Division of Oral and Maxillofacial Surgery
University of Iowa Hospitals and Clinics
First Published: May 2000
Last Revised: May 2000
Review Status: Internally Peer Reviewed
What does "faulty jaw" actually mean?
The faulty jaw can be either congenital or developmental in nature,
or from a traumatic injury. Faulty jaw is another word for malposition of the jaw
What kind of problems can arise by having a misaligned jaw cause?
When we talk about problems that the malaligned jaw can cause, we
should mention difficulty with chewing and speech, and some people think problems
with the temporomandibular joint, or TMJ. Faulty jaw position can also create
problems with sleep apnea and we in fact advance the lower jaw and sometimes the
upper jaw to aid with obstructive sleep apnea symptoms.
Can braces do damage to the jaw?
In general it is felt that orthodontic therapy is not specifically
related to damage or problems with the jaw.
What is TMD?
TMD is "temporomandibular joint dysfunction". Like all joint
problems, the causes are multifactorial and some people believe malposition of
the jaw is one of these causes.
I grind my teeth at night, is this cause by a problem with my jaw?
Bruxism or grinding teeth at night or during the day for that
matter can be associated with malposition of the jaw. Occasionally when the teeth
do not meet correctly, it can facilitate or encourage grinding of the teeth. This
of course can create muscle spasm or a "tired jaw."
What are other options, non-surgical for TMJ, TMD??
Non-surgical treatment for TMJ or TMD include physical therapy, the
use of medicinal therapy including non-steroidal anti-inflammatories such as
ibuprofen, the use of muscle relaxants, and occasionally in severe problems, the
use of narcotics on a temporary basis.
I was in an accident and broke my jaw. Will it heal properly? What should
I be concerned about?
With respect to a broken jaw, this certainly can be a cause of a
faulty jaw position. I am assuming the broken jaw was in the lower jaw, or the
mandible. In general, mandibular fractures are treated by closed or open
reduction. A closed reduction involves wiring the teeth together for
approximately 6 weeks. This acts as a "cast" to keep the jaw from moving. The
other way to treat a mandibular fracture would be to utilize an open reduction
and internal fixation. Fixation would involve the use of small titanium plates
and screws to reduce the fracture and to minimize the time the patient is wired
together. One of the more important aspects of mandibular reduction is to seat
the occlusion or bite, as it existed before the accident. If these things are
accomplished, it is very likely the mandibular fracture will heal. Occasionally
when a malaligned jaw occurs from a traumatic incident, meaning did not heal
correctly, we go back secondarily and perform an osteotomy or bone cut, to allow
realignment of the jaw.
What types of materials are used in jaw joint surgery?
With respect to temporomandibular joint surgery and materials
utilized during surgery, we have become very conservative with our approach. Many
autogenous (or materials that come from the patient) can be utilized. These might
include cartilage, muscle, or fascia lata. In severe cases, alloplastic or
artificial joint replacement is undertaken. But I must emphasize this would be
for a severe case.
What is TMJ? What causes it? Are there any ways to correct it?
The temporomandibular joint is the articulation between the
mandible and the skull. The actual joint is immediately in front of the ear. You
can feel your TMJ by placing your index finger in front of your ear and opening
the jaw. What you are feeling is the condyle of the lower jaw. When people speak
of problems with the temporomandibular joint (TMJ), there are many potential
causes that lead to difficulties. One contributing factor is stress, others
include muscle imbalance, severe jaw malposition, and displacement of the normal
anatomy or cartilage that lies between the mandible and the skull.
Are there any synthetic material used in jaw surgery? Is it possible for
people to be allergic to these materials?
There are synthetic materials used in jaw surgery. Typically in an
osteotomy we will reposition the bones using titanium screws and plates, which
eliminates the need for wiring the teeth together. In general, people are not
allergic to surgical-grade titanium. That is not to say, however, that one could
not be allergic to titanium. Titanium has generally replaced surgical-grade
Is chewing gum bad for your jaw?
Gum chewing is not necessarily bad for your jaw. However, like most
joints, overuse can eventually lead to problems. Since the jaw joint, or the
mandible, moves each time we swallow, speak or eat, it obviously is used to a
great extent. Thus, if you are prone to sore jaw joints or have TMD, I would
recommend against parafunctional habits including gum-chewing, fingernail
chewing, chewing on pens and pencils, and opening your jaw excessively wide to
What is the typical recovery time?
Following a jaw osteotomy, the recovery time varies depending on
the desired activity. A jaw surgery patient is usually hospitalized overnight.
They are typically restricted from heavy activity or lifting over 30 pounds for
approximately 1 month, and then they are restricted to non-contact sports for 3
months. We would allow our young patients to return to full contact sports in 12
weeks. Any surgery of the jaw also requires a change in diet. The diet is
typically liquids for several days followed by no-chew food for approximately 1
month with a gradual return to a normal diet starting at 6 weeks. If the surgery
requires the jaw to be wired together, then the diet would be liquids for the
full 6 weeks.
Does a cleft palate have anything to do with the jaw?
A cleft palate is often associated with a cleft lip and alveolus.
The patient usually undergoes several surgeries in the area of the cleft at an
early age. Because of this early surgery, the normal growth pattern of the upper
jaw is restricted. Thus, it is often necessary to advance the upper jaw when the
patient is in the mid to late teens.
How do you wire a jaw shut?
The teeth are wired together utilizing horizontal wires that go
around the teeth. This is done in both the upper and lower jaws, and then
vertical wires are used to connect the horizontal wires. We also utilize arch
bars, which are wired to the teeth, and then they are connected utilizing
vertical wires between upper and lower jaws. We ask patients who are wired
together to carry wire cutters with them in case they are involved in an
accident. It is usually not necessary for patients to cut their own wires.
Can a toothache indicate a problem with the jaw?
A toothache certainly can indicate a problem within the jaw.
Whenever a toothache occurs, it should be evaluated to prevent any potential
infection from spreading into the jaw or surrounding soft tissues.
Why would you wire the jaw shut -- can't you surgically advance the jaw
With most osteotomies or major jaw surgery to move the jaws, it is
not necessary to wire the teeth together. Instead, we use titanium plates and
screws to secure the jaw into the new position.
Isn't wiring a jaw shut painful?
The use of wires to close the upper and lower jaws together is not
painful because of the use of local anesthetics, conscious sedation, and
occasionally general anesthesia
With jaw surgery, are any scars visible?
There are generally not any visible scars when major jaw
osteotomies or cuts and movements are accomplished. The majority of incisions are
intraoral or inside the mouth. The oral mucosa or tissue has an amazing capacity
to heal and even intraoral scarring is minimal.
I have a severe underbite and would like to get it fixed. Should I
consult a surgeon like you, or a plastic surgeon?
With respect to a patient with a severe underbite, first and
foremost, one should visit an orthodontist. Correction of a malaligned or an
underdeveloped jaw requires a combined effort, usually including an orthodontist
and an oral and maxillofacial surgeon. Plastic surgeons also do osteotomies. I
would recommend relying on your orthodontist for ultimate referral.
What is JRA?
JRA is "juvenile rheumatoid arthritis". This condition will involve
both temporomandibular joints. Fortunately, unlike adult rheumatoid arthritis,
this process tends to "burn out" as the child reaches their late teens. The
ultimate diagnosis of JRA does not come specifically from the observation of TMJ
There is a new trend for moving facial bones called distraction osteogenesis.
This is essentially moving the bone very slowly after making a corticotomy or
bone cut, that movement being approximately 1 mm per day. This can be
accomplished with an intraoral or extraoral device. Distraction osteogenesis is
not a replacement for routine orthognathic or jaw surgery, but has been an
exciting addition to our surgical options for treatment of assymetries and the
severely underdeveloped jaw.
What kinds of pain medications are normally prescribed to a patient after
jaw surgery? Does welling often occur?
Following jaw surgery, we typically prescribe a mild analgesic. It
is not usually necessary to give antibiotics beyond the final dose give
intravenously in the recovery room. With upper jaw surgery, we often give a nasal
decongestant to decrease swelling of the nasal mucosa. Otherwise, no other
medications are generally prescribed. With respect to swelling, we utilize
peri-operative high-dose steroids. This limits the amount of swelling that occurs
from surgery and facilitates patient comfort. Patients are not swollen to a great
extent; however, the amount of swelling varies from patient to patient.
what is the percentage of people who will experience an infection after
The incidence of infection following orthognathic or jaw surgery is
very low. In the literature, the incidence is reported to be between 6 and 15
percent. These figures are high, in my opinion. When it occurs, the infection is
easily treated with antibiotics and drainage with minimal discomfort and no
Is there any long term follow up needed?
Following a jaw osteotomy, we have patients return for numerous
postoperative visits. We see patients typically at 1 week, 3 weeks, 6 weeks, and
12 weeks following surgery. We also see the patient back at the 6-month and
12-month intervals. This is to assure that the proper jaw correction has been
obtained, is stable, and that there is not an infection or any other
What can be done to prevent infection?
During jaw surgery, we utilize high-dose perioperative intravenous
antibiotics for prophylaxis to prevent infection. Meticulous surgical technique
and accomplishing the surgery in an efficient manner will also reduce infection
rates. Occasionally, if bone graft is utilized during osteotomy, we will continue
the antibiotic therapy for 7-10 days orally after discharge.
Like the Ilizarov leg lengthening procedure?
Jaw distraction osteogenesis is based on the Ilizarov leg
lengthening procedure. In many ways, it is more successful and reliable in the
head and neck region versus the extremities because of the ample blood supply
found in the head and neck.
How often is this jaw distraction performed?
The distraction osteogenesis procedures are somewhat new, and are
being utilized for the more severe deformities. It is also being utilized very
early in life to advance the lower jaw and prevent the need for a tracheostomy in
children with microgenia or micrognathia.
I have two bumps on my lip. How do I get rid of them?
With regard to bumps on the lip, I would advise seeking the opinion
of a physician or dentist. Many bumps on the lip can be related to the minor
salivary glands. There are, of course, many other causes.
Over what period of time is the distraction completed, and what kind of
Let's look specifically at mandibular or lower jaw distraction
osteogenesis: once the bony corticotomy or cut is made, and the distraction
device is placed, the distraction rate is approximately 1 mm per day. Thus it is
possible to advance the lower jaw approximately 14 mm in 2 weeks' time. This
obviously is a large advancement. Once the jaw has been advanced, it is necessary
to "lock up" the distraction device with the jaw in the advanced position. This
allows the newly formed bone to calcify and heal. One other advantage of
distraction osteogenesis is that the soft tissue envelope meaning muscle and skin
readily, follow the bone.
What is the likelihood that you would lose sensation in your mouth after
Following orthognathic or upper/lower jaw surgery, there will be
neurosensory changes. The nerves involved with jaw surgery are not motor, meaning
surgery will not affect how your face looks or moves. In the lower jaw, the
numbness will include the lower lip, chin and gum tissue, and in general, this
should resolve in about 3 months. Sometimes neurosensory changes take up to 18
months in an adult to resolve. Occasionally, minor neurosensory changes of the
lower lip and chin can be permanent. Permanent numbness following an upper jaw
(maxilla) procedure is less common.
Is there a great chance of infection at the pin sites?
These pin sites are remarkably free of infection; however, one
complication with the pin sites is stretching of the skin and scarring. Thus,
there is a great push to develop smaller and more efficient intraoral distraction
devices to eliminate this problem.
How is it locked up?
When one is using distraction osteogenesis, it is the patient's
caregiver or the parent who will activate the appliance either once or twice per
day. The device specifically clicks, indicating a 1-mm advancement, and after
achieving the desired movement, there is a locking mechanism to keep the device
in its final position during healing. Some devices have different measurements;
meaning 1 click might equal 0.5 mm.
Is it dangerous to nerves in jaw?
Distraction osteogenesis can also affect the sensory nerves within
the bone; however, patients are generally young and neurosensory recovery is
good. The distraction device is usually left in place for approximately 6 weeks
following the last distraction movement or after it is "locked up." If the device
is an extraoral appliance, it is usually quite easy to remove the pins and often
does not require a general anesthetic.