Questions about surgery

[Guest guest]

Hi, My daughter is 13 and we recently consulted a surgeon at the

suggestion of her orthodontist. The orthodontist says that he cannot

achieve a 100% correction of her open bite and cross-bite without jaw

surgery. However, he can get a pretty good (80-90%) correction and

her teeth will be straight without the surgery. The surgeon says she

should have a LeForte I procedure on her upper jaw but she cannot

have it for 12-24 months due to the fact that her facial bones are

not fully developed. We have to make a decision within the next few

weeks because the orthodontic treatment will go along one of two

paths depending on whether we opt for the jaw surgery. She does not

have trouble eating except for a few foods such as raw carrots. She

does not have any pain and is not unhappy with her appearance, other

than her crooked teeth. I am interested in hearing the opinions of

people who have been through similar surgery. Thank you very much in

advance. Ann

[Guest guest]

Ann,

Your daughter could probably be fine with orthodontics only, but

what I'd be worried about are the long term effects of her jaw problem.

Did the ortho mentioned anything about TMJ problems? Or possible

decay of some of her teeth? If he says for sure that no problem will

show up on the long term, and that 90% of her problem is corrected,

you might avoid the surgery then. But do ask those questions.

It's not always a quesiton of aesthetic, it's also a matter of functionning

and trouble free bite.

Ray

[Guest guest]

The scary part about having a malocclusion is that you never know

what is going to happen, or when it is going to happen, if it

happens at all. While I cannot tell you what to do, I can briefly

relate my experience for you to glean from it what you can.

I did not have regular dental care when I was a kid, and never went

to see an orthodontist. When I was a senior in high school, I was

diagnosed with TMJ dysfunction. I started treatment by a dentist

about a year later with my first occlusal splint. This was while I

was in college, so my parents' insurance covered it, though given

the fact that my father was self employed, the insurance didn't go

very far. The splint didn't help and my left jaw joint began to

lock closed on occassion. I still wore the splint because my jaw

joints ached without it.

I graduated and when I got insurance through my employer, I started

another splint therapy session with a dentist in the town I moved

to. By this time, my left joint was locking closed every time I

fell asleep. I'd gently force the disc back in place every

morning. After a little less than a year, he gave up and sent me to

an oral surgeon.

The oral surgeon recommended an arthroscopy on the left, which I had

done in May of 2001. While it helped in that my jaw has not locked

since, the cartilage was beyond repair, thus the surgeon diagnosed

the joint as having osteoarthritis. Once my bite settled after the

arthroscopy, he further recommended orthognathic surgery to try and

bring some stability to my TMJs (I only had two teeth that

touched).

So, I started my braces like a good patient, though as an adult, I

had to pay for them 100% out of pocket (most insurance companies do

not cover braces for adults regardless of the reason for them). I

don't know how I could have done it without flexible spending. My

out of pocket expense for the braces alone was $5089.

I'm now over a year post-op from upper and lower. It helped with a

lot of the muscle tension around my joints, but I continue to have

problems. My left TMJ continues to slowly deteriorate while my

right has begun to show signs of following in the left one's path.

It's sort of like when your knee hurts, so you limp and then your

back hurts - there is no way for my right joint to ever be 100%

healthy because of how diseased my left joint is - you can't

separate the movement of one joint from the other.

I've had three procedures done directly on my left joint (two before

the orthognathic surgery, one after) and will probably have to have

open joint surgery some day to repair or removed my renegade

cartilage. I'm sort of holding my breath when it comes to my right

joint.

I take Vioxx every day and have to ice both joints pretty

regularly. Mind you, this does mark an improvement from how things

were before orthognathic surgery.

No one can truly say why my joints are in the shape they're in, but

one possibility is that they would be healthy today had I had

orthodontic treatment and surgery when I was younger.

I'll be 27 in one week. I'd just turned 18 when I was diagnosed

with TMJ dysfunction. The arthritis was full force by the time I

was 23.

This does not mean that your daughter will have these problems

without surgery, but I view orthognathic surgery sort of like laying

a good foundation to build a house on. If your teeth meet the right

way, it generally means less stress on the TMJs. Even without

symptoms, no one can predict the future of what will happen to a

house with a weak foundation.

I wish you the best as you try to make this difficult decision and

would be happy to answer any questions I can if you have any you'd

like to ask me.

> Hi, My daughter is 13 and we recently consulted a surgeon at the

> suggestion of her orthodontist. The orthodontist says that he

cannot

> achieve a 100% correction of her open bite and cross-bite without

jaw

> surgery. However, he can get a pretty good (80-90%) correction

and

> her teeth will be straight without the surgery. The surgeon says

she

> should have a LeForte I procedure on her upper jaw but she cannot

> have it for 12-24 months due to the fact that her facial bones are

> not fully developed. We have to make a decision within the next

few

> weeks because the orthodontic treatment will go along one of two

> paths depending on whether we opt for the jaw surgery. She does

not

> have trouble eating except for a few foods such as raw carrots.

She

> does not have any pain and is not unhappy with her appearance,

other

> than her crooked teeth. I am interested in hearing the opinions

of

> people who have been through similar surgery. Thank you very much

in

> advance. Ann