Services - Seattle Jaw Surgery

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Upper jaw surgery is most commonly a Lefort Osteotomy. This is a surgical technique that moves the upper jaw in three dimensional space. The surgery either moves the upper jaw to the lower teeth position (single jaw surgery) or into a three dimensional position to optimize form and function of the face.

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Customization of hardware has always been a part of jaw surgery. We bend each plate and adapt each screw to your individualized anatomy. For TMJ surgery, replacement devices are fabricated by hand to fit your individual anatomy. These are all invaluable and have been a mainstay of contemporary orthognathic surgery

Over the last 5-10 years, hardware companies have been promoting 3d printed hardware. This type of hardware can be a very useful tool in complicated surgical situations such as cancer or trauma reconstruction. Dr. Bobek uses this type of hardware during jaw surgery with some inverted L osteotomies, some revision surgeries, and with some inferior positioning of the maxilla surgeries.

The trouble with the 3d printed hardware is cost. Jaw surgery can be very expensive and increasing the absolute cost of hardware by 5, 10, or even 15 thousand dollars seems wasteful for routine surgeries. American healthcare is plagued with cost overruns and it is our belief that the large hardware companies are marketing these devices to make more money. We value transparency in cost and being good stewards with all of our resources.

There has been no evidence that 3d printed hardware improves surgical outcomes or decreases surgical time for routine orthognathic surgery. Again, it is very useful in complicated scenarios, but we just cannot justify the cost for the vast majority of jaw surgeries. At Seattle Jaw Surgery, we will consider your situation from all aspects – quality, cost, risk and benefit. Come see us to see which kind of hardware is best for you!

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At Seattle Jaw Surgery, we uniquely involve patients in the process of their surgical planning. Each person now sits down with Dr. Bobek to “fly through” and adjust the surgical plan. He involves you in your preferences for surgery, customizing the amounts of movement, location of bony cuts and accounting for the particular risks in your anatomy. We find that patients learn much more from seeing and interacting with the actual 3 dimensional planned movements. Unfortunately, most centers give you pdf images of what they think is right. We want you involved!

Here is an example of how planning was used to correct the way the teeth fit while also narrowing the lower jaw. This improved the jawline esthetic while improving the function of the teeth.

At Seattle Jaw Surgery, we are on the cutting edge of planning. We use the latest technology for digital impressions of teeth, low dose, three dimensional CBCT imaging of the face and versatile surgical planning software. This allows for a comfortable patient experience while understanding what will be happening in surgery. Our all digital workflow allows for easy coordination with orthodontists and coordination of care for patients living far away from Seattle.

Jaw surgery planning has not always been this way! Traditional surgical planning involved dental impressions, clinical examination, 2 dimensional xrays and face bows. It is amazing that the surgeons at the time did such an excellent job with such limited data. Dr. Bobek has the unique experience of training in the traditional surgical planning while also being involved in the advancement of virtual surgical planning.

Virtual surgical planning shines in complex situations. Since jaw surgery is performed through very small incisions, the ability to visualize complex movements and trouble shoot difficult situations makes the surgical teams work much easier.

Here, more than 4cm chin advancement is planned with TMJ replacement devices, a segmental upper jaw surgery, and a subapical osteotomy.

Unfortunately, virtual planning isn’t perfectly accurate. Errors commonly are noticed in midlines of the upper and lower teeth, TMJ position, the way the teeth fit, and asymmetry. Our team has planned thousands of cases and we are always on the lookout for better ways to do things!

A good example of how virtual planning can be inaccurate is in head position. Here is an example of how much head position alters the final plan.