John Zackery no longer has to make a conscious effort to keep his mouth from hanging open. But the orthognathic surgery he received at the VCU Medical Center still makes his jaw drop — albeit in a good way.
"My mom was with me the day after my surgery, and she was like, ‘Wow, what a difference.' We could see my bone structure for the first time. I feel better and I look better," says Zackery, 33, a Roanoke resident who underwent the procedure in May 2012. Prior to his surgery, Zackery had a severe under-bite, and his front teeth did not line up properly. "It just felt like my jaw was worn out. It was a
heck of an effort just to eat," he says. "I couldn't use my front teeth, only my side teeth."
Orthognathic surgery — a term that literally means "straighten the jaw" — is used to correct skeletal and dental irregularities that hinder a person's ability to chew, speak and breathe, according to the American Association of Oral and Maxillofacial Surgeons, based in Rosemont, Ill. Properly aligning someone's jaw can help with a range of physical problems, including cleft palate and sleep apnea.
Corrective-jaw surgery takes up where orthodontics leaves off. An orthodontist corrects bite problems that stem from teeth being misaligned, while corrective jaw surgery is needed when the upper and lower jaws don't match up.
Zackery's plight is unusual, but not rare, says Dr. Omar Abubaker, his surgeon and chairman of the oral and maxillofacial program at the VCU School of Dentistry. Abubaker says studies indicate at least 10 percent of people have growth conditions affecting the lower jaw, with a slightly lower percentage suffering from upper-jaw abnormalities that are correctable with surgery. "Generally, however, only about 2 percent of these cases are severe enough to require surgical correction," Abubaker says. He estimates that about 100 patients have the procedure at VCU each year, adding that most health insurance companies cover the surgery.
The advent of three-dimensional simulation software enables oral surgeons to take more detailed measurements. Using a scan of the patient's head, doctors mark where incisions should be made. If they don't like the resulting look, a click of the computer mouse enables them to change it.
"The new technology makes it fun to do and enables us to be much more precise," Abubaker says.
People considering the surgery need to understand the commitment required, says Dr. Michael Miller, a dentist and board-certified oral surgeon at Commonwealth Oral and Facial Surgery.
"Orthodontics is a critical part of the process," Miller says, noting that patients go through about 18 months of orthodontics in advance of surgery. The surgical procedure involves breaking the jaw and matching up the upper and lower jaw. The surgery typically takes five to seven hours, but post-operative orthodontics could last a year or more.
The process, although arduous, provides cosmetic benefits as well. Surgeons are able to manipulate the cheeks, the chin and the position of the lips. "It affects how a patient feels about himself," Miller says.
Zackery can relate to that sentiment. "I'm a totally new person," he says. "I can't explain how good I feel.