POSTED UNDER Jaw Surgery REVIEWS
Uncomplicated Upper Jaw Surgery but No Tooth Show Post-op Due to Measurement Error? Chicago, IL
ORIGINAL POST
Hello all, I had upper jaw surgery 10 days ago,...
ltloanJanuary 23, 2015
WORTH IT$25,000
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.
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.
Replies (13)
January 28, 2015
Hi, regarding my previous reply, I should have added that I need a maxillary advancement. for functional reasons. I have an underbite. I'm not doing this to improve my appearance. As a matter of fact, I am worried that it might do things I don't want for me, as far as appearance, aside from the seriousness otherwise. As far as oral surgeons, they can have a dental degree or both a dental and medical degree. Not all oral surgeons are medical doctors. Also, depending on the procedure, Lefort 1, 2, or 3, experience and competence may be what matters since I'm not sure what they teach maxillo dental doctors in the medical portion of it. I would think they need to know the same untoward effects and risks of maxilla/cranial surgery as well as how to avoid them. I need about a 4mm maxillary advancement. I prefer to leave my mandible alone and not shorten it if possible. Since it is a moving bone, not fixed to stay in one place, I would be concerned about how stable it would be. As importantly I would want to have an outcome that improves my health with no negative trade off.
February 7, 2015
Hi ltloan,
Congrats on the surgery! I'm about 4 months out from a bimax advancement (Lefort 1, BSSO) and genio. In the beginning I was also really anxious about what to expect as far as soft tissue changes. I still have swelling in my lips and chin that changes depending on the foods I eat and how I sleep, but is going down slowly but surely. I found things made my upper-upper lip swell/ upper lip get really thin, like having the surgical hooks digging in. Wax and copious lip balm seemed to help.
Regarding your concerns of the alignment of your upper and lower teeth-- after surgery, I had the opposite problem. My teeth were perfectly aligned in the front, but had no contact at all on the back molars. Unfortunately, that’s where the surgical hooks and 24/7 orthodontic elastics came into play for me. The way one of my surgeons explained it, their goal is to align the bite as well as possible and leave the tweaking to the orthodontists.
For the first few weeks it really helped me to take a picture every day so I could compare my progress. Something about seeing the change for myself made it easier to take my surgeon’s word for it that my results would improve with time. I can sympathize with your frustrations towards your surgeon not taking your concerns seriously. Many times my surgeon seemed almost offended when I asked questions about how he planned to do the surgery and was told I was being too picky. It’s difficult to trust someone with your face, and to have hope that they can fix functional issues with your bite. I drove myself crazy to the point I wondered if surgery was worth it until I started seeing exactly the results my surgeon described. I know it’s tough when you’re swollen, hungry, and want to see results but try not to feel too frustrated. Your body is still healing and you won’t see final results for 6 months~1 year.
If you have any questions, feel free to message me. Recovery has been long and unpleasant but biting into a burger normally for the first time made it all worth it =)
February 7, 2015
Is BSSO bilateral sagittal split osteotomy? You said "bimax," meaning both sides of your maxilla was moved? Was your mandible moved forward or backward? Who are you surgeons? Thanks
February 7, 2015
Sorry, my mistake. I had my upper jaw advanced in a Lefort 1 osteotomy, and a bi-sagital split osteotomy on my lower jaw, with my lower jaw advanced. There was also vertical movement of my upper jaw, I believed they moved it down but I remember my surgeon saying something about correcting a gummy smile. I can send you a message with his info if you are interested, I had my surgery done at Mass General in Boston. I am extremely happy with my results
February 7, 2015
Yes, please do (message me). How far forward was your upper jaw/maxilla advanced? Did it affect your soft tissues, i.e., change the width of your nose, or make it turn upward? For some the slight upward turn is fine depending on the angle of their nose prior to the surgery. Did your surgeon ever mention distraction osteogenesis? Also, how did you go about choosing your surgeon? Thanks
February 7, 2015
I am not sure of the exact measurements unfortunately. My surgeon did put in an alar base stitch, but it does seem as though my nose has slightly turned up/widened at the base. I do still have a good amount of swelling in my upper lip area, so I wouldn't be surprised if my nose is still partially swollen as well. No, my surgeon did not mention distraction osteogenesis. I asked about why he chose a BSSO vs an Intraoral Vertical Ramus for me, and I believe he said something about the way the cuts in the bone are made helps with stability or healing? Sorry, it was close to a year ago. He only uses IVR in cases of deformities or where there isn't sufficient bone for a BSSO.
February 7, 2015
As far as choosing a surgeon, my orthodontist originally recommended a highly regarded pediatric surgeon. I had an initial consultation that went well, but when I went to make a second appt, I found she had moved out of state. I have family in healthcare, and my current surgeon had preformed surgery on a family friend's son, both of whom's parents are doctors.
February 7, 2015
That's interesting. It sounds like it worked out for you. I hope I can get this problem resolved. My back teeth don't touch (easily) because my 4 front do. It takes a lot of effort and pain to bite down. It hurts all the muscles in the temples, neck, face to speak, yawn swallow, bite down and even sleep because I have to sleep with my mouth open so I don't put pressure on my front teeth.
February 7, 2015
May I have the names of the surgeons who worked on you, who did the surgery as well as the pre surgical models, work-up? Seems they did a good job. This is not easily done by just any dr. Feel free to private message me. Thanks
February 10, 2015
Hi, please don't be too disheartened. Believe it or not it can take up to 6 months for all of your swelling to go down. I had upper jaw surgery 9 months ago and I look absolutely nothing like I did 10days post op. Your lip goes down loads after the surgery as your face gets a real battering during the surgery.
I wasn't 100% happy after my surgery as I felt like my bite was off, but my surgeon reassured me that the result could be fixed with a bit more orthodontics, and that if he had rotated my jaw to correct the bite it would of affected the symetry of my face and he was toally right. A further 9 months of orthodontics (although frustrating) has completely corrected my bite and I am now very happy with the results.
So persevere, and the surgeons know what they are doing, I am sure they had a back up plan during surgery - mine did. He had a plan a and a plan b, because until they operate they can't quite tell how your bite will look and so they have to make the final decision on the day. I'm sure in about 20 days when you reach the 6 week mark you will notice a dramatic difference.
Replies (8)
January 23, 2015
Notice one of my front lower teeth is *squeezed* up after the braces were tightened for the surgery. I need to have this fixed asap.
January 24, 2015
Thank you so much for adding these pictures! I would strongly recommend that you post them along with your question to our doctors here on RealSelf. Here is the link to do that: Post to the Doctors' Q&A Forum. (It's free.)
January 28, 2015
Thanks for letting me know, so I could follow the question! Still, I get so many notifications that I might miss an answer, so if the doctors answer you, it'd be fabulous if you could do an update on your review letting us know! :)
January 25, 2015
Actually, I know what you mean about wanting the lip to be higher. I want mine higher too, not so much for tooth show but because of a straight line for an upper lip - I need an upturn in the middle. It will result in 1-2 mms of tooth show but that little bit is fine since it will at least make my upper lip line more curvy. I don't think I will depend on the Lefort maxillary advancement to do that for me since I don't have a short maxilla and it won't be brought down. Please see what happens in a few short weeks, just in case. Were your drs medical or dental drs? Was it a high Lefort 1 or lower - I ask because you're right, it didn't negatively affect your nose so it seems the Lefort was done a little higher perhaps OR it's just the way the soft tissue adjusted to the bone movement below it.
January 26, 2015
My doctors are oral surgeons. You're right that Le Fort is too extreme for your need, although I'd say it could be more predictable and permanent than a lip lift. My lips are pretty full so I don't think I want a lip lift.
I don't know where my surgeons made the cut above the palate, likely not high because they cut it at an angle to move my maxilla forward and downward. Thanks so that my nose is rather intact, although they probably did something to close 2 corners of my nose too.
September 7, 2016
Hi hope you are going great with the progress! Do you have teeth visibility now??
Thank you so much for this thorough and honest review. I wonder whether you'd be willing to post a pic of just the jaw area, especially before/after, so that we can see the tooth show?