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Is orthognathic surgery indicated for wind instrument players? A multiple case study

British Dental Journal (2022)Cite this article

Abstract

Introduction For the ambitious wind instrument player with severe malocclusion, the decision to undergo orthognathic surgery can be difficult.

Aim To qualitatively explore and reveal key aspects of considerations for and outcomes of orthognathic surgery by interviewing a group of advanced and professional wind instrumentalists.

Materials and methods One investigator, using a standardised questionnaire, interviewed seven cases. The interviews were analysed by two investigators who are knowledgeable about embouchure.

Outcomes An ideal jaw relationship is not a prerequisite to achieving a professional career in music. Complete embouchure loss after surgery can be experienced due to changes in the position of incisors, lip relationship and tongue position relative to the shape of the oral cavity and as a result of neurosensory changes. Neurosensory recovery and 'wind instrument rehabilitation' takes at least six months, which was achieved in three out of five cases. The following temporary or permanent difficulties during playing after surgery were reported: onset of notes, high notes, leaps and intervals, and stable and well-tuned sound.

Conclusion In view of the risks involved, orthognathic surgery in wind instrumentalists should only be considered when there is an (oral) health indication.

Key points

  • An ideal jaw relationship is not a prerequisite to achieve a professional career in music. Considering the risks involved, orthognathic surgery in wind instrumentalists should only be considered when there is an (oral) health indication.

  • Wind instrument players can experience a complete embouchure loss after surgery because of changes in the position of incisors, lip relationship and tongue position relative to the shape of the oral cavity and as a result of neurosensory changes.

  • The neurosensory recovery and 'wind instrument rehabilitation' takes at least six months. This was achieved in three out of five cases but, unfortunately, not in the two other cases. Wind instrument players report the following temporary or permanent difficulties during playing after surgery: onset of the tone, high notes, leaps and intervals, and stable and well-tuned sound.

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Acknowledgements

The authors gratefully acknowledge the support of Jeroen Fennis, who helped with the imaging of Case 2. The authors are also grateful to Dewi van Stein Callenfels, who made contact with one case possible and to Romain Leleu for his permission to present his photos and mention his name.

Funding

This research received no specific grant from any funding agency in the public, commercial, or non-profit sectors. For this study, no funding was accepted, except for support from the listed institutions.

Author information

Authors and Affiliations

  1. Department of Orthodontics, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands

    Fawn N. van der Weijden, Ronald E. G. Jonkman & Sandy R. A. van Teeseling

  2. Dentist and Professional Trumpet Player, Lisztgaarde 290, 5344 ER Oss, The Netherlands

    Cees J. M. Hazenberg

  3. Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Northwest Clinics, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands

    Jean-Pierre T. F. Ho

  4. Orthodontic Practice ´Northo´, Gare du Nord 1, 1022 LD Amsterdam, The Netherlands

    Rein B. Kuitert

Authors
  1. Fawn N. van der Weijden
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  2. Cees J. M. Hazenberg
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  3. Ronald E. G. Jonkman
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  4. Sandy R. A. van Teeseling
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  5. Jean-Pierre T. F. Ho
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Contributions

All authors and the patients involved gave final approval. All authors agreed to be accountable for all aspects of work to ensure integrity and accuracy. Fawn N. van der Weijden. interviewed the patients, analysed all interviews and drafted the manuscript. Cees J. M. Hazenberg contributed three cases, analysed the interviews of the brass instrument players and critically revised the manuscript. Ronald E. G. Jonkman contributed one case and critically revised the manuscript. Sandy R. A. van Teeseling contributed one case and critically revised the manuscript. Jean-Pierre T. F. Ho contributed one case and critically revised the manuscript. Rein B. Kuitert initiated the idea, contributed one case and critically revised the manuscript.

Corresponding author

Correspondence to Fawn N. van der Weijden.

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The authors declare that they have no conflicts of interest. All patients signed an informed consent and thereby gave permission to use the presented details and photographs.

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van der Weijden, F., Hazenberg, C., Jonkman, R. et al. Is orthognathic surgery indicated for wind instrument players? A multiple case study. Br Dent J (2022). https://doi.org/10.1038/s41415-022-4292-9

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