What happens after surgery?

[Dogmatix]

I'm trying to figure out and get some insight in what the process normally looks like after orthognatic surgery.

What I've understood, you're normally left with the surgical splints and rubber bands between the jaws for about a month after surgery?
What's the purpose of this process, does this anticipate to force the teeth together to remove contact incompetence and fit better after the jaws are repositioned, or is it simply to keep the jaws from moving while healing?

[Perlkrys]

So I'm a month and a half out of surgery, and my surgeon didn't fit me for a splint or bands initially (but I'm starting to think he's a quack, so take that for what it's worth). From my understanding the splint is most often used after more complicated surgeries (palate expansion, etc) to stabilize the bite during healing and to give you a comfortable resting spot for the teeth, although some surgeons will use it every time. Bands, in my experience, are pretty weak and are mostly to give some support to teeth, and to fine-tune the bite (although they seem to be pretty clutch used in crazy configurations after surgeries to close an open bite).

[bex]

I'm 8 weeks out from my surgery (BSSO, Lefort 1, and genioglossus advancement), and was not fitted with any kind of splint. I was, however, banded from Day 3 through Week 5. Bands made a HUGE difference in my case. I could be atypical, though?

When I woke up after surgery, I could more or less open my jaw as wide (if not wider) than I could before surgery.
For the first three days (I was in the hospital for 4) I was barely able to get down any liquid, even my meds. Once the bands were on, it was SO much easier - they helped guide me to "feel" how to use my mouth when I largely couldn't feel, well, anything.

It does seem kind of ridiculous that these tiny rubber bands could have an impact on something as powerful as your jaws, but I can assure you, they were absolutely necessary. After week 1, my bite wasn't quite where it should be, so my surgeon doubled up two bands on each side of my mouth and anchored them on my IMF screws at a sharp angle. This helped me to learn how to properly hold my new jaws at rest, and after another week, my bite was exactly where it should be.

Something to keep in mind - my bite was more or less perfect before surgery, so I think that resulted in fewer bands and less restrictive placement than what would be typical for someone who required orthodontics before and after surgery.

[Dogmatix]

Thanks for your stories. It disappoints me a bit, since I thought the rubber bands would perform more orthodontic work, than it seems to do in your cases. But of course, if you already have a perfect bite, then there's no orthodontic work to be done. In my case my surgeon tells me that he will aim for a tripod formation, meaning that some contact incompetence is expected after surgery. My hope was that this was what the elastics would start working on from the minute I get out of surgery, to close the contact incompetence and not only guide the jaws, but also force my teeth to occlusion at the new bite. But then again, maybe this is the case for me, as it doesn't seem like neither of you had these problems to correct. Just as you say Perlkrys, if the elastics are used to close an open bite after surgery, this may be the equivalent of what I'm asking for in my case.

Bex, interesting story. I never imagined that it could be that hard to find the correct position to bite in after surgery. How I understand you the elastics didn't really do or move anything for you, but more for your muscle memory to get used to the new position. It sounds like a scary situation to wake up and not being able to actually find where to bite. How would you describe it? Is it like you tried biting and sometimes ended up at a class 3, sometimes biting to the right, left etc, or how sever was the situation for you?

[kavan]

THe purpose of the bands and splints is to stabilize the surgery during the healing process, so you don't 'undo' it or otherwise f*ck it up during the healing process. The 'old fashion' way, many years back was just to WIRE THE JAWS SHUT. So, more towards keeping jaws in place. This does not preclude further adjustments post healing of the surgery whether they be more bands or longer in braces.

[bex]

Bex, interesting story. I never imagined that it could be that hard to find the correct position to bite in after surgery. How I understand you the elastics didn't really do or move anything for you, but more for your muscle memory to get used to the new position. It sounds like a scary situation to wake up and not being able to actually find where to bite. How would you describe it? Is it like you tried biting and sometimes ended up at a class 3, sometimes biting to the right, left etc, or how sever was the situation for you?

I'm not sure to what degree the bands can move things, but they direct your jaw into the correct position, if that makes sense. I tried to think about it like a cast on a broken bone - for example. I had a friend who needed to have her broken arm rebroken and reset because the hospital originally just wrapped it and put it in a sling. The cast would have helped ensure a successful union. Same thing with the bands.


I wouldn't call the bite situation scary - there's honestly so much going on with your body post-op that you can't focus on any one thing too much. Since my bite was perfect before surgery, there wasn't any shifting/biting to the left or right; it was that I was trying to hold my teeth in their pre-op position (so, further back instead of forward). My surgeon had me bite in a few different ways, and once I was in the right spot, he said, "Wait. Hold that position. Remember what that feels like. That's where you should be." It took maybe a week for that position to feel natural, but it's otherwise been a non-issue.