P K Patel MD
Please read the more detailed information by clicking on buttons 1 through 15 on the main page. Please download the pdf of the check off list for surgery on the main page.
BEFORE THE SURGERY
1. What are the benefits of jaw surgery?
It will mprove the ability to eat comfortably may help to breathe easier and to say certain words that use the tongue tip and teeth sounds. The surgery will improve facial appearance, how your teeth meet and your smile. [Section 1 and 2]
2. What are the downsides of jaw surgery?
It requires time to achieve the desired outcome, from months to years. It requires many appointments, time off from school and work. It requires hospitalization and a recovery period. While risks, complications and an undesired outcome are rare, it is not zero. As an 'elective' procedure, you need to balance the benefits with the downsides of a surgical procedure. You are welcome to talk to my patients who have had jaw surgery to help you decide. [Section 2 and 5]
3. Will insurance cover the surgery?
Not all insurance policies cover jaw surgery. It is considered ‘elective’ surgery and is medically necessary only under certain conditions. It may also be specifically excluded from your policy to reduce the cost of the policy. It is helpful to obtain 1) supporting letters from your primary care doctor, 2) the orthodontist and 3) other professionals (speech pathologist, sleep medicine, psychologist). The insurance company will request photos, x-rays and an analysis of the x-ray. For most insurance plans you will need to meet both a functional criteria and anatomic criteria (how bad is the deformity/bite). [Section 6]
4. Do I need to see other professionals?
Ideally, yes. Repositioning the jaws affects breathing, speech and facial appearance that may either be positive or negative. The speech pathologist can assess the impact of surgery on your speech and a letter supporting the need for surgery can be beneficial to providing the insurance company functional reasons for surgery. The psychologist will help you get through the stress of surgery and provide assistance for school and work anxiety that can occur with surgery. With 2 decades of experience, patients who have been seen by a dedicated team psychologist who is familar with jaw surgery recover quicker. [Section 4]
5. What parts do the orthodontist and the surgeon play?
The orthodontist first straightens and alignes the teeth. The surgeon then moves the jaw bones so that the teeth fit. Orthodontic braces are put on many months before surgery, kept on during the braces and continued after the surgery. Well before the surgery the wisdom teeth are removed to that sectioning the bone can be safer and any other teeth that the orthodontist may request to help align the teeth. [Section 7]
6. What do I bring to the surgeon's appointment?
At the first appointment, please bring current x-rays and dental models from the orthodontist. This will help make the first appointment more efficient. Please check with your insurance if you need an approval from your primary care provider for the appointment.
At subsequent appointments, please bring current dental models (within a month), so that we can determine the readiness for surgery. We need to see how well the upper and lower teeth fit on the model. If the models show a good fit, then we can schedule surgery.
At the preoperative surgical appontment 4 weeks before surgery, please bring recent dental models (within 2 weeks of the appointment). Do not have the orthodontist mail them to our office. You must bring the models with you. We will obtain our own x-rays. We will use these records to plan the surgery. [Section 9]
7. When will I be ready for jaw surgery?
When the orthodontist and the surgeon feel that the teeth are in the correct position. This can only be checked by either stone/plaster dental models or digital models with a special software. This is called "surgical feasibility dental models" If the models fit well. Then two dates are assigned by my office: 1) the date of surgery and 2) preoperative surgical planning date. Your orthodontist will also need to see you: 1) surgical records (x-rays and dental models ) and 2) placement of surgical hooks. [Section 8 and 9]
8. How is surgery planned?
The final details of surgery are planned 4 weeks before the date of surgery. 3D x-rays of the facial skeleton and the final dental models are uploaded on a special computer that allows us to simulate the surgery. The simulatuion will allow us to print 3D models if needed and select the bone fixation plates needed for the suregry. This allows us to optimize and to more efficiently do the surgery. We need 4 weeks to properly plan for surgery. [Section 10]
9. What do I do to prepare myself for surgery?
Set aside sufficient time for appointments and to recover and reduce any outside stress. If you are anxious, please talk to our surgical psychologist and specifically my patients who have previously undergone surgery. Maximize your oral care to decrease the bacterial count and to improve the gum tissues: dental cleaning, brushing 3x/day, antigingivitis mouth rinse 3x/day, nasal saline (salt water) rinse 2x/day. [Section 9]
AFTER THE SURGERY
1. Will my jaw be wired shut?
No, but we will use dental elastics 1-2 weeks after the surgery to guide the bite until the bones heal and the teeth fit comfortably. Remember that the dental elastics act like tiny 'muscles' to help you find your new bite until it becomes stable and a habit. [Section 11 and 12]
2. How long will I be hospitalized?
Usually overnight. Occasionally 2-3 days. My preference is to keep you overnight because there is some bleeding and nausea/vomiting after the surgery. The next day you will be better off at home, where you can take a shower, be more comfortable with your family. [Section 11]
3. What is recovery like immediately after surgery?
The first few days and the first week is difficult. There is facial swelling that begins to improve 3 days after surgery, and by 2 weeks most patients are able to go back to school and light duty work. The initial pain and discomfort is managed by alternating a presribed narcotic with ibuprofen (Motrin, Advil). You will be able to open and close your mouth to breathe and to eat, and it will become easier as the swelling in the jaw muscles subside. [Section 12]
4. How will I eat after surgery?
You will be able to drink and eat after surgery, but it will be difficult because your bite will be different. This will take time to adjust. Begin with liquids for the first 2-3 days and then slowly advance the diet to soft foods (jello, pudding, pasta, fish). To avoid losing weight, you should have high calorie drinks as supplements. By 4-6 weeks after surgery many of our patients are able to eat an unrestricted diet. [Section 12]
5. How much time should I set aside for recovery?
Most patients are back to school/work 2-3 weeks after surgery. But it will take longer to have your strength completely back (6-8 weeks). We encourage you to go back to your daily activities as soon as possible. This will help with recovery. However, no contact sports for a minimum of 6 weeks. [Section 12]
6. How long will my braces be on?
Your orthodontist will continue to move the teeth until they are well coordinated withb each other and are stable. This may take 4 to 12 months after surgery. Please make an appointment with me before the braces come off so that I am in agreement as well. [Section 13]
7. Is the outcome of braces and surgery permanent?
No. Teeth will always move after braces come off and the jaw bones will remodel until a new 'equilibrium' is established by your body. Wearing retainers to hold the teeth in position will help maintain the outcome as long as possible. You must expect ongoing changes as we get older. Bones and teeth are living tissues. [Section 14]