How Is Orthognathic Surgery Performed?

How Is Orthognathic Surgery Performed?

Understanding what happens during jaw surgery can help you feel more prepared. Here is a step-by-step overview of the procedure.

Orthognathic surgery is performed in a hospital operating room under general anesthesia. Here is what happens:

• Step 1: Anesthesia and preparation
• General anesthesia is administered — you are completely asleep
• The surgical team positions you properly
• A breathing tube is placed through the nose

• Step 2: Local anesthesia
• A local anesthetic is injected in the surgical areas to manage post-operative pain
• This ensures you wake up comfortable

• Step 3: Incisions
• All incisions are made inside the mouth
• For upper jaw surgery: along the gum line above the upper teeth
• For lower jaw surgery: along the gum line behind the lower molars

• Step 4: Bone cuts (osteotomies)
• The surgeon uses a surgical saw or piezo-electric instrument to make precise cuts in the bone
• The cuts are guided by 3D-printed surgical guides
• For upper jaw: the maxilla is separated from the rest of the skull
• For lower jaw: the mandible is split on both sides (sagittal split)

• Step 5: Repositioning
• The jaw is moved to its planned new position
• The surgical splint is placed between the teeth to hold the correct bite
• Temporary wires or elastics may hold the jaw closed

• Step 6: Fixation
• Tiny titanium plates and screws hold the bone in its new position
• These are biocompatible and usually left in place permanently
• The splint is removed or left in place depending on the surgeon's preference

• Step 7: Closing
• Incisions are closed with dissolvable stitches
• Rubber bands may be placed to guide the bite during early healing

How Long It Takes

• Upper jaw surgery: 1.5–3 hours
• Lower jaw surgery: 1–2 hours
• Double jaw surgery: 3–6 hours
• Additional procedures (genioplasty, etc.): add 30–60 minutes

Clinical Guidance

Jaw surgery involves precise bone cuts made through incisions inside the mouth, repositioning the jaw to its planned position, and fixing it with titanium plates and screws. The entire procedure takes 2–6 hours depending on complexity.