Jaw Surgery Side Effects & Complications You Should Know EP.3 (Final)
By REFACE Oral and Maxillofacial Surgery (OMFS) Hospital
Read the Previous Episodes:
- Orthognathic (Jaw) Surgery Side Effects, Risks, and Complications You Should Know – EP.1
- Orthognathic (Jaw) Surgery Side Effects, Risks, and Complications You Should Know – EP.2
We have now reached the final episode of our “Jaw Surgery Side Effects” series. In the first two episodes, the doctor explained the common side effects and normal postoperative symptoms after orthognathic (jaw) surgery, along with practical guidance on how to manage them safely during recovery.
In this final part, we will focus on the possible complications and important warning signs after jaw surgery that patients should understand in order to recognize when additional medical evaluation may be needed.In Episode 3, we will take a closer look at the final two categories of jaw surgery side effects and complications: “rare complications that may require additional treatment” and “soft tissue side effects after orthognathic surgery.”
Understanding these possible postoperative complications, warning signs, and soft tissue changes after jaw surgery can help patients monitor their recovery more carefully and recognize when further evaluation or treatment by an oral and maxillofacial surgeon (OMFS) may be necessary.
Rare Complications That May Require Additional Treatment
1. Tooth Discoloration After Segmental Jaw Surgery
To achieve better balance between the upper jaw (maxilla) and lower jaw (mandible), some patients undergoing orthognathic surgery may require a segmental maxillary osteotomy. This surgical technique involves carefully dividing the upper jawbone into multiple segments so that the maxilla can be repositioned and realigned to improve jaw alignment, bite function, and facial balance.
In some cases, teeth located close to the bone-cutting or osteotomy sites may experience changes in blood supply or dental pulp vitality, which can potentially lead to tooth discoloration after jaw surgery.
If persistent tooth discoloration or loss of pulp vitality occurs following segmental maxillary surgery, additional dental treatment may be required. Depending on the condition of the affected tooth, treatment may include root canal treatment (endodontic therapy) followed by professional tooth whitening or bleaching to restore the appearance of the tooth.
2. Osteomyelitis and Tooth Loss After Segmental Jaw Surgery
One of the more serious but uncommon complications of segmental jaw surgery is osteomyelitis, or inflammation/infection of the jawbone. This complication is not limited to orthognathic surgery and can potentially occur after various types of oral and dental surgery.
Several factors may contribute to the development of jawbone infection or osteomyelitis after surgery. These can include the patient’s overall health condition, individual healing capacity, and possible injury to blood vessels surrounding the jawbone during surgery, which may affect the blood supply to the operated bone.
If the blood supply to the bone or nearby teeth is significantly compromised, it may increase the risk of bone healing problems, infection, or damage to adjacent teeth. In severe cases, additional treatment may be required to control the infection and preserve the surrounding bone and teeth.Regardless of the underlying cause, osteomyelitis of the jaw can cause significant inflammation, infection, and destruction of the affected jawbone. Because the maxilla and mandible form the structural framework of the jaw and face, severe bone damage may affect both jaw function and facial structure.
If the infected or necrotic bone cannot be preserved and surgical removal of the damaged jawbone (bone debridement or resection) becomes necessary, the resulting bone defect may potentially lead to facial asymmetry, changes in facial contour, or structural deformity. In extensive cases, oral and maxillofacial reconstruction may be required to restore facial form and function.Therefore, oral and maxillofacial surgeons must exercise meticulous care at every stage of orthognathic surgery to minimize the risk of serious postoperative complications. Based on many years of surgical experience and clinical cases, severe complications such as jaw osteomyelitis, extensive jawbone damage, or bone loss are considered extremely rare.
However, because these serious jaw surgery complications remain theoretically possible, they are included here to provide patients with comprehensive and transparent information about the potential risks and complications of orthognathic surgery, even when the likelihood of occurrence is very low.
3. Maxillary Sinusitis After Jaw Surgery
The maxillary sinuses are air-filled cavities located within the upper jaw on both sides of the face, near the cheeks. During certain types of upper jaw surgery (maxillary orthognathic surgery), particularly a Le Fort I osteotomy, the surgical procedure involves cutting through areas adjacent to or involving the maxillary sinus before the upper jaw is repositioned and stabilized. Because of this, blood or fluid may temporarily accumulate within the maxillary sinus after jaw surgery. In most cases, these postoperative changes gradually resolve as the body naturally absorbs and clears the accumulated fluid.
However, if a postoperative infection develops, it can lead to maxillary sinusitis after orthognathic surgery. Although postoperative sinusitis is considered an uncommon complication of Le Fort I upper jaw surgery, it can occur in some patients.
Possible symptoms of sinusitis after jaw surgery may include fever, persistent pressure or aching pain, and swelling around the area beneath the eyes and across the cheekbones. If these symptoms occur, prompt evaluation by the treating surgeon is important. When a bacterial infection is suspected, antibiotic treatment may be prescribed as appropriate. Once the infection is properly treated and has fully resolved, it typically does not significantly affect the final outcome of the orthognathic surgery.
4. Infection After Jaw Surgery
Because orthognathic surgery incisions are usually made inside the mouth, the surgical wounds are continuously exposed to saliva, food particles, and oral bacteria during the recovery period. If postoperative oral hygiene is not maintained properly, the risk of developing an infection after jaw surgery may increase.
After surgery, patients are generally advised to clean their teeth carefully using a small, soft toothbrush and to rinse the mouth regularly, especially after meals, to help remove food debris and keep the surgical area clean. Maintaining good oral hygiene after orthognathic surgery is an important part of preventing postoperative infection and supporting proper wound healing.
However, even with careful postoperative care, symptoms such as sudden or rapidly increasing facial swelling, significant pain, or a high fever may indicate a possible postoperative infection. If these warning signs occur, patients should contact their oral and maxillofacial surgeon (OMFS) promptly for further examination and appropriate treatment.
In most cases, when an infection after jaw surgery is identified and treated promptly, the surgical wound can heal normally without causing additional serious or long-term complications.
5. Jaw Relapse After Orthognathic Surgery
Because the human body continues to undergo biological and functional changes over time, the jawbone may experience some degree of postoperative movement after orthognathic surgery. This is known as skeletal relapse or jaw surgery relapse, in which the surgically repositioned maxilla or mandible may partially shift toward its original position during the healing process or over the longer term. Postoperative stability can vary depending on factors such as the type and amount of jaw movement, surgical technique, fixation, and individual anatomy.
For example, a patient who undergoes mandibular setback surgery to correct mandibular prognathism or a protruding lower jaw may experience some degree of postoperative skeletal change. For this reason, oral and maxillofacial surgeons (OMFS) carefully calculate the amount and direction of jaw movement and develop a detailed orthognathic surgery treatment plan to maximize long-term stability and minimize the risk of relapse.
However, surgical factors are not the only considerations. Daily oral habits, tongue function, and the activity of muscles surrounding the jaw may also influence postoperative dental and skeletal stability. Research has shown that tongue pressure and oral muscular function can change after orthognathic surgery and may be relevant to postoperative adaptation.
Patients should therefore follow their surgeon’s and orthodontist’s postoperative instructions carefully and address any oral habits that may place unwanted pressure on the teeth or jaws. Depending on the individual case, this may include guidance on proper tongue posture and oral muscle function. Rather than adopting a universal tongue-positioning technique on their own, patients should follow the specific recommendations provided by their oral and maxillofacial surgery and orthodontic team.
Soft Tissue Changes and Side Effects After Orthognathic (Jaw) Surgery
1. Widening of the Nasal Alar Base After Jaw Surgery
Nasal widening or flaring of the nostrils is a relatively common soft tissue change after upper jaw surgery, particularly following a Le Fort I osteotomy. During maxillary orthognathic surgery, the surgeon must detach and reposition some of the soft tissues and muscles surrounding the nose from the underlying upper jawbone. As a result, the alar base, or the width of the nostrils, may become wider after surgery.
To help minimize excessive alar base widening after jaw surgery, oral and maxillofacial surgeons may perform an alar base cinch suture (alar cinch suture). This technique uses surgical sutures to bring the soft tissues around the sides of the nostrils closer together, helping control postoperative nasal widening and maintain a more balanced nasal shape following Le Fort I maxillary surgery.
Although this technique can significantly reduce unwanted nasal flaring after orthognathic surgery, some degree of change in nasal width may still occur depending on the amount and direction of maxillary movement, individual anatomy, and surgical technique.
2. Sagging Cheeks and Loose Skin Under the Chin After Jaw Surgery
A simple way to understand this change is to think of a balloon after some of the air has been released. When the jawbone is surgically shortened or reduced in size, the underlying facial skeletal framework becomes smaller, while the amount of skin and subcutaneous fat may remain the same. This difference can sometimes lead to sagging cheeks, jowls, or loose skin under the chin after orthognathic surgery.
The degree of facial soft tissue sagging after jaw surgery varies from person to person and depends greatly on the patient’s skin elasticity, age, soft tissue thickness, facial fat distribution, and healing response. Patients with good skin elasticity may experience better natural skin contraction after surgery, while others may notice more visible laxity around the cheeks, jawline, or submental area.
The final appearance can also be influenced by the type of jaw surgery, the amount and direction of bone movement, and the surgical technique selected by the oral and maxillofacial surgeon (OMFS). Careful preoperative planning is therefore important for achieving both functional correction and a balanced postoperative facial contour.It is important to note that facial soft tissues generally require at least 2–3 months or longer to recover, adapt, and gradually contract after orthognathic surgery. Therefore, the final facial contour should not be evaluated immediately after surgery, as postoperative swelling and ongoing soft tissue remodeling can significantly affect the appearance during the early recovery period.
Patients should allow several months for the facial soft tissues, cheeks, jawline, and skin under the chin to settle before reassessing the final facial shape. If sagging cheeks, jowls, or loose skin under the chin remain a concern after the recovery period, additional aesthetic procedures may be considered following medical evaluation, such as facial lifting or skin-tightening treatments or facial liposuction to further refine the facial contour.
3. Snoring and Obstructive Sleep Apnea (OSA) After Jaw Surgery
For patients with mandibular prognathism (a protruding lower jaw) who require a substantial mandibular setback during orthognathic surgery, moving the lower jaw backward may reduce the dimensions of the upper pharyngeal airway. This narrowing can potentially contribute to worsening snoring or an increased risk of obstructive sleep apnea (OSA) in susceptible patients.
The risk appears to be more relevant when a large mandibular setback is required, which is why careful preoperative evaluation of the upper airway, jaw position, and individual OSA risk factors is important when planning orthognathic surgery. Evidence does not suggest that every patient undergoing mandibular setback surgery will develop OSA, but airway changes should be considered as part of treatment planning.In most cases, however, oral and maxillofacial surgeons may combine mandibular setback surgery with maxillary advancement as part of bimaxillary orthognathic surgery. Advancing the upper jaw may help offset some of the upper airway narrowing associated with moving the lower jaw backward, which is why airway-related breathing problems do not occur in most patients. Studies suggest that bimaxillary surgery generally produces less reduction in upper airway dimensions than isolated mandibular setback surgery, although the actual effect varies according to the amount and direction of jaw movement and each patient’s anatomy.
Certain patients may have a higher risk of snoring or obstructive sleep apnea (OSA) after jaw surgery, particularly those who require a large mandibular setback or who already have risk factors such as obesity. Therefore, careful assessment of the upper airway, jaw structure, and individual OSA risk factors is important when planning orthognathic surgery.
If snoring first develops several years after orthognathic surgery, it may not necessarily be directly caused by the surgery itself. Other factors that develop over time—such as weight gain, aging-related changes in the upper airway and surrounding soft tissues, and reduced muscle tone—should also be considered when evaluating newly developed snoring or sleep-disordered breathing.
4. Facial Asymmetry After Jaw Surgery
In reality, no human face is perfectly symmetrical. Everyone has some degree of facial asymmetry, although the amount and visibility can vary from person to person. For this reason, even after orthognathic surgery, a small degree of asymmetry may still remain.
This residual facial asymmetry after jaw surgery can be related to pre-existing differences in the patient’s facial fat distribution, muscle volume, eye position, cheekbone prominence, or other soft tissue and skeletal structures. Orthognathic surgery primarily corrects the position and alignment of the upper jaw (maxilla) and lower jaw (mandible), so asymmetry originating from other facial structures may not be completely corrected by jaw surgery alone.
In addition, after surgery, patients often examine their faces much more closely than before. As a result, they may begin to notice minor facial asymmetries that were already present before orthognathic surgery, but had previously gone unnoticed.
5. Intraoral Scarring After Jaw Surgery
Although surgical incisions inside the mouth generally have a lower risk of visible scarring than external skin incisions, intraoral scars can still develop after orthognathic surgery.
In some patients, fibrous scar tissue may build up around the surgical site and become thicker or firmer in certain areas. This can sometimes cause a feeling of tightness, pulling, or discomfort inside the mouth, particularly when chewing, speaking, or making facial expressions.
The degree of scar tissue formation after jaw surgery can vary depending on individual healing characteristics, the location of the incision, and the postoperative recovery process.During the first 2–3 weeks after jaw surgery, while the intraoral incision is still healing, patients are generally advised to avoid opening the mouth too widely or stretching the lips into an exaggerated smile, as excessive tension on the surgical wound may contribute to widening or thickening of the scar.
In most cases, fibrous scar tissue after orthognathic surgery gradually softens over time, and the sensation of tightness or pulling inside the mouth becomes less noticeable. This improvement often continues over several months, with many patients feeling significantly more comfortable by around 6 months after surgery.
However, if the intraoral scar remains tight, painful, or restricts normal daily activities after 6 months, additional treatment may be considered. In selected cases, an oral scar revision procedure can be performed. The surgeon may reopen the scar area and release, reposition, or reorganize the fibrous scar tissue to reduce tension and improve comfort and oral movement.
Source: Column by REFACE Oral and Maxillofacial Surgery (OMFS) Hospital
