Patient's Query
Hello doctor,
I would like to ask a few questions about my orthognathic surgery, which I underwent a couple of years ago.
I had lower jaw surgery for an open bite, along with a slight underbite and crossbite, if I remember correctly. My lower jaw was moved backwards and a few millimeters to the right.
I have attached two X-rays: one taken approximately two weeks before surgery, and the other around three months post-operation (the metal screws are visible in the post-op image).
In the pre-operative X-ray, the doctor noted in the report that my upper jaw midline (dental) was more or less perfectly centred, while my lower jaw midline was 5 mm deviated to the left. I am not sure whether this referred to the dental midline, the skeletal midline, or both.
Another specialist I consulted mentioned that the dental midline was off by about 5 mm, whereas the skeletal deviation was less. Could you please confirm this?
Also, in the post-operative X-ray, is the upper jaw dental midline the same as in the pre-operative X-ray, or has it shifted (possibly due to orthodontic treatment)? Since I did not have any surgery on my upper jaw, I assume the upper midline should be essentially the same before and after surgery.
If that is correct, then I believe I can estimate the right and left surgical movements fairly accurately by comparing the post-operative X-ray with the pre-operative one.
Kindly advise.
Thank you.
Hello,
Welcome to icliniq.com.
I have read your query and understand your concern.
You probably have both skeletal and dental malocclusion, judging from the pre-operative OPG (orthopantomogram) you enclosed. I am a maxillofacial surgeon, so that is my professional opinion. However, because I cannot assess you directly in a clinical setting, a proper evaluation of facial symmetry and occlusion (bite) requires an in-person examination by a surgeon. This is only a visual platform, so I can provide only an approximate assessment.
From my perspective, skeletal malocclusion is often the primary cause of underbite and crossbite issues. Since you had both conditions and underwent lower jaw surgery, it is likely that your condition was predominantly skeletal in nature. You should also know that skeletal malocclusion is often genetic in origin and can influence the dental alignment as well. If this had been purely a dental malocclusion, orthognathic surgery for open bite correction would usually not have been necessary.
Coming to your second question: the occlusion, or bite, has definitely changed. At present, it appears to be closer to an end-on relationship, meaning the dental bite relationship has shifted following the lower jaw correction, resulting in an improved bite pattern.
Ideally, the mesiobuccal cusp of the upper first molar should align with the mesiobuccal groove of the lower first molar. This is considered an ideal class I occlusion. Based on your history, you were likely originally a class III malocclusion case. In your situation, due to the open bite and crossbite, your bite relationship appears to have shifted mesially during your permanent dentition phase, likely influenced by the underlying skeletal discrepancy.
At present, your bite may resemble more of an end-on or mild class II relationship. However, because this is a visual platform and I cannot examine you clinically, this remains my opinion only. For definitive clarification regarding the extent of skeletal versus dental malocclusion, I would recommend consulting an orthodontist or maxillofacial surgeon in person.
In my opinion, your orthodontic and surgical treatment appears to have positively improved your jaw relationship.
You should continue monitoring your alignment and maintaining your oral health with follow-up visits every six to nine months with your orthodontist. An experienced maxillofacial surgeon can assess you directly in the clinic to confirm or refine these observations through examination of your teeth, jaw position, facial symmetry, and jaw angles.
Regarding your question about the midline: in my opinion, the midline does appear to have shifted on the post-operative X-ray. Lower jaw repositioning can contribute to such changes, and this may be related to the change in your bite relationship from a class III tendency toward a more end-on or class II tendency.
I hope this addresses your questions.
Please feel free to ask if you need any more clarification or support.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
I had this surgery many years ago, and the results were good according to both my doctors and me. These questions are mainly for my own understanding of some of the procedures that were performed.
In my country, I would need to book an appointment with long waiting times and considerable expense just to ask questions like these. My surgeon also retired a long time ago. Therefore, forums like this can be very helpful!
I understand that the lower jaw midline shifted because of the repositioning of the lower jaw. However, can I assume that the upper jaw midline remained the same in the post-operative X-ray as in the pre-operative X-ray? There are approximately three to four months between the pre-op and post-op X-rays.
If so, then I should be able to estimate fairly accurately how much sideways movement or rotational adjustment they performed on the lower jaw (for example, around 3 mm) to correct the midline.
Also, in the pre-operative X-ray, the doctor mentioned that the upper jaw midline was more or less perfectly centred or straight.
Could you please confirm whether that appears to be correct?
Kindly help.
Hello,
Welcome back to icliniq.com.
Yes, it would be reasonable to make that assumption regarding the midline. Your interpretation appears to be correct.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
Can we see that in the X-rays as well?
Hello,
Welcome back to icliniq.com.
No definitive dental assessment is possible from this alone. For evaluating skeletal malocclusion, cephalometric analysis is ideally important.
However, since you have already undergone lower jaw surgery, the midline repositioning should still be interpreted mainly in relation to your occlusion (bite). The pre-operative observations you mentioned are acceptable.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
So, I can see that the lower jaw midline appears to have shifted by about half a tooth width in the post-operative X-ray compared with the pre-operative X-ray. Can I conclude that this represents the movement to the right that was performed to correct the midline, along with the movements made to correct the open bite and underbite?
I am interested in understanding whether my lower jaw midline (according to the records) was about 5 mm deviated to the left before surgery, and whether moving the lower jaw approximately half a tooth width to the right (based on the comparison between the pre- and post-operative X-rays) corrected the issue.
Sorry if these are basic questions, but I would genuinely like to understand how this works.
Please help.
Hello,
Welcome back to icliniq.com.
That is exactly what I am saying. Jaw repositioning occurs automatically when lower jaw surgery is performed. That is how your dental bite relationship changes, for example, from a class III tendency toward a class II or end-on relationship.
The 5 mm shift to the right would also definitely affect the bite relationship.
No problem at all. Your questions are completely valid. And yes, a positive treatment outcome appears to be evident.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
Also, to confirm this, it would be helpful to know for sure whether the dental midline of the maxilla remained the same on the pre-operative and post-operative X-rays (taken three and a half months apart).
If that is the case, then I can clearly see the changes in the lower jaw midline by comparing these X-rays.
Please advise.
Hello,
Welcome back to icliniq.com.
No, I am sorry regarding that point. Because I cannot examine you in person, you would need to confirm that in a clinical setting. Only your orthodontist or maxillofacial surgeon can give you a definitive answer after a direct evaluation in the clinic or hospital.
Based on the X-rays you enclosed, I have tried my best to provide my observations. Positive changes are visible, and some degree of midline shift is a natural consequence after jaw surgery.
However, your question regarding the upper dental midline would need to be clarified through an in-person clinical assessment.
I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
From the X-rays, I believe I can see that the upper jaw midline is the same in the pre-operative and post-operative images. If there is any difference, it appears to be very small, perhaps no more than 1 mm.
In the clinical notes, the doctor also mentioned that my upper midline was more or less perfectly symmetrical before surgery.
Also, if the upper jaw midline had shifted or appeared different in the post-operative X-ray, that would be something you could identify, correct? Another expert I consulted confirmed this view.
Could you please confirm your opinion on this?
Hello,
Welcome back to icliniq.com.
No, I am sorry, I think there is a misunderstanding. This cannot be definitively confirmed online. We would need to analyze the X-rays properly in a clinical setting and take accurate measurements. I cannot do that online.
If your point is to confirm that your upper midline was perfectly symmetrical pre-operatively, especially considering that you did not have any treatment on the upper jaw, then this would still need to be evaluated in your current post-operative state in the clinic.
Do you understand what I mean? An unbiased confirmation can only be provided through cephalometric analysis or a direct in-clinic evaluation. Any opinion given online is based only on visual interpretation.
To confirm your point with certainty, this assessment would need to be done in a clinical setting.
I hope that clarifies things.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I understand. However, another expert told me the following, and I am comfortable with that explanation:
"Yes, your observation is accurate. If there had been a meaningful shift in your upper dental midline between the two radiographs, it would likely be visible. On a panoramic X-ray, the upper dental midline can be evaluated by examining the contact point between the two upper central incisors and comparing its position with stable skeletal landmarks of the upper face.
These landmarks include the nasal septum and the vertical bony midline structures of the maxilla, which are visible in the central region of the scan above the teeth. Since you did not undergo upper jaw surgery, these bony structures would have remained stable. If the upper teeth had moved significantly to one side or the other, the contact point between the upper front teeth would no longer align with these central landmarks in the same way, making the shift noticeable."
Hello,
Welcome back to icliniq.com.
I cannot agree completely, because panoramic X-rays are, after all, two-dimensional and have limitations and potential sources of error.
In orthodontic evaluation, whether we are assessing the nasal, gonial, or other orthodontic angles, cephalometric analysis is generally more accurate for measurements, including remote review. Even then, the findings should ideally be confirmed and cross-checked by an experienced maxillofacial surgeon in a clinical setting to minimize bias.
Now that your lower jaw surgery has already been completed, I would suggest not worrying too much about proving whether your upper jaw was perfectly symmetrical before surgery. The procedure has been performed, and your post-operative results appear commendable.
So, my suggestion is not to stress too much about this point.
Kind regards.
Patient's Query
Hello doctor,
Thank you for your reply.
I had lower jaw surgery many years ago for an open bite, mild underbite, and crossbite. The results were good, and I am satisfied with the outcome. I am mainly trying to better understand the surgical planning and movements that were performed, since I did not receive much detailed information at the time, and my surgeon has since retired.
I shared one pre-operative and one post-operative panoramic X-ray (approximately 3.5 months apart). According to the surgical notes, my lower dental midline was about 5 mm deviated to the left before surgery, while the upper dental midline was described as essentially centered.
Another specialist reviewed the images and explained that: The upper dental midline appears stable and aligned with fixed anatomical landmarks in both X-rays. Since I did not undergo upper jaw surgery, the upper jaw structures would be expected to remain unchanged. Any tiny difference (around 1 mm or less) could reasonably be explained by normal panoramic positioning/projection variation. Therefore, the visible changes between the scans likely reflect the surgical repositioning of the lower jaw.
Based on this, I believe I can see that the lower jaw shifted relative to a stable upper reference point.
I understand that panoramic X-rays have limitations and are not a substitute for cephalometric or in-clinic evaluation. However, from a visual and radiographic perspective, do you think this interpretation is reasonable, or would you disagree?
Thank you.
Hello,
Welcome back to icliniq.com.
So I understand that you may prefer the other opinion.
As a maxillofacial surgeon, I am trained to evaluate cases using clinical examination and three-dimensional diagnostic tools such as CBCT (cone-beam computed tomography) and other advanced measurements, which help eliminate the limitations and errors associated with two-dimensional panoramic imaging.
Based on an OPG alone, it is not possible to definitively confirm your assumption that the upper jaw midline remained perfectly symmetrical and unchanged before surgery. Even for an experienced surgeon trained in 3D assessment, a panoramic X-ray alone is not sufficient for a conclusive evaluation of that level of detail.
To accurately verify such findings, an in-clinic assessment would be required, ideally supported by records such as pre- and post-operative photographs, cephalometric analyses, and CBCT scans.
If such 3D records are not available, then interpretation is limited to 2D imaging only, and conclusions remain observational rather than definitive.
Kind regards.
Patient's Query
Hello doctor,
Thank you for your reply.
I just want to put my mind at ease about this.
Please advise.
Hello,
Welcome back to icliniq.com.
Take care.
Kind regards.
Patient's Query
Hello doctor,
Thank you for your reply.
I did visit a clinic a couple of years ago, and they said everything looked fine. At the time, I was not thinking about these specific concerns.
I feel I would probably need an expert or doctor to properly review my questions here, but in my situation, there is public healthcare with long waiting times. It can be difficult to get appointments for non-urgent concerns like this, as priority is usually given to active surgical cases.
So I was mainly hoping to get some clarity through this discussion.
Please advise.
Hello,
Welcome back to icliniq.com.
That is alright.
Kind regards.
Patient's Query
Hello doctor,
Thank you for your reply.
But anyway, I can see from the X-rays that the lower jaw was moved backward, the open bite was corrected, and the jaw may have been shifted approximately 2 to 4 mm to the right.
If I assume the upper jaw midline as a stable reference point, it seems like I can interpret these changes fairly clearly. In the journal, it was mentioned that my upper jaw midline was more or less perfectly symmetrical before surgery, so I assume that this upper midline would not have been significantly altered by braces within three and a half months after surgery.
Is that interpretation correct? Sorry for repeating the question.
Please advise.
Hello,
Welcome back to icliniq.com.
Yes.
Kind regards.
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Answered byDr. Achanta Krishna Swaroop
Medically reviewed byiCliniq medical review team
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