Oral Maxillofacial Surgery. I am 59 years old and have jaw misalignment. Am I too old for orthognathic surgery?

Patient Question

Robert Johnson 🇺🇸: Dr. Samuel, I’m 59 years old and have struggled with jaw misalignment my entire life. I have a significant underbite that causes problems with chewing, speaking, and I often experience jaw pain. I never had the opportunity to address this when I was younger. Recently, my dentist mentioned orthognathic surgery as a possible solution but expressed concern about my age. Am I too old for this type of jaw surgery? What are the risks for someone my age, and is it worth pursuing at this point in my life?

Dr. Rockson Samuel’s Response

Dr. Rockson Samuel: Thank you for your thoughtful question, Robert. It’s a common misconception that orthognathic (jaw) surgery is only appropriate for younger patients. I’d like to address your concerns directly and provide you with a comprehensive perspective on orthognathic surgery for someone in your age group.

Age Considerations for Orthognathic Surgery

The simple answer is: No, 59 is not inherently “too old” for orthognathic surgery. Here’s why:

1. Chronological vs. Physiological Age:

   • What matters most is not your chronological age but your overall health status
   • Many patients in their 50s, 60s, and even 70s have successfully undergone orthognathic surgery
   • Bone healing capacity remains adequate throughout adult life in healthy individuals

2. Changing Demographics:

   • The demographic of orthognathic surgery patients has evolved significantly
   • There is an increasing trend of adults seeking treatment for long-standing jaw issues
   • Modern surgical and anesthetic techniques have made the procedure safer for all age groups

3. Quality of Life Perspective:

   • Functional problems like difficulty chewing, speech issues, and TMJ pain can significantly impact quality of life
   • These issues often worsen over time without intervention
   • Many older patients experience decades of additional life with improved function after surgery

Medical Evaluation for Older Orthognathic Patients

That said, a thorough pre-surgical evaluation is particularly important for patients in your age range:

1. Comprehensive Health Assessment:

   • Cardiovascular status evaluation
   • Assessment of bone density and quality
   • Medication review for potential surgical implications
   • Evaluation of healing capacity based on medical history

2. Risk Stratification:

   • Controlled medical conditions (such as well-managed hypertension or diabetes) typically don’t preclude surgery
   • Uncontrolled or severe systemic conditions may increase surgical and anesthetic risks
   • A multidisciplinary approach involving your primary care physician, anesthesiologist, and oral surgeon is essential

Potential Benefits at Your Age

For someone with a long-standing skeletal malocclusion, the benefits of orthognathic surgery can be substantial:

1. Functional Improvements:

   • Enhanced chewing efficiency and nutritional intake
   • Reduced abnormal tooth wear and TMJ strain
   • Improved speech clarity
   • Potential reduction in sleep breathing disorders if present

2. Pain Reduction:

   • Relief from TMJ pain and dysfunction
   • Decreased muscle fatigue and headaches
   • Prevention of further joint degeneration

3. Psychological Benefits:

   • Improved self-confidence and body image
   • Relief from long-standing self-consciousness about appearance
   • Enhanced social interaction and quality of life

Special Considerations for Mature Adults

There are some aspects of treatment that differ for mature adults compared to younger patients:

1. Treatment Timeline:

   • Pre-surgical orthodontics may take longer due to slower tooth movement in adults
   • The overall treatment plan may need to be 6-12 months longer than for younger patients
   • Healing time post-surgery may be extended by several weeks

2. Orthodontic Approach:

   • Adult orthodontics often requires different biomechanical considerations
   • Pre-existing dental work (crowns, bridges, implants) may complicate tooth movement
   • Periodontal health must be excellent before proceeding

3. Surgical Technique Modifications:

   • More conservative movements may be planned
   • Additional fixation may be utilized
   • Special attention to blood supply and soft tissue management

4. Recovery Considerations:

   • Recovery may require additional rest and nutritional support
   • Physical therapy might be more extensive
   • Return to normal activities might take somewhat longer

The Decision-Making Process

I would recommend this approach to determine if orthognathic surgery is right for you:

1. Multidisciplinary Consultation:

   • Oral and maxillofacial surgeon evaluation
   • Orthodontist assessment
   • Prosthodontist input if significant restorative needs exist
   • Primary care physician clearance

2. Comprehensive Records:

   • 3D imaging (CBCT scan)
   • Facial and intraoral photography
   • Functional assessments of TMJ and masticatory system
   • Sleep evaluation if breathing issues are suspected

3. Treatment Simulation:

   • Digital surgical planning to visualize potential outcomes
   • Discussion of realistic expectations and limitations
   • Clear understanding of the risk-benefit profile specific to your situation

4. Alternative Options Exploration:

   • Non-surgical orthodontic camouflage (though limited in addressing skeletal issues)
   • Prosthodontic approaches to improve function without surgery
   • Minimally invasive interventions for symptom management

Risks vs. Benefits Assessment

All surgical procedures involve risk-benefit analysis. For orthognathic surgery in mature adults:

1. Potential Risks:

   • Slightly increased recovery time
   • Potentially higher risk of surgical complications (though still relatively low)
   • Greater adaptation period for neuromuscular adjustment
   • Possible impact on existing dental work

2. Comparative Benefits:

   • Relief from decades of functional problems
   • Prevention of progressive joint damage
   • Improvement in overall oral health
   • Potential decades of improved quality of life ahead

My Professional Perspective

Based on my experience with older orthognathic surgery patients, I can share these observations:

1. Satisfaction Rates:

   • Mature patients often report higher satisfaction with outcomes
   • Many express regret at not having pursued treatment earlier
   • Functional improvements frequently exceed expectations

2. Compliance Advantages:

   • Older patients tend to be more diligent with post-operative instructions
   • Better understanding of the importance of follow-through with all aspects of care
   • Greater appreciation for the transformative impact of treatment

3. Realistic Expectations:

   • Mature patients typically have more measured expectations
   • Focus tends to be more on functional improvement than dramatic aesthetic change
   • This often leads to greater satisfaction with outcomes

Next Steps I Would Recommend

If you’d like to explore this option further:

1. Seek a consultation with a board-certified oral and maxillofacial surgeon who has specific experience with orthognathic surgery in older adults

2. Undergo a comprehensive orthodontic evaluation to understand the pre- and post-surgical orthodontic requirements

3. Request a 3D virtual surgical planning session to visualize potential outcomes

4. Obtain medical clearance and risk assessment from your primary physician

5. Consider speaking with other patients in your age range who have undergone similar procedures

I would be happy to examine your specific case and provide a more tailored assessment of your particular situation. With proper evaluation, planning, and execution, many patients your age achieve excellent functional and aesthetic outcomes with orthognathic surgery.

Further Reading and Resources

For more information on related topics, you might find these resources helpful:

• Understanding Orthognathic Surgery: Process and Recovery
• TMJ Disorders: Comprehensive Treatment Approaches
• Adult Orthodontics: It’s Never Too Late
• Preparing for Jaw Surgery: What to Expect