Patients for orthognathic treatment involves various factors that may ultimately influence levels of
patient satisfaction. These include: physiological; medical; interpersonal and psychological. The majority of studies investigating the psychological aspects of patients undergoing orthognathic treatment, have shown that patients seeking orthognathic treatment are psychologically well
adjusted prior to surgery, and appear to have fewer deficits in their personality dimensions than those patients seeking other ‘cosmetic-type’ procedures.
It is important your teeth are moved into the correct position before surgery so that they will meet properly after surgery. Therefore, as the teeth are lined up before the surgery, your bite may actually look worse. This is done purposely to give the best result and provide maximum improvement in your bite and facial/dental appearance.You will need to wear a fi xed brace for approximately 24 months before surgery and for 6 to 9 months afterwards. However this varies from patient to patient and your orthodontist should be able to advise you on this. Fixed braces are used as they allow the most accurate positioning of your teeth prior to surgery. During your operation, they also help the surgeon position your jaws correctly. The brace will consist of metal brackets, it is not possible to use tooth coloured braces or invisible aligners.The operation will be done from inside your mouth. If there is a possibility of scars on your face, this will be discussed with you before starting treatment. Some operations involve surgery on both your top and bottom jaw. Others involve only one jaw. Operations to reposition the jaw bones are called “osteotomies”. Your surgeon will tell you exactly what type of osteotomy you need. • All operations carry risk related to the general anaesthetic. This risk is rare, but potentially very serious. • It is common for you to have numbness or tingling of the lower lip, chin and tongue after an operation on the lower jaw. This is usually temporary and may last for a number of weeks or months. It may feel a bit like a dental injection that has not worn off. The numbness will not affect the appearance or movement of your lower lip or tongue, only the feeling in it. • There is a risk that you may experience permanent nerve damage. This can range from mild tingling through to a feeling of complete numbness. Your surgeon will discuss this with you in more detail. • Numbness of your upper lip, cheek, nose, palate and gums can occur after an operation on the upper jaw. Again, this usually resolves over a number of weeks. • Some bleeding is unavoidable during surgery but it is rare that patients need to be given extra blood during the operation. • It is usual to feel tired and weak for two to six weeks after surgery as your body makes up for any blood loss that has occurred. Patients who are having upper jaw surgery can fi nd their nose and sinuses feel blocked and can often taste blood from the operation for several days afterwards. • A small amount of bleeding or oozing after your operation is normal and you will have blood-stained saliva initially. This usually stops after 24 to 48 hours. If the bleeding is excessive, you will have to go back to theatre for the bleeding point to be located and sealed, however this is extremely rare. • There is about a fi ve per cent chance that at the end you will feel that the fi nal result was not worth all the trouble of the treatment. The reasons that patients feel like this are often complex but include their experience of the treatment process and their expectations of what the treatment will change in their life. • There are also risks associated with the braces and your orthodontist should have already provided you with some of the following information leafl ets, however if you have not been given these leafl ets, please ask your orthodontist when you see them next: i) Fixed braces ii) Risks of treatment iii) Retainers. The body’s usual response to surgery is one of mild depression. This seems particularly true of facial surgery. Most patients feel a bit low for a couple of weeks after the surgery. You might feel like you want to stay in bed, or at least at home, for a little while. You will need someone to look after you, both physically and emotionally, during this time.Patients who have signifi cant changes to their facial appearance can lose that comforting feeling of seeing a familiar face when they look in the mirror. This can be worrying until you get used to your new appearance. It takes time and patience.While patients often do experience psychological benefi ts as a result of the treatment, we cannot guarantee that this will happen. As a result of this potential change, we have a liaison psychiatrist on our team. You can meet them to: • clarify your current concerns • work out what you are hoping to achieve through treatment • weigh up the possible risks and benefi ts of the proposed treatment They can also help you to make the most of the physical changes that result from treatment. Some patients are extremely sensitive about their appearance and fi nd it diffi cult to talk to professionals about what they want. The liaison psychiatrist can support you so that your views are heard and considered We know that patients who have the support of family and friends are more likely to feel satisfi ed with the fi nal outcome. We suggest that you discuss decisions about your treatment with those close to you. Our liaison psychiatrist is happy to see patients with their friends or family. For patients who hope that they will feel more confi dent etc. after treatment, they may fi nd that this happens quickly after surgery, or gradually over a period of months, and occasionally not at all. If you do not experience the psychological or social benefi ts that you hoped for, you can see our liaison psychiatrist again to explore other ways of improving the situation.
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