What Is Double Jaw Surgery (Bimaxillary Osteotomy)?

Double jaw surgery is used to fix jaw deformities. The procedure could:

Correct jaw misalignment

Normally, the upper jaw and teeth fit slightly over the lower teeth. This jaw alignment lets you eat and talk properly.

But if your jaws are misaligned, your upper and lower teeth may not come together correctly.

Types of jaw misalignment include:

• Deep overbite
• underbite
• open bite
• jaws that overlap sideways
• jaws that meet at the wrong angle (asymmetric jaws)

The surgery could fix these issues by moving or rotating your jaws.

Correct jaw size

If your jaws did not grow at the same rate, you may have jaw abnormalities.

Either jaw might be underdeveloped or overgrown. This can occur in combination with jaw misalignment.

The procedure can correct uneven jaws. Your surgeon may position your lower jaw forward or reduce your jaws to make them more proportional.

Balance facial features

Double jaw surgery could correct facial asymmetry due to:

• jaw misalignment
• incorrect jaw size
• small chin
• Gummy smile

The procedure may correct these issues, thus balancing facial features.

Improve jaw function

Normal jaw alignment and size are essential for basic functions, including:

• biting
• chewing
• swallowing
• speaking
• breathing

If your jaw deformities make it difficult to do these activities, double jaw surgery may help.

Relieve facial pain

The procedure can also ease facial pain due to jaw abnormalities, including severe temporomandibular joint (TMJ) disorders. Treatment of TMJ could be including a double-jaws surgery.

The TMJ is like a hinge that attaches your lower jawbone to your skull. Issues with this joint can lead to pain in your jaw, face, or around your ear.

It may also cause:

• jaw tightness
• jaw locking
• jaw popping or clicking
• difficultly chewing

Improve obstructive sleep apnea

In obstructive sleep apnea (OSA), your breathing temporarily stops during sleep. It occurs when the space in your airways become too narrow, making it difficult to breathe while sleeping.

A type of double jaw surgery, called maxillomandibular advancement (MMA) surgery, can provide relief. Both jaws are often moved forward close to 10cm.

During the procedure, your upper and lower jawbones are shifted forward. This creates more space in your airways, helping you breathe better during sleep. This surgery doesn’t always result in a successful elimination of OSA.

Double jaw surgery may be recommended if you have:

• severe jaw misalignment
• incorrect jaw position or size
• severe TMJ disorders
• impaired jaw function
• moderate to severe obstructive sleep apnea

But to be considered a good candidate, it’s also important that you:

• have tried treating your condition with nonsurgical options
• stop smoking cigarettes and cannabis, if you smoke (quitting can be difficult, but a doctor can help create a plan that works for you)
• understand the risks
• have reached skeletal maturity (14 to 18 years old)

To prepare for surgery, you’ll get braces 12 to 18 months before the procedure. This will help align your teeth. Some orthodontists use clear aligners for this phase.

You’ll have several appointments with your orthodontist and surgeon. They’ll take photos and use imaging tests to plan your surgery.

On the day of your procedure:

1. You’re given general anesthesia, which makes you fall asleep. You won’t move or feel pain during surgery.
2. Your surgeon makes incisions inside your mouth. This prevents visible scars on your face. Occasionally, they might make small cuts on your cheeks.
3. Your surgeon cuts and repositions one jawbone. If you’re getting a jaw enlargement, they’ll add an implant. If you’re getting a jaw reduction, they’ll remove some bone.
4. Your surgeon moves, enlarges, or reduces the other jawbone.
5. Your surgeon adds titanium screws and plates to hold your jawbones in place.
6. They add elastic bands or wires to keep your jawbones in their new position.
7. You’re brought to the recovery unit, where nurses monitor you until you wake up.

During the procedure, your surgeon may work on your upper jawbone first or your lower jawbone first. The sequence depends on their preference and your procedure.

Double jaw surgery, like all procedures, has potential risks. This includes:

• Lip numbness. It’s normal to feel lip numbness right after. Sometimes, nerve trauma during surgery can lead to permanent numbness.
• Hearing changes. If the procedure causes swelling or muscle stretching, you may develop temporary hearing changes.
• Jaw relapse. Rarely, the upper and lower jaws may return to their original positions after surgery.
• Jaw fracture. The operation can cause a jaw fracture, or “bad split.” You may need a second surgery.
• TMJ dysfunction. Double jaw surgery may cause or worsen existing TMJ problems.
• Severe bleeding. If vessel damage occurs, you might bleed more than expected. Your medical team may give you a blood transfusion and apply pressure, bone wax, or gauze.
• Need for second surgery. You might need a second surgery if the first one doesn’t properly fix your bite.
• General surgery risks. Like other surgeries, the procedure poses the risk of negative reactions to general anesthesia and surgical wound infections.

If you’re concerned about these risks, talk to your surgeon.

There are many possible types of double jaw surgery. Here are examples of before and after results:

According to CostHelper Health, double jaw surgery can cost $40,000 or more. There have been anecdotal reports of the procedure costing around $56,000.

The total cost depends on the severity of the jaw abnormalities and hospital stay.

Generally, health insurance will cover the surgery if it’s needed to fix health issues like obstructive sleep apnea. You may get partial or full coverage.

If the surgery is purely cosmetic, your insurance provider might deny coverage. Be sure to check with your provider before seeking out the procedure.

After double jaw surgery, you’ll likely spend 1 to 3 nights in the hospital. The exact amount of time depends on your progress.

Your face will be swollen for about 48 hours. You may be able to drink water right after. You might be able to eat liquid foods the next day.

Before you’re allowed to go home, your surgeon will check your jaws and order X-rays.

When you’re discharged, you’ll need someone to drive you home.

You can expect to take 3 to 8 weeks off from work or school. During this time, you’ll likely experience:

• Pain. Your doctor will prescribe pain relievers to manage the pain.
• Swelling. After the first 48 hours, the swelling will subside. But it will take a couple of weeks to fully disappear.
• Stiffness. You won’t be able to open your mouth for the first several weeks.
• Numbness. Temporary numbness in your jaw is normal. This takes a few months to go away.
• Dry lips. It’s common to develop dry, chapped lips during recovery. It’s recommended that you apply lip balm frequently.
• Blocked nose. You can expect to have nasal blockage and bloody discharge, but it’s critical to avoid blowing your nose. These side effects will go away after a few days.

To support a speedy recovery, it’s best to:

• eat pureed or soft foods for the first 6 weeks
• take your medication
• avoid smoking
• avoid alcohol
• practice good oral hygiene (according to your doctor’s directions)
• stay hydrated
• avoid strenuous activity
• rest

You’ll have weekly follow-up appointments for the first few weeks.

The initial phase of recovery usually lasts about 6 weeks. It can take up to 12 weeks for your jawbones to fully heal.

Before suggesting double jaw surgery, your orthodontist will try alternative treatments. The best option depends on your jaw abnormalities.

Possible alternatives include:

• braces (with or without elastics)
• clear aligners
• retainers
• mouth guards
• oral splints
• muscle relaxants (for TMJ disorders)
• Botox injections (for TMJ pain)
• airway pressure devices, like a continuous airway pressure machine (for OSA)
• sleep apnea appliance (mouthpiece)
• behavioral therapy to relax your jaw muscles

Double jaw surgery involves both jaws. It’s done to fix jaw deformities, like jaw misalignment or uneven size.

You may be a good candidate if nonsurgical treatments haven’t helped your jaw problems. Yet, like all surgeries, it may cause complications like numbness or hearing problems.

Your orthodontist can help you decide if the procedure is right for you.