Orthognathic Surgery

What is Orthognathic Surgery?

Orthognathic surgery, from the Greek orthos, "straight" and gnathos, "jaw", is a surgical intervention that is responsible for correcting dento-cranio-maxillofacial deformities by means of maxillary and mandibular bone movements, to achieve the perfect balance between all facial features of the patient.

This type of facial alterations appear in the growth phase of patients, stabilize at the end of it and can cause problems such as sleep apnea, TMJ disorders, malocclusion problems, or lack of skeletal harmony, among others.

Orthognathic surgery

Orthognathic surgery

Orthognathic surgery should be performed by a maxillofacial surgeon, the only specialist indicated to treat both bone and soft tissue of the facial area. There are three types of orthognathic surgery:

  • Maxillary Surgery
  • Mandibular surgery
  • Maxillomandibular surgery, also called bimaxillary surgery


The maxillary surgery is performed to place the upper jaw (maxilla) in the correct position so that facial harmony can be achieved and, most importantly, a recovery of the functionality of this bone, key for chewing, breathing and speaking.

This procedure is performed to correct several facial deformities, such as mandibular prognathism, or Class 3, open bite or gingival smile.

Orthognathic mono maxillary surgery consists of a cut of the maxillary bone called Le Fort I Osteotomy, which allows the advance, retrusion, lengthening, shortening or rotation of the maxillary bone. Once the jaw is in the desired position, it is fixed in place with titanium plates, a completely biocompatible material.

This procedure is performed in our center with a minimally invasive approach in approximately 40 minutes of surgical time.


Orthognathic mandibular advancement surgery is necessary when people have a small and retracted jaw with respect to the maxilla, a condition known as retrognathia or class 2.

This type of malformation especially affects the harmony of the lower part of the face and causes various functional problems such as sleep apnea.

The mandibular advancement surgery is done by means of a bilateral sagittal split osteotomy, or BSSO, which consists of a cut on each side of the lower jaw, an advancement of the jaw bone and fixation of the bone in the new position by means of titanium plates, a completely biocompatible material.

This is a simple procedure that, thanks to our 3D planning software and our minimally invasive approach, takes an average of 30 minutes of surgical time.


In most orthognathic surgery patients, it is necessary to reposition both jaws (maxilla and lower jaw) to achieve proper occlusion and facial harmony, this procedure is known as maxillomandibular surgery, or bimaxillary orthognathic surgery.

Bimaxillary orthognathic surgery is used to treat the following malformations: Class 2, Class 3, facial asymmetry, or open bite, among others, when a monomaxillary surgery is not enough to repair the patient's problems.

Thanks to our 3D planning system and our minimally invasive approach, maxillomandibular surgery at the Maxillofacial Institute takes between 90 and 120 minutes, and the patient can go home the day after the intervention.


The term “orthofacial surgery” is becoming more and more common in the specialized and informative media. Although orthognathic surgery and orthotofacial surgery can be used to refer to the same procedure, the difference is in the approach:

Orthognathic surgery is a surgical procedure that focuses mainly on achieving the correct function of the maxillo-mandibular complex, while orthofacial surgery involves a holistic approach in which function and aesthetics go hand in hand, and where the face as a whole is taken into consideration.

This paradigm shift is mainly due to medical advances and new technologies:
- On the one hand, the development of minimally invasive surgical techniques, which are less traumatic for the patient and allow for shorter surgical times.

-On the other hand, the technological advances applied to the planning of surgeries (3D planning software, virtual models, piezoelectric scalpel, etc.) allow a more precise and predictable planning and a quick and more accurate execution.

Thus, in a few words, orthognathic surgery is a functional procedure, and orthofacial surgery goes one step further, seeking the ideal balance between function and aesthetics. To do this, in ortho-facial surgery, in addition to addressing the maxilla and mandible of the patients, in the planning process, the surgeon also studies the changes that will occur in other parts of the face as a result of the intervention, and complementary procedures are considered to attenuate them (in case of being undesired) or harmonize the 'new' lower third of the face with the rest of the facial features with procedures such as:
- genioplasty
- Rhinoplasty
- septoplasty
- otoplasty
- neck or face lift
- facial fillers
- blepharoplasty
- canthopexy
- Bichat bags' extraction
- etc.

At the Maxillofacial Institute we are pioneers in using the ortho-facial approach thanks to the research of the team led by our Director, Prof. Federico Hernández Alfaro.


When there is a discrepancy between the position of the maxillary bone and the jaw, there is what is known as malocclusion (a defective bite) that can be of different types:

-Class 2: also known as retrognatia or mandibular retrognatism or maxillary prognathism. It occurs when the maxilla is advanced with respect to the jaw.

-Class 3: also known as mandibular prognathism. It occurs when the jaw is advanced with respect to the maxilla.

-Facial asymmetry: when one side, or a part of one side of the face is decompensated with respect to the other.

-Gummy smile: when excess gingival tissue (or gum) is shown when smiling



These deformities may be accompanied by other malocclusion problems such as narrow palate, open bite, cross bite, edge to edge bite, overbite or dental crowding.

Orthodontics and Orthognathic surgery

Orthodontics and Orthognathic Surgery

Orthognathic surgery is closely related to orthodontics. Therefore, correcting dento-cranio-maxillofacial deformities always involves teamwork between the orthodontist and the maxillofacial surgeon.

In the conventional treatment scheme, orthodontics-orthognathic surgery-orthodontics, the aim of pre-surgery orthodontics is to eliminate any existing dental compensation and to provide the surgeon with a stable and adequate structure between the upper and lower arches in order to be able to carry out the planned skeletal movements. Post-surgery orthodontic treatment is essential for establishing the adequate final occlusion.

The maxillofacial surgeons at the Maxillofacial Institute work together with the best orthodontists in the country. During the treatment of any patient suitable for orthognathic surgery, both the maxillofacial surgeon and the orthodontist ensure that they know the essential aspects of diagnosis and treatment. They must also fully agree on the proposed treatment and the way it should be carried out so that the patient is fully confident all the time of accepting it.

Why choose Maxillofacial Institute?

When a patient who is a candidate for orthognathic surgery comes to the Maxillofacial Institute, the medical team will perform a complete analysis of his/her face. All the elements that form the facial area are exhaustively studied: mandible, maxilla, zygomatic bones, nose, orbital regions, teeth and all the soft tissue that covers the facial skeleton and the neck region.

Since all these components form an indivisible whole, the maxillofacial surgeon must also jointly assess morphology and function. Therefore, when aiming to harmonize the face, the entire dento-cranio-maxillofacial complex, with its various aesthetic and functional elements, must be assessed holistically. The professionals at the Maxillofacial Institute consider functionality and aesthetics as a whole.

The Maxillofacial Institute, world leader in Orthognathic Surgery

Prof Federico Hernández Alfaro and his team have created protocols that allow certain orthognathic surgery procedures, such as orthognathic surgery for mandibular advancement, SARPE (Surgically Assisted Rapid Palatal Expansion), and mentoplasty, to be performed under local anesthetic and sedation, without requiring hospital admission.

Patients can go home within two hours after surgery, which lasts an average of 30 minutes. The patient’s post-surgery experience is dramatically improved in comparison to the conventional technique, which is carried out under general anesthesia and which requires hospitalization: the total surgery time is significantly reduced, surgical trauma is non-existent and recovery is immediate.

The Maxillofacial Institute is the only centre in Spain to perform this technique and it is one of two centers in the world that practices it. Prof. Hernández Alfaro explains it in his two articles published in 2002 and 2010 respectively: The sagittal mandibular osteotomy under local anesthesia and intravenous sedation: Four years of multi-center experience and Minimally Invasive Surgically Assisted Rapid Palatal Expansion with Limited Approach Under Sedation: A Report of 283 Consecutive Cases.

A medical team
Multidisciplinary and professional
A medical team
With teaching activity and continued formation
Leader in technological advances
Applied to the oral and maxillofacial surgery
More than 150 cases of orthognathic surgery
Operated every year