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Jaw Alignment Surgery -- An Explanation

by Joanne Green

Hi...the jaw alignment surgery goes by several names. Those include Jaw Alignment, maxillofacial advancement, bone surgery, or LaForte surgery (after the man who developed it).

With clefting, one potential is that, as the child grows, the upper and lower jaws do not align. The midface is constricted by scar tissue (usually tissue of the palate and/or the maxillary bone) and fails to grow at the same rate as the lower jaw. The result, then, would be a "pushed in" or "pugged" or "flat" profile. This can be more than simple aesthetics. For instance, the bite can be totally off, causing problems with eating and talking. The child will develop what is called a "type three malocclusion" where the upper teeth fit behind the lower teeth in a relaxed position. This, then, can lead to excruciating Temporal Mandibular pain.

The Jaw advancement surgery is done only after the child has pretty much finished their normal facial growth. Therefore, this is an adolescent surgery. While there may be indications along the way that this surgery will need to be done, there are other things that can be tried to avoid it. For instance, Jacob had a type three malocclusion, but aggressive orthodontics has corrected that for him. However, his malocclusion was very minor too, and intervention began at age 8, with no guarantee at that time that the jaw advancement surgery would be avoided by age 16.

In this surgery, the upper jaw is broken, extended, and grafted to add as much as an inch or more to the profile. On occasion, when the discrepancy is particularly great, the lower jaw (or mandible) is also broken, pulled back and shortened so as to align the two jaws. In the past, the jaws were wired shut during the recovery period for this operation. However, now, more often than not, plates are used to hold the position of the bone and the jaws are seldom wired any longer for this one. This is a very large surgery - and not one that every child will be doing. This surgery can also create the need for more surgeries to follow.

For instance, often, pulling the upper jaw forward will cause the lip to be tight. If that happens, perhaps an abbey flap surgery will be required to fill out the upper lip once more. (An abbey flap is a surgery in which tissue from the lower lip is grafted to the upper lip for more fullness). Also, moving the jaw forward may leave the palate too short to make proper closure, which then means that a secondary palate lengthening surgery may be required to regain speech control.

We do have an excellent pictorial of the jaw advancement surgery and then the abbey flap in our gallery. It was given to us by Tanya, who very bravely shared this entire experience with us. Go to

and click open Tanya's surgical pages. She did an excellent job of walking us all through the whole process.


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