Introduction
Underbite and mandibular protrusion are dental and facial conditions that can cause a variety of problems, including difficulty chewing, speaking, and even breathing. Correcting these issues often requires the expertise of specialized hospitals and surgeons. In New York City, several top - notch medical facilities offer advanced treatments for underbite and mandibular protrusion correction. This article will explore these hospitals, the conditions they treat, the surgical procedures involved, and other related aspects.
Common Conditions of Underbite and Mandibular Protrusion
Underbite and mandibular protrusion are part of a spectrum of jaw deformities. The following are some common jaw - related conditions:
- Mandibular hyperplasia (prognathism): This condition presents as an excess of the lower third of the face, making it appear very prominent. It may also involve an underdeveloped upper jaw. Mount Sinai plastic and reconstructive surgeons frequently treat this condition, as the excess growth of the lower jaw can lead to a misaligned bite and affect facial aesthetics and function.
- Mandibular hypoplasia: Characterized by a small lower jaw, an overbite (skeletal malocclusion), and it may include a tall upper jaw and long - face syndrome. In some cases, the lower jaw may appear to rotate backward, leading to facial asymmetry and functional issues such as difficulty chewing properly.
- Maxillary hypoplasia: Appears as a small upper jaw with a shallow, concave mid - face and an underbite (skeletal malocclusion). The lower jaw may be undersized, oversized, or normal. This condition can be associated with a cleft of the lip and palate or other craniofacial syndromes, which further complicates treatment.
Hospitals Offering Treatment in New York City
Mount Sinai - New York
Mount Sinai is a leading institution for jaw deformity treatment. Its plastic and reconstructive surgeons form a team of specialists who coordinate care with dentists, orthodontists, and other plastic surgeons as needed. The team is highly experienced in treating all kinds of jaw deformities, including complex cases.
For patients with underbite and mandibular protrusion, Mount Sinai offers orthognathic (corrective jaw) surgery. This procedure involves moving the upper jaw (maxilla) and lower jaw (mandible) to an anatomically correct position. This allows for a good occlusion (bite), opening of the airway, and facial symmetry. Mount Sinai uses advanced 3D x - rays and computer - assisted technology for treatment planning. The virtual surgical planning (VSP) process is also a significant advantage. It begins with pre - operative orthodontic therapy, followed by a complete workup using cone - beam 3D CT scan and 3D photo morphometry. This allows surgeons to "rehearse" the surgery in a virtual environment before performing it in the operating room, improving the accuracy of the procedure and predicting outcomes more effectively.
NewYork - Presbyterian Lower Manhattan Hospital
The oral and maxillofacial surgery service at NewYork - Presbyterian Lower Manhattan Hospital provides a full spectrum of oral and maxillofacial surgery. It places emphasis on orthognathic and reconstructive surgery, which is crucial for treating underbite and mandibular protrusion.
Among the services offered are impacted wisdom teeth extractions, treatment of facial, oral, and dental trauma, surgical corrections of facial deformities, and dental implants. All physicians at this hospital are on the faculty of Weill Cornell Medical College. This means patients in their community hospital can experience a level of care typically found in a leading academic medical center. The hospital also offers specialized care for temporomandibular joint dysfunction, which can sometimes be associated with jaw alignment issues.
Weill Cornell Medicine
Weill Cornell Medicine has a team of oral and maxillofacial surgeons who are specialists in orthognathic / corrective jaw surgery for overbites, underbites, and cross - bites. The hospital's approach focuses on comprehensive, individualized care. They are sensitive to patients' needs and create a supportive, comfortable environment.
Multidisciplinary care is a key feature at Weill Cornell Medicine. Orthognathic surgeries require collaboration between orthodontics and surgery, and this hospital excels in coordinating such complex care. Before surgery, patients undergo a thorough evaluation, which includes collecting data through radiographs, measurements of the face and teeth, clinical photographs, and health history. The team analyzes this data to develop a comprehensive plan to correct the problem. After surgery, patients receive detailed instructions for recovery, and the hospital ensures they are well - supported during the healing process.
Treatment Procedures for Underbite and Mandibular Protrusion
Orthognathic Surgery
Orthognathic surgery is the primary treatment for underbite and mandibular protrusion. It is a complex procedure that involves moving the upper and lower jaws to correct malocclusion, facial asymmetry, and other related issues. The following is a detailed breakdown of the orthognathic surgery process:
- Pre - operative Evaluation: The typical treatment sequence begins with an evaluation by an orthodontist and an oral and maxillofacial surgeon. This evaluation includes x - rays, models of the dentition, photographs, facial measurements, and a complete analysis of the data. Surgeons at Mount Sinai and other hospitals use advanced 3D x - rays and computer - assisted technology to create an accurate treatment plan. They also communicate with the orthodontist and explain the plan to the patient, as well as obtain insurance approval.
- Pre - operative Orthodontic Therapy: This phase aims to level and align the teeth over the maxillary and mandibular bony arches. It can take 12 to 18 months. The goal is to prepare the teeth for the surgical repositioning of the jaws, ensuring that the final bite will be properly aligned.
- Virtual Surgical Planning: When the patient is ready for surgery, a cone - beam 3D CT scan and 3D photo morphometry are used for virtual surgical planning. This allows the surgeon to simulate the surgery in a virtual environment, predict the outcome, and design surgical guides using 3D printers. The surgical guides ensure the accurate transfer of the virtual plan to the operating room.
- The Surgical Procedure: The orthognathic procedure is performed under general anesthesia in the operating room with the braces in place. Internal fixation devices, such as small titanium screws and plates, are used to connect the repositioned segments to the jaws. Depending on the case, the surgeon may perform different types of osteotomies, such as a Le Fort I osteotomy of the maxilla or an osteotomy of the mandibular ramus.
- Post - operative Care: Patients usually stay in the hospital for approximately 1 to 2 days. After the procedure, training elastics are used from the upper jaw orthodontic appliances to the lower jaw appliances to help retrain the patients to close into their new bites. The patient's diet is limited to a liquid or non - chew diet for four weeks to allow for undisturbed healing of the osteotomies. Patients return to the orthodontist 6 to 8 weeks after the surgical procedure to start the post - operative orthodontic phase, which can last from 3 to 6 months to fine - tune and perfect the final occlusion.
Alternative Treatment for Children - Bone Anchored Maxillary Protraction
For younger patients with underbite, bone anchored maxillary protraction, also known as bollard plates, is an innovative treatment option. This procedure involves small metal plates that are screwed into the upper and lower jaw bones. They are used for a short period of time, along with rubber bands, to help slowly move the upper jaw into a better position.
Candidates for bollard plates should be about 11 - 13 years old, have no cavities, healthy gums, and good oral hygiene. They also need to be motivated for treatment as success is related to compliance with wearing the rubber bands. The procedure is an outpatient surgery, and it can usually achieve a forward movement of the top jaw between 2 mm - 4 mm, although this varies from child to child. An orthodontist is involved throughout the treatment process to ensure proper rubber - band usage, gum health, and to monitor changes in the bite.
Patient Considerations and Recovery
Patient Eligibility
Orthognathic surgery is usually appropriate for adults and teens after growth has been completed. Females typically stop growing at 15, and males at 18. However, there may be exceptions for children with birth conditions or severe orthodontic problems where surgery is needed at an earlier age. Patients considering jaw surgery should first see a surgeon to determine if they are a good candidate. If so, they will be guided to choose a qualified orthodontist to start the presurgical orthodontic treatment.
Recovery Process
The recovery process after orthognathic surgery is crucial for a successful outcome. In the first week after surgery, patients often experience discomfort, swelling around the cheeks, lower jaw, and nose, and some bruising is normal. Some surgeons, like Dr. Majid Jamali at Oral & Maxillofacial Surgery of New York, do not wire the teeth shut after surgery, believing it is unnecessary with modern hardware.
The patient's diet is restricted to liquids for the first 6 weeks, followed by a soft diet for the next 6 weeks. At the end of 12 weeks post - surgery, they can return to a regular diet. It takes 5 - 6 months for the bone to heal completely, and during this period, contact activity is prohibited. Patients are encouraged to start with short walks inside the house in the first week, and gradually increase their activity level as they recover. Regular follow - up appointments with the surgeon and orthodontist are essential to monitor the healing process and make any necessary adjustments.
Potential Side Effects and Risks
After jaw surgery, patients may experience side effects such as discomfort, swelling, infection (although rare), bleeding, nausea, and vomiting (also rare). Some more serious risks include numbness to the lower jaw, chin, and lips, which can last from a few days to months or rarely be permanent. Upper jaw surgery may result in 2 - 3 months of numbness in the mid - face area, with an extremely low chance of permanent numbness. There is also a risk of the bone failing to heal in the correct position, although the use of screws and plates reduces this risk. In some cases, further growth of the jaw may be a concern, especially in cases of mandibular protrusion, which is why surgeons may wait for the patient to mature completely before performing the surgery.
Cost and Insurance
The cost of underbite and mandibular protrusion correction can vary depending on the hospital, the complexity of the case, and the treatment procedures involved. Many hospitals, such as Weill Cornell Medicine, participate in certain medical insurances for oral surgery care but may not participate with commercial dental insurance. Patients should contact the hospital's billing department or insurance provider to understand their coverage and potential out - of - pocket expenses. It is also advisable to discuss the cost and payment options with the surgeon during the consultation phase to avoid any financial surprises.
Conclusion
In New York City, there are several excellent hospitals that offer high - quality treatment for underbite and mandibular protrusion correction. Mount Sinai, NewYork - Presbyterian Lower Manhattan Hospital, and Weill Cornell Medicine are at the forefront of providing advanced surgical and orthodontic solutions. With their teams of experienced specialists, state - of - the - art technology, and comprehensive approach to patient care, they are well - equipped to handle even the most complex cases. Whether it's orthognathic surgery for adults or innovative treatments like bollard plates for children, patients can find the necessary resources and support in these hospitals.
If you or someone you know is suffering from underbite or mandibular protrusion, don't hesitate to reach out to these hospitals. Schedule a consultation with a qualified surgeon to discuss your options and take the first step towards a healthier, more confident smile. Share this article with others who may benefit from this information, and explore related topics on our website for more in - depth knowledge about jaw deformity treatments.
