Uncomplicated Upper Jaw Surgery but No Tooth Show Post-op Due to Measurement Error? Chicago, IL

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Hello all, I had upper jaw surgery 10 days ago,...

Hello all,

I had upper jaw surgery 10 days ago, and I am sailing through the recovery quite easily. I must be lucky. But I am not as happy about the outcome as I had expected: I still have zero tooth show. In fact, I'm very upset, as I'm trying to understand why that happened. Sure, I'm still swollen, but not by much, and my upper lip likely won't contract much anymore.

To give you a bit of background: 38 y.o, mild underbite -3mm, a bit of cross bite, and a short upper jaw that showed no tooth at rest and 50% teeth at posed smile.

We all agreed that I only needed upper jaw surgery to move the maxilla 5mm forward, and downward. I have a rather narrow upper jaw, and a proper bite with the lower one allows the maxilla to move from -3mm to +2mm only. At +2mm now, it merely goes over the lower teeth a tad, less than ideal but okay.

When it comes to the downward move of the upper jaw, they measured it pre-op at -3mm. As a result, they planned to move it down 5mm to give me +2mm tooth show. My measurement was -5mm, but that somehow got brushed over during conversations, because partly I trusted their professional opinion, partly I focused more on the resulting tooth show of 2mm-3mm and counted on them to do the right math to get me there. The chief resident took the measurement and I expected he knew what he was doing.

Before the surgery I read quite a bit about the ideal tooth show at rest/smile, the risk of relapse, and the aging effect, the effect of braces, and insisted on having +4mm post-op (i.e. with braces on). They yielded and proposed 3mm. My biggest regret now is that I didn't press them on how they'd get there, I could've got to the difference between their measurement and mine.

So the lesson is, don't assume they know everything, be inquisitive about the surgery plan and why. Even though they keep saying that they can't be sure about the shift of soft tissues, if your moves are small and simple then the math should add up.

Otherwise, my recovery has been surprisingly easy: one day at the hospital, off the pain medication 2 days after that, was able to drive the next day, and 50% of the swelling is gone within the first 10 days. No strange change of the nose. I only have a stretch mark and a lump on the left cheek which is the salivary lymph node being irritated.

Pics pre-op and post-op

Loyola University, Oral and Maxillofacial Surgery

Loyola University, Oral and Maxillofacial Surgery Dr. Stephen MacLeod Dr. resident Falk Dr. MacLeod is rather short tempered. He seemed to take offense easily when I questioned about surgery plan pre-op, which was communicated verbally to me just 6 days before the surgery. I did some more research in the meantime then called and insisted on more toothshow, just to be replied tersely "you can cancel the surgery, this is not life threatening, I would not be offended". I regret now that I had not trusted my gut and postponed the surgery. I didn't see him on the day of surgery, pre- and post-op. Only his residents and the nurses. Post-op, I repeatedly complained about the lack of toothshow, and Dr. MacLeod aggressively and repressively defended his work and brushed aside my concern: you're still swollen, you got exactly what you asked for, I can see your teeth, that's the best I could do for you, sorry, feel free to contact another surgeon or your lawyer, sue me, I have a clear conscience, I have no problem sleeping at night, what you got is within acceptable., we didn't guarantee, it's unpredictable..." Dr. Falk: "You get too hung up on the cosmetic aspect, you don't want a horse-like look, you look great..." Well, he is not sorry. Unpredictable really? For a simple Lefort 1 anterior move of 5mm and inferior move, which they deemed so simple that I didn't need a CT? No patient wants a tooth less grandma look, and pictures don't lie do they? And any oral surgeon who says functional is their main goal is trying to deflect their mistake or incompetence. The goal of maxillary surgery is to move it to its ideal position: "meet the lower jaw at +2mm overjet, and for females, +3mm/4mm below the lip line". What agonizes me is that Dr. MacLeod had done another Lefort 2 case 5 months before me, with no bone graft. And the patient saw no tooth show post op and complained about that too. Didn't they learn something from that?

1 out of 5 stars Overall rating
2 out of 5 stars Doctor's bedside manner
1 out of 5 stars Answered my questions
2 out of 5 stars After care follow-up
3 out of 5 stars Time spent with me
2 out of 5 stars Phone or email responsiveness
2 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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