Children with cleft palate or cleft lip often require corrective jaw surgery, also known as orthognathic surgery, as part of their overall treatment plan.
Orthognathic surgery, which involves repositioning the jaws, may be required later in life if the cleft lip causes significant jaw misalignment or functional issues that orthodontic treatment alone cannot address.
Jonathan Skirko, MD, a craniofacial plastic surgeon and pediatric otolaryngologist with Banner Children’s, walks us through why this surgery is necessary, how it can benefit your child and what you can expect before, during and after the surgery.
What is orthognathic surgery?
Children born with a cleft lip and palate may face challenges in their facial development.
“Some children with cleft lip and palate can have underdevelopment of the upper jaw (maxilla), causing the upper jaw to be smaller than the lower jaw (mandible),” Dr. Skirko said. “This can make the upper lip and nose look flatter and make the top teeth sit behind the bottom teeth causing an underbite.”
One of the ways to address these challenges is through corrective jaw surgery. “The surgery aims to improve bite alignment, facial balance and overall function for children affected by cleft lip and jaw-related concerns,” Dr. Skirko said.
Benefits of orthognathic surgery
Corrective jaw surgery can bring about several significant benefits for your child:
- Improved facial symmetry: By aligning the jaws, the surgery can change the appearance of your child’s face, especially from the side. “Your child can experience a positive change in their appearance, boosting their self-confidence and overall well-being,” Dr. Skirko said.
- Better functionality: By repositioning the jaws, this type of surgery can enhance your child's ability to eat, chew and speak effectively. “By addressing the cleft through orthognathic surgery, speech patterns can be improved, leading to clearer and more understandable communication,” Dr. Skirko said. “This benefit can be life-changing, especially for children who may have faced challenges expressing themselves clearly.”
- Enhanced breathing: In some cases, corrective jaw surgery can also help improve breathing by creating a more open airway.
When is the right time for orthognathic surgery?
The decision to proceed with corrective jaw surgery requires careful planning and collaboration between you and various health care providers, including plastic surgeons, orthodontists, speech therapists and oral and maxillofacial surgeons.
This type of jaw surgery is typically performed once your child’s facial growth is nearly complete, around 16 to 18 years old.
The journey of orthognathic surgery
The process of corrective jaw surgery involves several steps:
Evaluation and planning
Before the surgery, your child’s health care team will work together to gather the information they need to plan the surgery. This may include dental impressions, X-rays and 3D imaging, which will help the team understand the extent of the jaw misalignment and develop a precise treatment plan.
Preparatory orthodontic treatment
In many cases, your child will undergo orthodontic treatment before the surgery. Braces are typically used to align the teeth, creating an optimal dental foundation for the upcoming jaw surgery.
“Braces are put on your child’s teeth to move them into position so that when your jaw is moved, your teeth will fit together comfortably,” Dr. Skirko said.
On the day of the surgery, your child will be placed under general anesthesia to ensure comfort and safety during the procedure.
The surgery is done inside your child’s mouth, so there typically are no visible scars on their face. Incisions or cuts are made inside the mouth to access the jawbones.
Repositioning of jaws
The surgeon carefully cuts the jawbones and moves them into the desired position according to the preoperative plan.
“Plates and screws are used to secure the bones in their new alignment,” Dr. Skirko said. “Rubber bands guide your child’s teeth together in the new position.”
Recovery and postoperative care
After the surgery, your child will need to stay in the hospital for a short period, typically a day or two. The initial recovery period may involve discomfort, swelling and a restricted diet.
“Your child will start on a liquid-only diet and slowly advance to soft foods and solid foods when their jaw has fully healed,” Dr. Skirko said.
Your child must keep ice packs on their face throughout the first 24 hours. They will also sleep with their head raised to help minimize and reduce swelling.
Follow-up appointments will be scheduled to monitor your child’s progress and ensure proper healing.
Will my child need more than one surgery?
This type of surgery is usually a one-time procedure. However, in some cases, a second, more minor surgery may be required to make fine adjustments or address minor issues not fully corrected in the initial procedure.
“Such additional surgeries, if needed, are relatively rare and are typically less invasive than the first orthognathic surgery,” Dr. Skirko noted. “The need for additional procedures will be determined based on your child’s specific case and the success of the initial surgery.”
What is the long-term outlook for children who undergo orthognathic surgery?
The long-term outlook after orthognathic surgery is very positive. However, your child’s experience and results can vary based on the degree of their jaw defect, the specific surgical plan, healing capacity and cooperation with the postoperative care instructions.
“Adhering to regular follow-up appointments, maintaining good oral hygiene and cooperating with orthodontic treatment are essential for achieving the best long-term outcomes,” Dr. Skirko said.
In most cases, the effects of orthognathic surgery are permanent, and the jawbones remain stable and well-aligned for the rest of the patient's life.
Corrective jaw surgery (or orthognathic surgery) for cleft palate and cleft lip offers more than a physical transformation. It can be a life-changing experience, empowering your child to embrace their unique beauty and confidently face the world.
If you are considering corrective jaw surgery for your child, speak with a Banner Health craniofacial plastic surgeon near you.