[MACS OMFS] Double Jaw Surgery Myths: Fact-Checking the Claims with Dr. Macs Bong
"People say that your nose widens if you undergo double jaw surgery..." "I've heard that the jaw goes back to its original position after the surgery..." These are just some of the various rumors that you might have encountered before getting double jaw surgery. While they may seem laughable, it can be hard to distinguish fact from fiction. Many people hesitate to undergo orthognathic surgery due to various scary rumors.
Starting now, Dr. Park Jae-bong from MACS OMFS will delve into each of these claims one by one! Stay tuned as we uncover the truth behind these myths!
Q. Do many of your consulting patients ask about these rumors?
Yes, they do. Since it is a complex and significant surgery, unlike more common cosmetic procedures like double eyelid or rhinoplasty, there aren't as many people in their surroundings who have experienced it. This makes it difficult to obtain accurate information, leading to a belief that it is a very dangerous and scary surgery, which causes a lot of concern among potential patients.
Of course, based on the questions I receive, there are cases where concerns are valid and others that are completely unfounded rumors. Therefore, let's take some time to address the common questions about orthognathic surgery and provide only the truth.
Q1. Does orthognathic surgery inevitably cause the nose to appear wider?
Well, I get this question a lot! To answer it directly: no, it does not.
Before performing double jaw surgery, we measure the width of both nostrils using a caliper. The musculature and tissue are attached to the sides of the nostrils and the maxilla (upper jaw) bone. This tissue helps maintain the width of the nostrils. When we perform the maxillary surgery, we make incisions and separate tissues inside the mouth, which results in those connections being cut. As a result, the nose may appear wider during the surgery. However, once the surgery is completed, we use a non-absorbable suture called nylon to reattach and secure the previously measured distances. So, the nose doesn't actually widen, but it may appear so for several reasons right after the surgery.
First of all, it's due to swelling. The surgery typically lasts about two hours, so there isn't significant swelling during the procedure itself. By the time we finish the surgery, we can suture the nose back to its original position, allowing it to maintain its width. However, after the surgery, the face tends to swell significantly for about 72 hours. This varies from person to person, but in some cases, particularly in the maxillary region around the upper lip and sides of the nose, the swelling can be quite pronounced. It may appear as though the nose is spreading outwards as it is squeezed from the inside due to swelling. Generally, after about a month, the swelling reduces significantly, and the appearance usually returns to normal. Any residual swelling will continue to decrease over the course of a year, so there's no need for major concern.
The second reason is due to changes in the face. In most cases, double jaw surgery results in a reduction in the length or width of the face, and it's quite common to perform cheekbone surgery alongside it, which further contributes to a smaller overall appearance of the face. As a result, in the early stages, the swelling can make the nose appear larger in proportion to the rest of the facial features. While the swelling does subside and the appearance improves significantly, the reduced size of the face often leads many individuals to consider additional procedures like eyelid or nose surgery to enhance their appearance further after double jaw surgery.
Q2. Does the jaw shift back after double jaw surgery?
Yes, this is referred to as ‘relapse.’ This happens quite often, and both OMFS and orthodontics have made significant efforts to address it. I will explain this in three parts.
First, why does this happen?
The bones are connected to muscles and tissues, and there are also ligaments involved. Even if I perform beautiful surgery on the bones, the bones are fixed in place with plates and screws after the surgery, so they remain stable. However, the surrounding tissues, muscles, and ligaments have been displaced from their original positions. These tissues exert a pulling force to return to where they originally were.
We need to make efforts to manage these aspects at all three stages: the pre-surgery planning stage, the surgical technique stage, and the postoperative care stage.
- Pre-Surgery Planning Stage:
When planning surgeries for the upper and lower jaws, if there is a significant difference between them, moving just the lower jaw can involve too much displacement. Instead of making all the adjustments in one area, we can slightly reduce the upper jaw and slightly advance the lower jaw to make a planned compromise, minimizing bone movement and thereby reducing the likelihood of relapse. It is noted that the more the lower jaw is advanced, the more it is associated with the amount of relapse. - Surgical Techniques to Mitigate Relapse:
The second approach involves surgical techniques. During surgery, it is essential to adequately separate the tissues, especially in the area beneath the square jaw, where there is a lot of pulling action. This may involve carefully cutting the bone or reshaping any protruding bone structures in advance to reduce the forces that would push them forward or pull them back. These methods have been well-studied academically, and I understand that oral and maxillofacial surgeons perform surgeries in accordance with these principles. - Postoperative Management to Prevent Relapse:
The third approach is during the recovery period after surgery. Patients should actively participate in follow-up appointments with the orthodontist or surgeon, use splints properly, and perform exercises to prevent jaw stiffness as instructed. This helps minimize relapse, especially during the critical period of about 6 weeks to 3 months when relapse is most likely to occur.
In summary, while relapse is indeed a possibility, we make significant efforts to control these factors before, during, and after surgery, and it’s important for patients to actively participate in this process as well.
Q3. After double jaw surgery, do you not feel it when you spill water while drinking?
The nerve that requires the most attention during double jaw surgery is the inferior alveolar nerve, which runs from the brain down to the jaw joints on both sides. During the SSRO (Sagittal Split Ramus Osteotomy) procedure, when we separate or cut the jaw, there can be instances where the sensory nerve is temporarily affected. After surgery, patients may experience reduced sensation, making it difficult to feel when something spills. Alternatively, they might feel tingling or tightness, and it may feel like water is flowing, among other sensations. Most of these sensory changes typically recover within a few months, but in some cases, it can take years. Generally, this sensation loss returns within a year, so there's no need to worry too much.
Q4. Can the pins used in double jaw surgery set off metal detectors?
The pins used in double jaw surgery are made of titanium, an inert metal used in implants. While they are indeed metal, they should not trigger a beeping sound in metal detectors. So, there’s no need to worry about that. However, when you undergo imaging tests like CT scans or MRIs to diagnose various conditions in the facial area, these pins can create artifacts. For instance, in a CT scan, they might cause reflections, and in X-rays or MRIs, the area around the pins might appear dark.
If inflammation occurs for any reason at the site of the screws, it can become challenging to remove them after a year or more due to bone growth around the screws. Typically, we actively recommend removing them about 6 months to a year after surgery.
Conclusion
We have taken some time to address your questions and concerns about the surgery, including some urban legends and myths surrounding it. These types of questions are ones that we find ourselves answering multiple times a day. Therefore, I hope this video helps patients understand what is real and what is not. We are committed to utilizing 3D AI technology for thorough and precise analysis, always striving to create beautiful, well-proportioned faces that function properly. You can trust our medical team and rest assured.
For those who have further questions, please refer to our YouTube videos https://www.youtube.com/@macs_bong or leave a question on our website, https://macs.co.kr/eng/qna/ and Dr.Park, Jae-bong will personally reply to it.