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
