Ideally, the upper and lower teeth align in such a way that the upper teeth are slightly more ventral than lower teeth. However, when teeth are misaligned, it can lead to one tooth or a group of teeth of the lower jaw being more outwardly oriented than teeth of the upper jaw. This condition is known as a crossbite. This is a type of malocclusion that can be purely dental, i.e., due to misaligned teeth, or may even be skeletal in nature.
When the problem is dental in nature, it can be corrected with the help of orthodontic treatment. However, when the problem is skeletal, it can be due to either a protrusively placed mandible (lower jaw), retrusive maxilla (upper jaw), or a combination of both. In such cases, merely treating the case with orthodontic braces is not enough. In these cases, there is need for surgical intervention.
Types of Corrective Surgery
Surgery for Retruded Maxilla
If the cause for crossbite is a retrusive maxilla and a normally positioned mandible, then the maxilla needs to be brought forward. This may occur due to maxillary hypoplasia, which is congenital, or due to the presence of a syndrome.
For this type of surgery to be a success, the combined efforts of an orthodontist and a surgeon are needed. One can successfully correct the aesthetic and the functional manifestations of this skeletal deformity with the help of maxillary advancement, augmentation of the mid-facial region, and in the end, if required, orthodontic treatment. The usual procedure followed is surgical advancement of the maxilla by Le Fort I osteotomy. In this procedure, the maxilla and palate are separated from the skull under general anesthesia, and the maxilla is fixed in its new position with the help of titanium screws and plates.
Surgery for Protruded Mandible
This surgery is known as a mandibular sagittal split osteotomy. For this procedure, one has to first get wisdom teeth extracted. In this procedure, which is done under general anesthesia, the back of the lower jaw is split bilaterally in the region of the wisdom teeth. The procedure is then carried out, and due to the splitting of the jaw, it is then pushed back, ensuring that there is adequate bone contact for proper healing.
The bone is then fixed into its new position with the help of screws, which are inserted through small external skin incisions done at the angle of the jaw. These are harmless incisions, as they heal with minimal visible scarring. After this procedure is complete, the upper and lower jaws are attached together with the help of an elastic band traction, which is kept in place for around one or two weeks.
The cost of crossbite surgery varies greatly, and depends on many factors, like the pre- and post-operative requirements, unforeseen complications, and whether or not the procedure is followed by orthodontic treatment.