) is the joint that connects the jawbone to the skull. TMJ disorder is a condition that causes pain and discomfort in the jaw joint and surrounding muscles. Good candidates for jaw surgery are those who have been diagnosed with TMJ disorder and have not found relief from other treatments, such as medication or physical therapy.

Benefits of Jaw Surgery

Jaw surgery is typically performed by an oral and maxillofacial surgeon, and it can have a significant impact on a patient's quality of life. Below are some of the benefits of jaw surgery.

Improved Function

One of the primary benefits of jaw surgery is improved function. Patients who have a misaligned jaw or bite may experience difficulty chewing, biting, or speaking. Jaw surgery can help to correct these issues and improve the patient's ability to perform daily activities, such as eating and speaking.

Alleviation of Pain and Discomfort

Jaw misalignment can cause chronic pain and discomfort in the jaw joint and surrounding muscles. This can lead to headaches, neck pain, and other symptoms. Jaw surgery can help to correct the underlying issue and alleviate pain and discomfort.

Improved Breathing

Jaw surgery can also improve breathing in patients who have a narrow airway or sleep apnea. By correcting the jaw alignment, the airway can be widened, allowing for better airflow and improved breathing during sleep.

Enhanced Aesthetics

Jaw surgery can also improve the appearance of the face by correcting facial asymmetry or imbalance. Patients who have a misaligned jaw may have a noticeable difference in the size or shape of their jaw, which can affect their facial appearance and self-esteem. Jaw surgery can help to correct these issues and improve facial symmetry and balance.

Improved Oral Health

Jaw misalignment can also affect oral health by causing issues such as gum disease, tooth decay, and tooth loss. By correcting the jaw alignment, patients can improve their oral health and reduce the risk of these issues.

Boosted Self-Confidence

Jaw misalignment can have a significant impact on a patient's self-confidence and self-esteem. By correcting the underlying issue, patients can feel more confident in their appearance and improve their overall quality of life.

Long-Term Results

Jaw surgery provides long-term results that can last a lifetime. While the recovery period may take several weeks or months, the benefits of jaw surgery can be enjoyed for many years to come.

Possible Risks and Complications of Jaw Surgery

While jaw surgery can provide numerous benefits, it is important to understand the possible risks and complications associated with the procedure. 

Infection

As with any surgical procedure, there is a risk of infection following jaw surgery. Patients may be given antibiotics to reduce the risk of infection, but it is important to follow all post-operative instructions to minimize the risk of complications.

Bleeding

Bleeding is another possible complication of jaw surgery. While some bleeding is normal following surgery, excessive bleeding may require additional medical attention.

Nerve Damage

Jaw surgery can cause nerve damage, which can result in numbness, tingling, or loss of sensation in the face, lips, or tongue. While this is a rare complication, it is important to discuss the risks with your surgeon prior to the procedure.

Swelling and Bruising

Swelling and bruising are common after jaw surgery and can last for several weeks. While these symptoms are not typically serious, they can be uncomfortable and may require pain medication or other treatments.

Difficulty Eating and Speaking

Following jaw surgery, patients may experience difficulty eating and speaking due to swelling and discomfort. This is typically a temporary issue and can be managed with a soft diet and speech therapy.

Malocclusion

Malocclusion is a possible complication of jaw surgery that occurs when the teeth do not fit together properly after the procedure. This can be corrected with orthodontic treatment, but it is important to discuss the risks with your surgeon prior to the procedure.

Relapse

In some cases, the jaw may gradually shift back to its original position after surgery. While this is a rare complication, it is important to follow all post-operative instructions to minimize the risk of relapse.

Anesthesia Complications

Jaw surgery typically requires general anesthesia, which carries its own set of risks and complications. These may include allergic reactions, breathing problems, and other issues related to anesthesia

Aftercare Tips for Jaw Surgery

While the surgery itself is a major step, the recovery process is equally important. Proper aftercare can help to minimize discomfort and complications and ensure a successful outcome. Below are some aftercare tips after jaw surgery.

Follow All Post-Operative Instructions

Following jaw surgery, your surgeon will provide you with specific post-operative instructions to follow. It is important to follow these instructions carefully to ensure proper healing and minimize the risk of complications.

Manage Pain and Discomfort

Pain and discomfort are common after jaw surgery. Your surgeon may prescribe pain medication or recommend over-the-counter pain relievers to manage these symptoms. It is important to take medication as directed and to avoid taking aspirin, which can increase the risk of bleeding.

Apply Ice Packs

Applying ice packs to the face can help to reduce swelling and discomfort after jaw surgery. Your surgeon may recommend applying ice packs for 20 minutes at a time, several times a day, for the first few days after surgery.

Follow a Soft Diet

Following jaw surgery, you will need to follow a soft diet to avoid putting pressure on the jaw. This may include foods such as soup, yogurt, mashed potatoes, and scrambled eggs. Your surgeon may provide you with a specific diet plan to follow.

Practice Good Oral Hygiene

Proper oral hygiene is important after jaw surgery to prevent infection and promote healing. Your surgeon may recommend using a special mouthwash or other oral hygiene products to keep the mouth clean.

Avoid Smoking and Alcohol

Smoking and alcohol can delay healing and increase the risk of complications after jaw surgery. It is important to avoid smoking and alcohol for several weeks after surgery.

Rest and Relax

Rest and relaxation are important after jaw surgery to allow the body to heal. Your surgeon may recommend avoiding strenuous activities and getting plenty of rest for the first few weeks after surgery.

Attend Follow-Up Appointments

Following jaw surgery, you will need to attend follow-up appointments with your surgeon to monitor your progress and ensure proper healing. It is important to attend these appointments and to follow any additional instructions provided by your surgeon.