The musings of a final year medical student

Sunday, 12 July 2015

Orthagnathic surgery

On the 31st of July 2015 I am hoping to have my long awaited orthagnathic surgery to correct my overbite.

I have mentioned this surgery in previous posts but will go through it again.
I get so many questions about the operation, and most friends look exasperated and a little scared for me. So, I have structured this post to explain the When/What/Why/How/Whos surrounding my orthagnathic surgery.

I would like to put out a disclaimer that I am not in any way an expert, and my personal explanations are formed from information accumulated from my surgeon, orthodontist, dentist, the internet and general heresay. This operation varies from surgeon to surgeon and country to country, so  this information is specific only to my own case and my experience of NHS care in England.

What is an overbite?
The maxilla and mandible are meant to lie parallel, and most people find that the lower teeth are slightly behind the upper teeth. For me, the lower teeth are more recessed than what would be usually expected. An underbite is the reverse problem; the mandible protrudes further than the maxilla. Many friends have told me they've never noticed I had a 'funny jaw' - it can be quite subtle for some people and much for noticeable for others. The overbite means I can actually stick my tongue out between my front upper and lower teeth when I bite my teeth together! 

What is it like to have an overbite?
For me, it's very embarrassing and frustrating. Despite most people not noticing there is anything particularly wrong about my jaw, it causes several problems for me. Firstly, I can't keep my mouth closed for more than a minute at a time. This may seem very simple, but it is something that really gets me down. If I try to keep my lips together, the muscles surrounding them become very sore and I get an aching, throbbing sensation. Eating is also difficult, and I am always worried people are going to notice, although they almost never do. It's rude to eat with your mouth open, but I find it really hard to chew with my mouth closed. I also get jaw ache whenever I talk too much or become stressed. 

When did I know I had an overbite?
I first noticed there was something wrong with my jaw when I was preparing for a flute exam. I was 13 and was preparing my pieces for my grade 6, and I started to notice the aching and throbbing sensation around my mouth that I mentioned in the previous paragraph. It became very uncomfortable to maintain the correct mouth position, and by the end of an A4 side of sheet music my mouth would throb so much that I had to have a break from playing and wait for the sensation to stop. I had to give up because I couldn't progress due to this problem, not knowing why it was happening. I saw an orthodontist at 15 who told me I had an overbite and offered me the surgery. It all made sense after she had explained it. 

Why am I having orthagnathic surgery?
Initially, I said no to the operation. I didn't understand how it worked or why I needed it. I then did some research and also consulted my dentist. She informed me that the operation would stop the jaw ache, I would be able to eat normally and I would be able to close my mouth comfortably. She also warned me that if I did not have it done then I would run the risk of molar erosion due to the uneven distribution of weight caused by the overbite. There was also a possibility I could start playing the flute again. So, after a lot of consideration, I realised that this operation could benefit me in many ways and in the long-term, and I said yes.

What does the surgery involve?
The surgery is performed by a maxillo-facial surgeon, and they are required to obtain a degree in both dentistry and medicine. The surgeon makes incisions on the inside of the mouth (so no visible facial scarring), and breaks the jaw bones. He or she manipulates the bones according to very precise lengths arranged prior to the operation and then secures the bones with metal plates. The surgery requires the patient to go under general anaesthetic and takes around five hours. These operations vary depending on the individual's case. For example, some people only need one jaw moved; I require both to be altered, so the operation lasts longer. 

What happens after the surgery?
To use my orthodontist's words: "You'll look like you've been hit by a bus". Charming. The facial swelling varies from person to person; pain relief is prescribed and is often taken for the first week or so. After a day or two, elastic bands are attached to the braces vertically; the bands will attach from the upper tooth to the immediate bottom tooth below it. This is so that the range of motion of the jaws is limited whilst they are healing. Consequently, you can't open your mouth much at all! The elastic bands stay on the braces for about a month, and during that time you are resigned to a liquid-only diet. For this, I am booked to see an NHS dietician to give advice of what to have during that time. Once the elastics are off, soft foods can be introduced, progressing slowly back to a regular diet. Your face will look 'more normal' and proportional. It can also affect the position of your cheek bones and your nose shape and width slightly. Normally people need 2-4 weeks before they feel well enough to go back to work, and normal speech will come back after about a month. 

Is it cosmetic?
I thought initially it wasn't at all, but it can be depending on the individual. This is an NHS treatment that was offered to me in order to help me feel physically more comfortable on a day-to-day basis and prevent possible complications in the future. For me, that is the only reason I chose to have it. Given that nobody ever suspected I had a jaw deformity, it is unlikely that this operation will have a dramatic change to my appearance. In my later surgical appointments I was told that because they were also moving the maxilla upwards 3 to 5 mm, this would mean that I will show less gum and teeth when I smile. I didn't get any say in this, and I didn't ask for them to correct my smile - I don't have a problem with my smile! It is a part of the corrective process. 
However, I know that for some people, having an overbite/underbite has crushed their self confidence, and I can understand why they would want this surgery to help them. For some, a jaw deformity is the same as having a big wonky nose or a cleft palate; some people have put up with years of bullying just for how they were born. I am very lucky that my overbite isn't very noticeable and I have never had any confidence issues surrounding it. A blogger called Leanne Woodfull has documented her orthagnatic surgery experience, and her underbite was a massive contributor to her depression. She describes in one vlog on her YouTube channel that if her surgery was delayed again she wouldn't want to live or she would "jump out of a window". I found that heartbreaking to hear, and I am so happy that orthagnathic surgery has empowered her and boosted her self confidence. 

I am prepared to show before, during and after photos and document the process in order to shed some light on this operation. It is a massive decision for anyone to make and should not be taken lightly, and I want to help other people make an informed decision. 



  1. Hi, I just wanted to wish you luck in your surgery tomorrow and I hope everything goes well!
    I am due to have this surgery myself and have been on the waiting list in Cornwall since the
    beginning of the year, having had braces for two years now.
    At the moment I'm hoping to have the surgery at the end of this year/ beginning of next year
    and I just wanted to ask if after your surgery you could share some information about your experience/
    how it went/ whether your pleased with the results etc?
    Obviously I know there is a long recovery process though so get better first!
    My case sounds exactly the same as yours, from the tongue sticking out between the teeth in photos to
    the struggling to chew. It's things I'd never noticed I did until I thought about my teeth not meeting together.
    Tearing up my food because my incisors didn't meet together to do it, I never even realised I did it.

    Again, I hope everything goes well and you get a fantastic result and finally get that perfect bite!
    Take care, Courtney x

    1. Thanks Courtney! I hope you find these posts helpful. So far I am delighted with the results, but it was a very tough process and I don't think it is for everyone. If you have any more questions don't hesitate to contact me and I wish you the best of luck if you decide to have the operation!

      Kate xx


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