Bill Klaproth: This is OMS Voices, an AAOMS podcast. I’m Bill Klaproth. And with me is Dr. Faisal Quereshy, who is here to discuss why corrective jaw surgery can be necessary. Dr. Quereshy, thanks for being here.

Dr. Faisal Quereshy: Hey Bill, good to see you again.

Bill Klaproth: You, too. Always enjoy having you on OMS Voices. So let me ask you this. What is corrective jaw surgery?

Dr. Faisal Quereshy: Well, thank you, Bill. Corrective jaw surgery, or also known as orthognathic surgery, is performed by oral and maxillofacial surgeons to correct a wide range of minor and major skeletal and dental irregularities, which includes misalignment of the jaws and teeth. Surgeries can improve chewing, speaking and breathing. And while the patient’s appearance may be dramatically enhanced as a result of their surgery, orthognathic surgery is primarily performed to correct functional problems.

Bill Klaproth: Is it generally elective surgery at this point?

Dr. Faisal Quereshy: Correct. So, most of the patients are referred by either their orthodontic practitioners, looking for a bite correction. Some will have difficulties with chewing, finding normal foods, even biting into lettuce, difficulty with swallowing sometimes, and speaking. Oftentimes they can come in with what we call open bites, where the teeth don’t touch. And that might indicate the need for corrective surgery. 

Bill Klaproth: Okay. And those types of conditions, if severe enough, require surgery. Are there non-surgical treatments for the things you just mentioned? 

Dr. Faisal Quereshy: Yeah. So, depending on the discrepancy of how the teeth fit, most likely the orthodontist will make the assessment if it can be corrected with simple orthodontic tooth movement that can correct minor problems. The major problems we get involved with when orthodontists can no longer correct the tooth positions and therefore the bite, we get involved by moving the bones. 

Bill Klaproth: Okay. Got it. Are there other people that would need surgical correction of skeletal deformities outside of what we just talked about? 

Dr. Faisal Quereshy: Yeah. I mean, there are people who present with chronic what we call TMJ or facial pain issues, headaches, et cetera, people who demonstrate excessive wearing of their teeth. Those can also be related to a misalignment of the jaws itself. Also, I treat a lot of children with birth defects, from a cleft lip and palate, deformities, or what we call facial asymmetry issues. They also come to us, but at a later stage in life, once growth is complete. 

Bill Klaproth: So, you can perform these surgeries on really any age then it sounds like, from children to people that are fully adult? 

Dr. Faisal Quereshy: There are some cases where we do intervene when children are younger, but we do like to wait until the growth maturation is complete. So therefore we will see them between 16 and 18 years of age. Unless it’s a significant facial deformity that maybe affects a social aspect of the patient’s condition. 

Bill Klaproth: Sure. Like somebody’s smile, right? Or an obvious chewing problem. 

Dr. Faisal Quereshy: A chewing problem – I mean, we do see a lot of patients who in the elementary school systems get ridiculed, bullying, and that affects their development because of facial appearance and they see us earlier for earlier correction. We don’t like to do that earlier, but sometimes we do offer that as a step in between. 

Bill Klaproth: Let’s talk about the corrections, then. What are some of the common corrections of dental facial deformities? 

Dr. Faisal Quereshy: So, we’ve got open bite deformities as you mentioned, that’s when some of the bone in the upper tooth-bearing portion of the jaw is removed, the upper jaw is then secured and positioned to realign the position of the upper jaw. A lower jaw can be either protruding or recessed, that’s either a strong jaw, what we call an underbite or a receding jaw or an overbite, both leading to separation of the upper and lower teeth meeting. The lower jaw, we also see patients with receding or weak chin positions, even though the chin is not structurally a functional part of the face, but it is a cosmetic issue that is often related to an underdeveloped lower jaw. 

Bill Klaproth: Okay. So that’s interesting. So, people with an open bite, an overbite, an underbite, and then a weak chin. You know, as you say all that, I’m like touching my chin, how is my jaw doing? You’re making me self-conscious. No, I’m kidding. So, tell me about the Le Fort osteotomies. 

Dr. Faisal Quereshy: So Le Fort is actually the name given to an upper jaw procedure what we call the maxilla or mid-face. So the midface is really the area of the cheeks and the area of the nose and upper lip region. Le Fort was actually termed by anatomist Henry Le Fort, who determined that there were three categories of a Le Fort Procedure: type one, two and three. 

Bill Klaproth: So can you spend just a little bit of time and tell us about each of those procedures? 

Dr. Faisal Quereshy: Sure. Le Fort I osteotomy is what we call the most common type performed to correct most of the problems related to the upper jaw. The upper jaw can be either excessive, which is vertically longer, it can be retruded, that means back in the back position or in the open bite position, so we can use the Le Fort to correct those three common scenarios. The second version is a little bit more advanced, a condition we call the Le Fort II osteotomy. And Le Fort II really is performed for a more complex facial deformity that really involves the cheekbones and under the orbits or the eye sockets. And if you have underdevelopment of this mid-facial area, we perform what we call the osteotomies or the cuts at a higher level. And then finally, the most extensive is the Le Fort III condition, where actually the entire orbits and mid-face is moved to correct severe craniofacial deformities, such as Crouzon’s or Apert Syndrome that we see in our craniofacial clinics. 

Bill Klaproth: Okay. So generally, Le Fort I, II and III. Generally, how do you do this? 

Dr. Faisal Quereshy: This is all actually strategically done with meticulous planning using now cone beam software, CT scan, what we call DICOM software engineered and planned with partners in the industry. And we can actually precisely make these bone cuts with the use of surgical guides and templates so we know exactly what we’re doing at the time of surgery. All the surgeries are performed in the mouth. There are no external cuts or scars the patient has to experience or endure. And so, they’re really well hidden because they’re underneath the cheeks and in the lips. There’s a lot of swelling that takes place which can take up to two to three weeks to completely resolve. So, although there are no scars, there is a lot of swelling that takes place, but that’s the advantage of doing it inside the mouth. 

Bill Klaproth: Yeah. So, you would generally then do, you said a CT scan, you would basically map the structure of the bone under the skin, and from that, you would put your procedure together for the corrective surgery. 

Dr. Faisal Quereshy: We precisely know by the hundredth of a millimeter how much and what location to actually make the cuts. For example, some patients may have areas of the bone that are weaker than others, so we know exactly where to stay away from. There are nerve structures that we can navigate around and prevent any adverse nerve injuries that used to be a potential complication. 

Bill Klaproth: And you’ll do this through the mouth, then, up into the chin if it’s Le Fort II, right? 

Dr. Faisal Quereshy: In the cheeks up top. And if it’s in the chin, we do it in the mouth to get to the chin as well, or the back of the jaw. 

Bill Klaproth: It is incredible for sure. So, then what are the benefits of corrective jaw surgery for someone who needs a Le Fort I, II or III? 

Dr. Faisal Quereshy: So those people came in with the problems that we’ve mentioned earlier, for example functional correction obviously is the biggest advantage, getting the teeth together, getting a more balanced bite. We call it occlusion. A lot of people end up having facial pain or TMJ because of imbalance in their biting. Sometimes they’ll eat more on one side and the other side or the teeth don’t touch on certain sides. So, by doing this and creating harmony and balance, we stabilize the facial musculature by putting the jaws together. So those are the clear benefits. In terms of sleep apnea, sleep apnea is a condition that we’re seeing a lot of in our population, people who are underdiagnosed, people who present with early signs and symptoms that are all related to the jaw position, we can do

jaw surgery. As we mentioned Le Fort osteotomy and lower jaw surgery. Bring the jaws forward, open up the airway, and now you’ve treated almost to a hundred percent correction of a sleep apnea condition that impacts mortality and morbidity. 

Bill Klaproth: I wonder how many people wait or don’t know that an OMS is able to correct these dental facial irregularities and deformities. Do you think there are a lot of people who just try to live with these conditions throughout their lives? 

Dr. Faisal Quereshy: We’ve been trying to educate our dental colleagues because our patients often see their dentist regularly, just like they would see their physician for routine checkups. Dentists who see these patients regularly can spot these issues and ask simple questions related to sleep apnea. There’s a quick algorithm called STOPBANG, which is the acronyms for the various questions to ask regarding sleep apnea symptoms. If they have those symptoms, they should send them our way. 

Bill Klaproth: And these are really quality of life issues. If you’re having trouble with your bite, eating, going to parties, smiling – this really could impact self-esteem. These are real quality of life issues, right? 

Dr. Faisal Quereshy: Absolutely. Like I tell all my patients, I do so many of these orthognathic procedures. We’re correcting the bite, we’re correcting the functional issues. You will have a facial change, that’s for the better because we are correcting proportions and facial balance.

 Bill Klaproth: Wow. This is amazing, Dr. Quereshy. I’ve always loved talking to you about these things. As we wrap up, any final thoughts on corrective jaw surgery? 

Dr. Faisal Quereshy: I think it’s a wonderful procedure. If you were asking me about thirty years ago when technologies were different, our operating times have really been cut down to provide these procedures in a very quick, effective, efficient manner. I can do these procedures within less than two hours, change the patient’s complete outlook of what they came in for, without the long-term effects and side effects, like swelling. We also don’t wire the jaw shut. That’s a misnomer. Jaws are not wired anymore, and patients can resume normal function within one to two weeks. 

Bill Klaproth: That’s great information. Thank you for sharing. It’s amazing hearing you talk about this, it is incredible. What I’m thinking is, don’t wait. If you think you have been living with an underbite or an overbite your whole life, don’t wait, go see an OMS, right? 

Dr. Faisal Quereshy: Absolutely. If you know you have that condition, see us. We’ll refer you to an orthodontist if you don’t have one already. We work in collaboration with our orthodontic colleagues to get the best outcome. 

Bill Klaproth: Absolutely. Dr. Quereshy, thank you so much for your time. We appreciate it. 

Dr. Faisal Quereshy: Thank you for having me again. 

Bill Klaproth: Absolutely. Once again, that is Dr. Faisal Quereshy. For more information and the full podcast library, please visit MyOMS.org. And if you’ve found this podcast helpful, and hopefully you did, please share it on social media so others can learn about the amazing work our OMSs are doing today. And don’t forget to subscribe. Thanks for listening.