SEATTLE JAW SURGERY

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Double Jaw and Chin Surgery - Correcting an Anterior Open Bite

This patient presented with an anterior open bite, condylar resorption, mandibular asymmetry, and a Class II malocclusion, along with a significant history of TMJ symptoms including joint soreness, locking episodes, and difficulty chewing. She had completed multiple prior rounds of orthodontics, after which her bite had not fully stabilized. Her orthodontist determined that further orthodontics alone would not correct her malocclusion and referred her for surgical evaluation.
Treatment included a segmental Le Fort (upper jaw), bilateral sagittal split osteotomy (lower jaw), and genioglossus advancement (chin). She completed post-surgical orthodontics and is now able to chew without difficulty.
Orthodontics team: Pacific Orthodontics (Dr. Diane Doppel)

TMJ Ankylosis

Case breakdown

Cutting guides for the ankylosis resection were useful here to allow for proper positioning of the TMJ replacement components. The vertical position of the fossa and the medial/lateral position of the condylar components were very much dependent on accurate vertical and lateral reduction of the ankylosis.
The usual technique of holding the jaw forward with an occlusal splint wouldn’t work here given the poor teeth. To create reproducible anatomy, alveolar custom cutting guides were designed based off of stable landmarks – the nasal floor and chin. Care was taken to keep the cutting guides away from the TMJ replacement surgical sites. Positioning guides importantly engaged the lingual alveolus of the mandible and the palate to resist soft tissue pull. This allowed the joints to be inserted.
The last step in the operation was managing the teeth. Typically we get patients teeth in a second operation but in this patient’s case, we were concerned about monitoring jaw dislocation and rehabbing his mouth closers (masseter, temporalis, pterygoids.) These are typically weak in ankylosis patients. The solution was to create implant supported upper and lower dentures. We created custom implant guides that fit into the same places as the alveolar cutting guides. 10 dental implants were placed with immediate pick up and loading.
Last technical bit that was very useful – islets on the temporary dental appliances for rubber bands. Rubber bands helped the patient learn his occlusion after surgery and were easily removed when they were no longer being used. Surgery took about 14 hours given the complexity involved. We were able to get the patient safely through it and he was up and around the day after. At 6 weeks after surgery, still in his temporaries, he was already able to bite and chew things he remembered from childhood!
The patient’s mandibular advancement was done with bilateral custom TMJ replacement devices. The devices advance the mandible allowing for an increase in upper airway size. In his situation his apneic events dropped from 78 an hour to 19. Typically jaw surgery for sleep apnea involves upper and lower jaw surgery but in his situation, a 2cm lower jaw advancement made a big impact

Condylar Hyperplasia - Mandibular Asymmetry

Condylar hyperplasia is a condition where one side of the jaw joint grows more than the other, causing the jaw to shift and the teeth to meet unevenly over time. In this case, the uneven bite had also led to significant wear on the teeth.
Treatment was planned in two phases: orthodontics first to align the teeth, followed by surgery to correct the jaw. The single surgical operation included upper and lower jaw surgery, a chin procedure (genioplasty), and removal of the overgrown portion of the jaw joint (condylectomy).

Masseter Hypertrophy - Botox Narrowing The Face



Enlarged jaw muscles can develop from habits like clenching and grinding (also called parafunction). While it’s a benign condition, it can cause jaw pain and change your facial shape over time. Botox injections in the masseter can reduce muscle bulk and relieve spasms
 
 
This patient came in with Masseter hypertrophy, which refers to enlarged jaw muscles that can cause jaw pain and change your facial shape over time. Botox can be effective in reducing muscle bulk and relieve spasms.

Surgery First Approach to Correct Bit and Jaw Alignment

 
This patient’s jaw and bite were corrected using a surgery first approach. Rather than waiting to complete orthodontics beforehand, they went into surgery with their braces already in place. The procedure included upper (paramidline osteotomy) and lower jaw surgery (BSSO) to address the midline and symmetry
 
Orthodontics Team: The Smart Orthodontic Group

Rheumatoid Arthritis — Correcting an Anterior Open Bite

This patient developed an anterior open bite over time, meaning his front teeth no longer made contact when his mouth was closed. This gradual change in his bite was linked to a diagnosis of rheumatoid arthritis, which can affect the jaw joints and alter how the teeth meet. Their condition was stabilized through medication before moving forward with surgery.
Treatment included upper (segmental LeFort) and lower jaw  (BSSO) surgery, with the upper jaw divided into segments to precisely fit his front teeth together.
 
Orthodontics Team: Islander Orthodontics

Lower Jaw and Chin Surgery

Diagnosis: Class II Malocclusion and Retrogenia
 
Procedure: Lower jaw surgery (BSSO) and chin (genioplasty) surgery
 
Orthodontics Team: Yousefian Orthodontics

Double Jaw Surgery

Diagnosis: Class III Malocclusion and Mandibular Hyperplasia

Procedure: Upper jaw (Segmental LeFort) and lower Jaw (BSSO) Surgery

 

Botox is not only used for cosmetic purposes. At Seattle Jaw Surgery, we offer Botox as a clinical treatment for patients experiencing jaw pain, chronic muscle tension, and TMJ-related discomfort. It is sometimes referred to as “Botox for TMJ” because of how commonly it is used to address TMJ-related symptoms.

How it works

The masseter muscle, located on either side of the jaw, is responsible for chewing and clenching. In patients who grind their teeth, clench habitually, or have chronic jaw tension, this muscle can become overactive and enlarged. Over time, the sustained pressure it generates contributes to jaw pain, headaches, and accelerated tooth wear.

Botox injected into the masseter temporarily reduces the activity of the muscle. As it relaxes, patients typically experience a noticeable reduction in jaw tension, pain, and clenching force. For patients with tension headaches originating from the jaw, treatment of the temporalis muscle may also be recommended.

Who performs the treatment

All Botox consultations and treatments at Seattle Jaw Surgery are performed by Andrea Burgess, PA-C. Andrea’s background in oral and maxillofacial surgical care means she approaches this treatment with a detailed understanding of jaw anatomy, muscle function, and the relationship between the masseter and the broader TMJ complex.

Is it right for you?

A consultation is the appropriate first step. At that visit, Andrea will complete a full assessment of your jaw, muscles, and joint function. If Botox is the right fit, treatment can typically be completed the same day. If a different approach would be more effective, you will leave with a clear understanding of your options.

Masseter Botox may be appropriate if you experience:

Benefits

Patients who respond well to masseter Botox typically experience:

Risks

As with any injectable procedure, there are risks to be aware of prior to treatment:

Schedule a consultation

To schedule a TMJ consultation with Andrea Burgess, PA-C, contact our office by phone or email.

[(206) 207-1525] | [info@seattlejawsurgery.com]

For a full walkthrough of the appointment process, visit: What to Expect at Your Masseter Botox Appointment.

Traveling to Seattle for Jaw Surgery (orthognathic surgery), maxillofacial treatment, or total joint replacement treatment? We’ve compiled everything you need to plan a comfortable, stress-free stay in Seattle’s First Hill, from airport arrival through post-surgery recovery. Our board-certified oral and maxillofacial surgeon and treatment care team are here to support you every step of the way.

Getting Here

Seattle-Tacoma International Airport (SEA) is your primary gateway, located approximately 14 miles south of our First Hill office. 

Seattle-Tacoma International Airport (SEA)

The main gateway to Seattle, SEA is a major hub served by most domestic and international carriers. Located in SeaTac, WA — approximately 30–45 minutes by car from our First Hill office depending on traffic. Rideshare, taxi, and rental car services depart from the ground transportation level after baggage claim.

Link Light Rail — Direct from the Airport

The most affordable option: Sound Transit’s 1 Line runs directly from SeaTac Airport to Capitol Hill Station (~38 min, $3.00 fare). From Capitol Hill, the First Hill Streetcar connects directly to our neighborhood. Visit soundtransit.org to plan your trip.

Rideshare (Uber & Lyft)

Uber and Lyft are widely available throughout Seattle and at the airport. Budget approximately $35–$55 for an airport-to-First Hill trip. Please note: you will not be permitted to drive or use unsupervised rideshare following any sedation procedure. A responsible adult companion must accompany you.

First hill streetcar

The First Hill Streetcar Line runs 2.5 miles connecting Capitol Hill, First Hill, the International District, and Pioneer Square. It links directly to the Link Light Rail at Capitol Hill Station. Visit seattle.gov/streetcar.

Accommodations

How long should you plan to stay? 

All patients should plan for a minimum of 1 week in Seattle following surgery to attend their one-week post-operative appointment before traveling home. International patients typically choose to stay for 3 weeks to ensure they are comfortable and cleared for the journey home. If you are planning an extended stay, we recommend exploring alternative lodging options outside the city center — such as extended-stay hotels, furnished apartments, or Airbnb rentals in the greater Seattle area — which can significantly reduce accommodation costs over a multi-week stay.

Silver Cloud Hotel

1100 Broadway
Seattle, WA 98122
P: (206) 325-1400
0.3 miles / 6 min walk

Website Link

Crowne Plaza Seattle-Downtown by IHG

1113 6th Ave
Seattle, WA 98101
P: (206) 464-1980
1.0 miles / 17 min walk

Website Link

Hilton Garden Inn Seattle Downtown

1821 Boren Ave
Seattle, WA 98101
P: (206) 467-7770
1.0 miles / 21 min walk

Website Link

Grocery Store

348s

QFC Broadway

1401 Broadway
Seattle, WA 98122
0.4 miles / 9 min walk

Stockbox first hill

Ninth and Jefferson Building Garage, 901 James St
Seattle, WA 98104
0.3 miles / 7 min walk

Yellow Bee Market & Cafe

922 E Yesler Wy
Seattle, WA 98122
0.5 miles / 11 min walk

Pharmacy

Swedish Pharmacy - First Hill

1221 Madison St, 3rd Floor
Suite 03AR34
Seattle, WA 98104
P: 206-386-6020
Mon – Fri: 9 a.m. – 5 p.m
0.3 miles / 6 min walk

 

A pharmacist-on-call is available 24 hours a day/7 days a week for any question you may have, including emergency and clinical situations such as concerns about side effects, medication assistance and complaint resolution.

Additional Resources

We’ve put together a set of patient resources to help you feel informed and prepared every step of the way.

Helping other professionals understand surgery

We have over the years partnered with many providers – orthodontists, oral surgeons, dentists, physical therapists, endodontists, ENTs, sleep physicians, prosthodontists, oral medicine doctors, and others. There are many misconceptions in regards to surgery and the typical perioperative course. We have been recording topics of interest to other providers to address these issues that can come up. The podcast is called Downfracture and we are partnering with Arizona Jaw Surgery to bring weekly episodes that you might find interesting. Look for new weekly content for additional information.

Here is the link

Spotify

Jaw Surgery

Mandibular Advancement (BSSO)

The Bilateral Sagittal Split Osteotomy (BSSO) is the most common mandibular osteotomy done at Seattle Jaw Surgery. This is a bilateral procedure and done through incisions in the mouth. This shows the indication to advance a small lower jaw to get the front teeth to fit.

 

Genioplasty (Chin Surgery)

This is a simple sliding genioplasty to advance the chin. This procedure is used for facial balance or to allow the tongue attachment to be pulled forward.

 

 

 

Maxillary & Mandibular Advance (CCW Segmental), Teledontics

 

 

 

 

Bilateral Total Joint Replacement with Maxillary Advancement

Both joints are again replaced with TMJ concepts devices. The position of the lower jaw is changed with these devices. The upper jaw position is changed as well to increase the size of the upper airway, improving and possibly correcting obstructive sleep apnea.

Condylar Resorption

This shows the process of arthritis taking away the bone of the condyle in the TMJ. This causes the lower jaw to receed. The functional concerns this can cause are being unable to get the front teeth to touch and/or a smaller upper airway size.

TMJ Surgery

One sided TMJ replacement with orthognathic surgery

Here a right sided TMJ replacement is completed at the same time as a left sided sagittal split osteotomy and a Le Fort osteotomy. The reasoning here is to restore the position of the upper and lower jaws in the setting of severe right sided TMJ arthritis but an intact left joint.

Total Joint Replacement (TMJ)

Due to severe TMJ arthritis, the joint is unable to be repaired with conservative measures. Bilateral TMJ replacement with custom TMJ concepts devices are shown to restore the lower jaw position, improving the occlusion and upper airway size.

TMJ Arthroscopy

This video shows arthroscopic TMJ surgery. Here the disc is stuck and is not allowing the lower jaw to move fully. The disc mobility is improved with this technique, restoring movement and function.

TMJ Arthroplasty

Open TMJ surgery where the disc is repositioned in the correct location.

 

Coming Soon!

Coming Soon!

Traditionally, if your orthodontist suspects that you may need jaw surgery you will be referred for a jaw surgery consultation prior to the initiation of your orthodontic treatment.   At that time we will discuss the surgical options that are available and the typical timeline.  After your consultation with our office your orthodontist will begin your orthodontic treatment.  Keep in mind that you will typically be in braces for 6 months to 2 years prior to your jaw surgery.  When you are ready for surgery your orthodontist will notify you and our office.  We will see you in clinic 2-3 months prior to your planned surgical date to be sure that we are ready for your surgery.  You will be seen in our clinic one additional time 2-3 weeks prior to surgery for your pre-operative appointment.  After your surgery is completed you can expect to spend one night in the hospital.  Typically patients are discharged home the day after surgery.  We will then see you for follow up appointments at 1 week, 3 weeks, 6 weeks and 6 months.  About six weeks after your surgery your orthodontist will see you and begin the final stages of your orthodontic treatment to fine tune your teeth.

 

Joint replacement is a commonly performed surgical procedure. Each year in America, hundreds of thousands of knees, hips, and shoulders are replaced. For the temporomandibular joint (TMJ), it is more unusual. Despite the rarity, many patients can benefit from the procedure. TMJ replacement is useful for patients with severe arthritis, severely limited mouth opening (ankylosis), joint tumors, trauma, infection, or failed previous devices. In fact, it is the most predictable treatment for the worst situations. 

Most commonly, people see us because their mouth can’t open and/or their joints hurt.  The TMJ is one of the most used joints in the body and issues with joint function can influence overall well being.  Talking, eating, breathing, and speaking can all be influenced by severe TMJ disease. The goal for TMJ replacement is to restore function of the jaw joints. Replacing the TMJ can not only help reduce pain and improve mouth opening, but it allows the lower jaw to move to fit your upper teeth. This can make your upper airway bigger, correct a poor occlusion, and improve facial balance. Overall, our focus is to allow patients to improve their quality of life.

Dr. Bobek is known in the Pacific Northwest for his surgical expertise with TMJ joint replacement. He has treated more than 150 patients with joint replacement.  Our most frequently used device is the Stryker TMJ Concepts device.  They fabricate custom titanium joints based on your actual anatomy. This allows for a customized and precise surgical planning with positive patient outcomes. 

Unfortunately, the history of TMJ replacement in America started with failure. The first devices in the 1960s and 1970s were taken off the market by the FDA in 1991. Government oversight picked up from there as people were getting worse with some TMJ replacement devices.  Four devices were followed by the FDA starting in 1998 to evaluate outcomes. Over the next 30 years, two devices have demonstrated the safety and good patient outcomes to be still be on the market in America.  Since the 1990s, we have learned extensively from our orthopedic surgery colleagues.  Modern TMJ replacement has very similar outcomes as orthopedic hip or knee joint replacement. 

Once you have exhausted all nonsurgical methods or are in a situation where nonsurgical methods don’t help, replacement should be considered. There are replacement options using your own body (autogenous grafts), but you will notice those parts missing. Costochondral (rib) grafting involves removing your 5th or 6th rib to be placed into your jaw joint. With this operation, there is at least a 50% reoperation rate in the first 10 years. The other options involve removing your lower leg bone (fibula) or second toe (metatarsal) through free flap transfer. These are very invasive operations that require connecting the blood vessels of your flap to the neck or face.  For most people, TMJ replacement devices are the best bet.

Orthodontics are often used in the care of patients who are having a TMJ replacement.  Orthodontists use braces or invisalign to help align the teeth prior to and after TMJ replacement surgery.  For many people, orthodontics are not necessary but we will discuss the pros and cons in your situation. 

Metal allergy, specifically nickel allergy, is a common issue with TMJ replacement.  While the device is largely made up of titanium, the condylar component has a Cobalt-Chromium alloy.  The FDA allows for compassionate use of a device that does not contain that alloy (all titanium device) if you have a documented metal allergy to one of the components. We can arrange for your blood to be tested through orthopedic analysis to verify your allergy. 

While the percentage risks are low, the consequence of complication is high. Joint infection happens 1-2% of the time and often requires further surgery to manage. The expected life of the devices is thought to be at least 20 years but we don’t currently recommend device replacement until they break. 30 year data seems encouraging thus far.   Bone growth over the devices can happen over time and we place abdominal fat over the devices to minimize bone growth. Lastly, typical surgical complications like nerve injury, scarring and bleeding are possible. We will talk with you about your risks at your visit. 

With just TMJ replacement, you will be able to chew soft foods right after the surgery. We want you rehabilitating as soon as possible after the surgery and we will give you a jaw stretching device immediately after your surgery.  We will also want you to meet a physical therapist before surgery as everyone who has TMJ replacement will need physical therapy after the operation. Luckily, we have many options in the Seattle area. 

For some people, upper jaw surgery happens at the same time as joint replacement. When this happens, we need the upper jaw to heal before chewing. This is a process that can take 2-3 months. 

Recovery after joint replacement can take several weeks to months. Your surgery is done at either the hospital or our surgery center. At the hospital, you may be admitted for one night after surgery.  Life is pretty different for the first week and you are followed in clinic with post-operative appointments at 1, 3, and 6 weeks and 6 months. Patients start TMJ physical therapy about 2 weeks after surgery. At this time, they can generally return to work and begin many normal jaw functions. Given the core functions that the TMJ supports, we generally estimate that it takes 6 months before patients stabilize into their new normal state following joint replacement

Many medical insurances do have coverage for TMJ replacement.  We will be able to send your information to your insurance company to find out about coverage. Unfortunately, we are aware of plans that do not cover TMJ surgery. In those situations, cash pricing and payment plans exist.  

Orthognathic Surgery is the medical term for Jaw Surgery. It is a surgery to reposition the jaws to correct alignment. This realignment allows teeth to fit when misalignment cannot be solved by orthodontics alone.

We think it is reasonable to consider going through jaw surgery for a few reasons. Most frequently, the upper and lower teeth fit in a way that makes chewing and biting difficult. This match between the upper and lower teeth is referred to as your bite (occlusion.)   

If the occlusion is incorrect, you will hear the term malocclusion (bad bite.)  Common malocclusions are referred to as overbites, underbites, crossbites, and open bites.  These conditions are frequently related to the underlying structure of the bone being mismatched to the opposing bone.  Those two bones are the maxilla (upper jaw) and mandible (lower jaw).  When the lower jaw is too far forward (mandibular hyperplasia), or the upper jaw is too far back (maxillary hypoplasia), an underbite is present.  When the lower jaw is too far back (mandibular hypoplasia), or the upper jaw is too far forward (maxillary hyperplasia) there is an overbite.  the front teeth don’t touch (anterior open bite), the back teeth don’t touch (posterior open bite)

While malocclusions can lead to difficulty with biting and chewing, the cause of the malocclusion can cause other functional problems.  Small lower and upper jaws are associated with difficulty breathing during the day and night.  This is because there is less space for the tongue and soft palate to live.  You are good at compensating for this and the most common compensation is head position. People come in with neck pain and postural concerns because the are chronically adapting to their poor jaw position.

Underbites and open bites are associated with speech difficulty.  The tongue forms many sounds by touching the roof of the mouth behind the front teeth. If the front teeth are far away from the tongue, it can be difficult to speak.  Air escape can happen as well with front teeth that don’t touch. 

Jaw joint (TMJ) issues are complex but with severe malocclusions, people often find fatigue with chewing. This is because only a few teeth work to chew. Many chewing cycles can wear out the joint. 

Upper and lower jaws are mismatched for variable reasons. Common causes are TMJ arthritis, trauma, congenital issues, growth abnormalities, open mouth breathing, low muscle tone, jaw tumors or systemic issues. 

Jaw surgery is completed under general anesthesia as an outpatient surgery.  It is used to treat several conditions including a severe underbite or overbite, open bite, jaw or facial asymmetry, sleep apnea and others.

Typically, patients find themselves in our office after seeing an orthodontist. The orthodontist will make the recommendation based on your jaw alignment.  Surgery may be needed in addition to orthodontic treatment to correct your bite. They would refer you to discuss orthognathic surgery with a maxillofacial surgeon.

Your initial consult in our clinic will consist of one of our surgeons taking a history, doing an examination, reviewing your clinical photos and any available imaging. They will then discuss what is involved with jaw surgery and anticipated surgical intervention. You will also be shown a cartoon demonstration video of how jaw surgery is used to reposition the jaws. After this consult you return to your orthodontist to begin orthodontic treatment.

The traditional timeline for jaw surgery patients is to be in braces for a period of time, on average this is about 6-18 months to straighten and align the teeth prior to surgery. Then the orthodontist will tell the patient when they are close to being ready for surgery. It is then that you follow up in clinic for a recall visit. One of our maxillofacial surgeons will do another exam and we will take updated photos. The surgeon will then have a better idea of what surgical treatment they recommend. At this recall if you are ready for surgery you will meet with one of our care coordinators to schedule a surgery date.

You return to clinic to obtain presurgical records. These records include an updated CT scan and an optical scan of your teeth. These are used by the surgeons to complete your virtual surgical planning (VSP). This is a way to customize the surgery to each individual patient. At your preoperative visit we will discuss the process of surgery at the hospital, review your specific plan for surgery, and review instructions for recovery after surgery.

Surgery takes place at the hospital; you spend one night in the hospital after surgery and are discharged the following day. We see you in clinic for your post operative visits at 1, 3, and 6 weeks after surgery and then 6 months after surgery.

Jaw Surgery

Did you know?

Though only an oral surgeon can let you know if jaw surgery is right for you, there are some signs and symptoms that the procedure could be right for you:

  • Your lips do not meet in your natural bite
  • Your jaw protrudes noticeably forward
  • Your chin is receded backward
  • Your face seems unbalanced
  • You have open space between your upper and lower arches when your mouth is closed
  • You have breathing difficulties during sleep
  • You find yourself breathing primarily through your mouth
  • You have difficulty chewing and/or swallowing food
  • You have excessive wear on your teeth
  • You have ongoing jaw joint pain
  • You suffer with chronic headaches

You may be a candidate for corrective jaw surgery if you have a malocclusion (bad bite) that is caused by poorly aligned jaws. Only a complete consultation with an oral surgeon can help you determine whether jaw surgery is right for you.

At Seattle Jaw Surgery, you will be evaluated by Dr. Bobek to determine if surgery is right for you.  If you can avoid surgery he will be honest with you! If you could benefit from surgery, he will discuss the pros and cons.  

The decision to recommend surgery is based off of the individual. Functional troubles, clinical examination, radiographs (xrays), history, orthodontic exam and dental impressions are all considered when recommending for or against surgery. 

On the day of your operation, you’ll be placed under general anesthesia. An incision will be made on the inside of your mouth, through which your surgeon will reposition your jaws. Some jaw surgeries involve bone shaping, which may include shaving some bone away or grafting new bone into the jaw. A combination of plates, screws or wires may be used to hold the jaw in place before your incision is closed.

Please view our jaw surgery techniques on our videos page.

 

Yes. The initial healing phase is usually a few weeks long. During this time, you’ll be placed on a modified diet and instructed to avoid certain activities. It is important to take all medications as prescribed and to keep the incision site clean and free of debris. Your jaw may be swollen and sore for several days after surgery. Be sure to contact your doctor if you experience fever or any discomfort that worsens with time. Keep in mind that your jaw will continue to heal over the course of several months – a process that can take up to one year to complete.