The evolution of orthognathic surgery

Where it began

Orthognathic surgery began with osteotomies, precise cuts in the bone, so that the teeth could bite properly. Over time, the goal grew: repositioning the upper jaw (maxilla) and the lower jaw (mandible) not only for the bite, but also to improve the face. That planning was done with plaster models and tracings on paper over X-rays, measuring by hand and taking those measurements to the operating room. It was a great advance for its time, and everything that came after was built on that foundation.

From wires to plates

For a long time, after surgery, the jaws were held together with wires and the mouth stayed closed for weeks. The arrival of plates and screws changed that: the bones are held firmly in their new position, you can talk and open your mouth from the first day, recovery is faster and there's more confidence in the results. Later, photographs were added to the study of each case, to look at the face in more detail.

Virtual planning

Virtual planning opened up new possibilities, and today it's the standard. With your 3D scans and a scan of your teeth, a digital twin of your face is built: bones, bite, joints and airway. On that twin, the surgery is first performed virtually, reviewing each option with its benefits and its limits. Then, guides printed just for you make it possible to reproduce that plan with precision in the operating room. Nothing is improvised: it's planned. That means fewer surprises and a peace of mind that didn't exist before.

Minimally invasive surgery

Minimally invasive surgery brought new ways of performing the techniques and of caring for recovery. In general, the work is done from inside the mouth, with no visible scars on the face, and instruments like the piezoelectric device, which cuts bone using ultrasound, better protect the sensitive structures around it, such as nerves. All of this translates into something concrete: a calmer recovery and, usually, going home the next day.

Sleep apnea and 3D diagnosis

Orthognathic surgery also found its place in obstructive sleep apnea. When the growth and arrangement of the structure of the face (the jaws, the muscles and, above all, the tongue) leave little room to breathe, moving the jaws forward widens the upper airway, and because the structure changes, that change is permanent. At the same time, 3D diagnosis makes it possible to see beyond a flat X-ray and to measure in volume. Together, they have expanded what surgery can do and improved its results.

Orthofacial: the whole face

Orthofacial surgery brought a more comprehensive view, in two ways. In how it's thought out: from the bite to the whole face. How you bite, how you breathe, how you look and how you feel are all one thing, and the plan considers the harmony between nose, lips and chin, the airway, the joints and stability over time. And in what's done: jaw surgery is joined by other procedures of the face, such as rhinoplasty, facelift and other facial techniques, which are usually assessed, planned and performed together. Everything is chosen case by case to achieve more harmonious results, and the work is done as a team when the case calls for it. It's a field that keeps evolving: today we can do things that used to be impossible; everything else we'll go over at your consultation.