Orthognathic Surgery and Bollard Plates

The Cleft and Craniofacial team at Joe DiMaggio Children’s Hospital is a regional leader in treatments for the jaw for children with cleft and craniofacial differences. Children with these health conditions often have differences in the anatomy of their upper jaw, lower jaw or both jaws. These can lead to challenges with activities of daily living, including eating, drinking, breathing and speaking. Our team is here to help your child live their fullest life possible.

Orthognathic surgery is a series of surgical procedures that your child’s doctor may recommend to treat their jaw. In general, orthognathic surgery helps better align the upper and lower jaws. The total treatment usually takes between two and three years.

Children who need orthognathic surgery will typically have orthodontic treatment (such as braces), followed by jaw surgery, several months of recovery and then additional orthodontic treatment.

Candidates for Orthognathic Surgery

Your child may need this treatment if they have one of the following conditions:

• Cleft palate: When a child is born with an opening or split in the roof of their mouth.
• Crossbite: Teeth are misaligned with some bottom teeth fitting in front of the top teeth, and some top teeth fitting behind the bottom teeth, when the child brings the teeth together into a bite.
• Open bite: A space in between the front top and bottom teeth when the child brings their teeth together into a bite.
• Pierre Robin sequence (PRS): A rare congenital (present at birth) syndrome that causes a baby to have an underdeveloped jaw, tongue too low in the throat, a U-shaped cleft palate, or obstruction (blockage) of the upper airway.
• Underbite: When the bottom teeth sit in front of the top teeth when the child brings their teeth together into a bite.

Bollard Plates

In some cases, doctors need to straighten your child’s adult teeth further than braces alone can accomplish. When this occurs, your child’s orthodontist may recommend bollard plates. With bollard plates, the orthodontist surgically attaches implant hooks in the upper and lower jaw above the teeth inside the mouth. The implants connect the upper and lower jaw with a flexible band that allows your child to open and close their mouth (with a slightly limited range of motion) to eat, drink and talk. Over time, the implants and flexible bands move your child’s teeth into the desired position. Once the teeth have moved, your child’s orthodontist removes the bollard implants and bands.

Candidates for Bollard Plates

If your child’s adult teeth have come in, are in good health (no cavities), and positioned in a way braces alone cannot straighten, the orthodontist may recommend bollard plates typically around the age of 11 or 12. Your child’s care team may also recommend bollard plates as part of the orthognathic surgery process.