Book a consultation
Practical information
Frequently asked questions
Implant reconstructive
Orthognathic surgery
Orthognathic classification
Aesthetic facial surgery
Snoring and sleep apnea
Typical stay - Operation on Wednesday
Cookies & privacy
Frequently asked questions - Orthognathic surgery
Lower jaw surgery
Is it necessary to wire the jaws together?
No, not at all. The healing of the jaws goes through the screws and plates, which are necessary to keep the ‘voluntary fracture’ immobile. After surgery, some elastics can be used for a couple of weeks just to guide the occlusion. This is certainly the final tuning.
What about postoperative facial swelling?
This is highly variable. During surgery, you are given intravenous steroids during the anaesthesia. The tendency for swelling varies from person to person. There is usually more swelling with younger patients. People with blond hair are more likely to experience swelling than people with dark hair. After one week, 1/3 of the swelling has gone, and after three weeks, at least 2/3 has gone. The mini-drains are put in place for this purpose and are removed the next day.
Is it possible to speed up the swelling resorption?
Yes, it is. After a few days, you can apply a lymfedrainage massage carried out by a specialised physiotherapist. This is even more helpful after a La Fort I.
What about facial bruising?
Facial bruising is possible as well. You gradually get all the colours of the rainbow, from blue to yellow, and by gravity it sinks from face to clavicle. However, it is nothing to worry about, since the yellow disappears completely in a couple of weeks.
What about diet?
Patients require a light diet for some days. Spaghetti and hamburgers are possible after a few days. The best is to make a quality broth soup with meat. You can add mixed potatoes and vegetables to the soup. We advise you to eat small quantities, but frequently. The best is to eat six to eight small meals for the first few days, rather than just three times! The most important thing is to drink a lot of fluid, at least half a litre a day.
Is there any sensory nerve damage?
The sensory nerve to the lower lip runs into the lower jaw in the region of the osteotomy bone cuts. During surgery, this nerve is always visible and protected. Following the surgery, all patients should expect some numbness of the lower lip, but this improves over a period of days, weeks, or months. About 5% of patients experience some degree of permanent altered sensation. Younger patients are not particularly concerned about this. For older people this can be more cumbersome, since sensibility with ageing becomes part of the overall self-image. However, it never leads to a disability and it is not a reason to renounce the surgery. The sensory nerve of the tongue lies close to the osteotomy cuts in the soft tissue and is retracted away from the operation site. Altered sensation associated with this traction is rare and usually temporary if it does occur.
What about motor nerves?
A branch of the facial nerve innervates the mimic muscles of the face and lip. Injury to this facial nerve, which supplies movement of the lower lip muscles, has been reported. This may produce some weakness of the lower lip, which is more noticeable when the patient smiles. This is very exceptional and is hardly ever permanent. This is an extremely rare complication.
What about relapse?
Long-term complications include relapse. It can be related to your age or type of mandible. The majority of relapses are unnoticed by the patient. It is uncommon for a relapse to affect the achieved cosmetic improvement adversely, but it can compromise the occlusion.
What about elastics?
Some setting of the bite is often mandatory after surgery. This is usually achieved with two elastics on some brackets, just to guide and settle the bite.
What about blood transfusion?
Blood transfusion is not required.
Is a hospital stay necessary?
Usually one night.
Screw fixation or plate-screw fixation?
It is a matter of surgical preferences. The screw fixation goes through completely. The plates are usually fixed with mono-cortical screwing, so there is therefore less risk of harm to the sensory nerve. However, this is merely a matter of habit. The plates often need to be removed after some months for a diversity of reasons, including infection and cumbersome discomfort. Plates are more difficult to install then bicortical screws.
Upper jaw surgery
Is it necessary to wire the jaws together?
No, not at all. The healing of the jaws goes through the screws and plates. Sometimes, for a couple of weeks, two elastic bands are used to guide the occlusion.
What about postoperative facial swelling?
This is highly variable. During surgery, you are given intravenous steroids. The tendency for swelling varies from person to person. Younger patients usually experience more swelling. Blond people are more likely to experience swelling than people with dark hair. After one week, 1/3 of the swelling has gone, and after three weeks, at least 2/3 has gone. After three weeks, there is still some puffing around the cheeks, but this swelling is merely lymph oedema. This takes some more time to resorb.
Is there a cure to speed up the resorption of the swelling?
Yes, there is. After a few days you can apply a lymfedrainage massage carried out by a specialised physiotherapist. This is substantially helpful after a Le Fort I.
What about facial bruising?
Facial bruising is possible as well. You gradually get all the colours of the rainbow, from blue to yellow, and by gravity it sinks from face to clavicle. However, this is nothing to worry about, since it disappears in a couple of weeks.
What about diet?
Patients require a light diet for some days. Spaghetti and hamburgers are possible after a few days. The best thing is to make a quality broth soup with meat. You can add mixed potatoes and vegetables to the broth soup. We advise you to eat small quantities but frequently. It is best to eat six to eight times a day for the first few days, rather than just three times!! The most important thing is to drink a lot of fluid. At least half a litre a day.
Is there sensory nerve damage?
There is sometimes sensory nerve damage in the upper lip and cheeks, but there is almost always a recovery after some weeks. This is caused by the retraction of the soft tissues towards the cheeks. A degree of permanent altered sensation is rare after upper jaw surgery. Sensibility of anterior gingiva and palate is often affected for some time (weeks to months.), but this will eventually resolve itself, and sensation returns gradually from posterior to anterior.
What about motor nerves?
This is almost impossible, so it is therefore an extremely rare complication.
What about a relapse?
Long-term complications include relapse. It can be related to your age. The majority of relapse is unnoticed by the patient. It is very rare for relapse to affect the cosmetic improvement achieved adversely, but it can compromise the occlusion.
What about elastics?
Some setting of the bite is often mandatory after surgery. This is usually achieved with two elastic bands on some brackets just to guide and settle the bite.
What about blood transfusion?
Blood transfusion is not required.
Is there a hospital stay?
Usually one night.
Can I sneeze or blow through my nose?
You should sneeze with your mouth open! Don’t blow through the nose, since air can slip through the bone cuts. The sinuses are momentarily open through the overlaying soft tissues and you can blow air into the cheeks through the nose, then the sinuses, then the bone cuts, and then the soft cheek areas.
What will happen to the shape of my nose?
When the upper jaw is advanced or impacted superiorly, you might have a ‘turned up nose’ for some weeks, but this will return to normal within weeks to months. Sometimes, the nose flares out a bit and widens, but there are ways of working around this during surgery.
Do I need to worry about some nose bleeding?
Slight nose bleedings are possible postoperatively, but this disappears in the course of the healing.
Widening of the jaws
Does SARPE (smile distractor) affect breathing in a favourable way?
One of the benefits of maxillary expansion with the smile distractor (Titamed®) is better nasal breathing and a favourable effect on snoring and sleep-apnoea. This is because the wider the palate becomes, the more the suspensory muscles of the soft palate become stretched. Furthermore, the lower cage of the nose becomes wider.
Does SARPE (smile distractor) affect the smile and any black corridors?
Broadening the narrow upper jaw in a stable and bony manner enhances greatly the overall aesthetics and, in particular, the smile of a person. The procedure fills up the black corridors near the laughing mouth corners. Hence also the name of the distractor: smile distractor (Titamed®).
My orthodontist wants to use a hyrax after the SARPE instead of a bone borne device such as a Smile Distractor. Is this okay?
An major disadvantage of the hyrax is that mouth hygiene is difficult during the five to six months that the device should be in the mouth. And so, they often cut down the necessary time for this reason. Another major disadvantage is that during the time (six months) the device is in place orthodontics are impossible, since the device is tooth bearing. Cutting on the time frame makes the hyrax device even more unpredictable. Most importantly, the hyrax is fixed onto the upper teeth. All forces are applied directly to the teeth, and only indirectly to the bone. Therefore, this device often causes flaring of the teeth. This flaring of the more posterior teeth is cumbersome, since the final result becomes much less predictable and relapse is never far away.
From what age onwards do you recommend a smile distractor?
To perform a SARPE safely, the definitive teeth should be in place. If teeth still have to descend, then their roots can get damaged by the surgery, especially the canins. Practically, and after a mouth examination, 12-13 years old.
My daughter is seven years old and the orthodonist wants to apply a hyrax in order to widen the upper jaw?
Most probably this is a good idea since at that age the bone of the palate is not yet fused and can be distracted slowly. The mechanics are different. SARPE is in essence an RPE (rapid palatal expansion). The activation is 0.5mm a day. The Hyrax is an SPE device (slow palatal expansion) for young children 6-7-8 years old and is activated 0.5mm a week.
Chin surgery
Is a silicone implant or medpor implant an alternative method?
Some surgeons are indeed using silicone or medpor, and often the implant is inserted through a sub-mental skin incision. Maxillofacial surgeons usually don’t use implants or a sub-mental skin incision. Silicone After being in place for years, silicone often gets pushed deep into the bone, sometimes ½ to 1cm. This is caused by the pressure of the muscles overlaying the implant, melting away the chin bone over time. Dr Defrancq has removed several of those and replaced them with a proper genioplasty advancement.
Are nerve disturbances an issue?
There can be some temporary sensibility alterations to the lower lip, as there is with lower jaw surgery (BSSO). Normally, this fades away after some time.
Jaw angle surgery
Is silicone a reasonable alternative?
Silicone implants are rather soft and the difficulty here is the proper fixation in the proper location and keeping the implant there over time. This makes this kind of implant more unpredictable.
Are there possible aesthetic complications?
Muscle disruption is possible if the muscle sling around the inferior border of the mandible (the pterygo-masseteric sling) gets breached and rides up since there is no longer adherence to the bone. The muscle can then form a ball above the implant when the patient chews.
When is orthopaedic resin indicated and when is a Peek (poly-ethylene-ethylene-ketone) implant indicated?
It is a matter of cost, complexity, and surgeon preference. Orthopaedic resin is more artisanal and work-intensive for the surgeon, but finally works out at half the price of the Peek. The Peek implant is made in a factory and is guided totally by computer. For a surgeon it is easier to be guided by a stereolytographic model, since it is a plastic copy of your own jaw with the same touch and feel, and to use this as a direct work model. Peek is about computers and 3D rendering, and images going backwards and forwards to the company until the baby is delivered.
Cheek bone surgery
Why is it that cheekbone augmentations are frequently done at the same time as orthognathic surgery?
The cheek bones are not an isolated island in the face and flat cheekbones are often the blue print of growth abnormalities in the upper jaw. Most young people with flat cheekbones have something wrong with their jaws and teeth positions. Those patients, for example,. have a long face or an end-to-end bite, or a class III (reversed bite) with mid-face deficiency.
In conclusion, most patients with flat and unexpressive cheekbones have an orthognathic deformity. This is most often a developmental deformity i.e. occurring during the growth process of the face, and since it is anatomically located in the same facial area they have a profound and direct influence on the cheekbones! During growth with an excessive vertical or retro-directed clockwise vector, the cheekbones are, so to speak, sucked in a mannerism fashion within the same vertical vector line in downward and retro direction.
In conclusion, most patients with flat and unexpressive cheekbones have an orthognathic deformity. This is most often a developmental deformity i.e. occurring during the growth process of the face, and since it is anatomically located in the same facial area they have a profound and direct influence on the cheekbones! During growth with an excessive vertical or retro-directed clockwise vector, the cheekbones are, so to speak, sucked in a mannerism fashion within the same vertical vector line in downward and retro direction.
Can the cheek bone augmentation also be done with silicone or medpor?
Some surgeons use preformed implants in silicone or medpor material. Exact localisation and fixation on long term is a challenge. Silicone implant is quite easy to remove whenever necessary. Medpor is hard to remove.
Can the same result be achieved with an osteotomy?
Some surgeons perform an osteotomy with lateralisation of the bone. It is more invasive. The osteotomy certainly gives a lateral dimension, but not more anterior dimension. Symmetry, fixation, and frontal volume is the challenge with an osteotomy.
What kind of material is hydroxyapatite?
Hydroxyapatite granules are processed starting from sea coraIs. Up till now, it is the material implant that most closely resembles natural bone. It has both the sponge-like structure and chemical make-up of bone, so the body accepts it completely as part of its own (the dry weight of the human body is hydroxyapatite, exactly the same formula!). Hundreds of patients have been treated for cheek bone augmentation with this material through his hands. Dr Defrancq has many biopsies available of this area built up with H.A. granules, proving that bone becomes embedded between and inside the porous granules after one year. And so, the structure becomes a bony part of the facial skeleton for real. Could it be more ideal?