Minimally Invasive Aesthetic and Functional Jaw Surgery

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Presented by: Sabine Girod, MD, DDS, PhD, FACS
Associate Professor, Oral and Maxillofacial Surgery
Stanford University Medical Center
October 20, 2011

When it comes to your face, how you look and what lies beneath your skin are intimately related. Facial aesthetics are based on balance and symmetry, which are determined by the set of your bones and teeth. From Nefertiti to Mona Lisa, attractive faces share uniform proportions that are balanced and relatively symmetrical. Research has shown that most people seem to have similar ideas about what constitutes an attractive face, which generally features wideset eyes, a large forehead, prominent cheekbones, thick lips, and a small, short nose and chin.

But aesthetics are only part of the issue, said Sabine Girod, MD, DDS, PhD, FACS, an associate professor of surgery, at a presentation sponsored by the Stanford Health Library. Dr. Girod specializes in oral and maxillofacial surgery (OMS), a specialty that combines dental, medical, and surgical skills.

While skeletal and dental structures are the basis of good looks, more than your self-esteem can suffer when things are off-kilter. Poor skeletal structure or jaw alignment can cause chronic pain, dental or orthodontic problems, sleep disorders, breathing problems, or speech impediments.

“In OMS we do a lot of initial and ongoing analysis of both the bones and teeth to determine where the deficiencies and imbalances are and what changes we can make to improve symmetry and function,” Dr. Girod said. “Often we can change these asymmetries by doing oral surgery. In a case of a recessive jaw, for example, the right surgery can change move the jaw forward, which can balance the facial features, improve function, and make the bite better.”

Improving Function and Appearance
Surgical techniques have changed drastically over the past decade and most are now minimally invasive, leaving no facial scars. For problems like an imbalanced lower jaw or receding jaw, orthognathic surgery combines orthodontic treatment with surgery to correct function and balance between the teeth, jaws, and facial structures. Various techniques can be used to correct anomalies, such as when the jaws do not align or when the teeth do not fit. The surgeon will realign the jaw, working from the inside of the mouth or under the lip, and will stabilize the jaw by using small plates held in place with bands.

“The plates are stable enough that you don’t need to wire the jaw shut any more,” said Dr. Girod, who showed several before and after photos of patients. “After about 10 days we can take out the elastic bands and the patient can start on soft food. The jaw never needs to be wired shut.”

Addressing Sleep Disorders
Orthognathic surgery is used to treat people with obstructive sleep apnea, a condition that affects more than 13 million people in the United States—though less than one-quarter receive treatment. People with apnea experience recurrent episodes throughout the night in which their throat closes and they cannot pull enough air into their lungs. The lack of oxygen causes the person to awake repeatedly, which leads to extreme daytime drowsiness. People with untreated sleep apnea face a greater risk of stroke and are more likely to have heart disease, along with hypertension, arrhythmia, and stroke.

Dr. Girod is a specialist in maxillo-mandibular advancement, a surgery for obstructive sleep apnea that realigns the jaw. Because the procedure not only corrects the compressed airways but also affects the person’s profile, she utilizes computer simulation to plan the operation, using three-dimensional virtual planning programs to anticipate the end result.

“We always try to correct function in a way that makes the patient look good,” she said. “This procedure affects not only function but aesthetics, and most patients have been very happy with the results.”

Dr. Girod is also involved in refining a technique called distraction osteogenesis, which stimulates the growth of new bone. The jaw is cut and pulled apart slowly with a distractor in small increments—about a millimeter a day—allowing new cells to grow between the segments. She compared it to the process used to lengthen a leg and said that the technique can correct asymmetries and discrepancies in both the upper and lower jaw.

Minimally Invasive Procedures
Another minimally invasive procedure called orthodontic distraction has shown to remedy facial deformities and enhance orthodontic treatment in children, eliminating the need for jaw surgery later on. The technique pulls on the bone, rather than the teeth, and can correct many jaw problems during the child’s growth..

“You can pull on the bone while the sutures are still open,” said Dr. Girod. “It takes about a year, but all they have to do is use these rubber bands day and night. The idea is to avoid any other treatment later on. We’ve been seeing a lot of success and positive development with this approach.”

About the Speaker
Sabine Girod, MD, DDS, PhD, FACS is an associate professor in the Department of Surgery and chief of Stanford’s Oral Medicine and Maxillofacial Surgery Service. She is also director of the Stanford Plastic Surgery Adult Clinic. An expert in oral and maxillofacial surgery, Dr. Girod has a special interest in refining virtual surgical simulations to plan surgical outcomes. She received her degree in dentistry from the University of Bonn in Germany and continued her medical training, residencies, and fellowship at Harvard Medical School, the University of Cologne, and Hannover Medical School in Germany.  She has been at Stanford since 2000.

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About Dr. Girod

Stanford Oral Medicine and Maxillofacial Surgery

Stanford’s Division of Plastic Surgery

American Association of Oral and Maxillofacial Surgeons

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