Consult with Dr West in Seattle! YEAH!

[Guest guest]

Hi everyone,

As promised, here is a report of my consult. I will post the

answers to the questions people from this board asked as well, but

will do that in a separate post. It will be shorter that way, and

more specific to your questions.

No problem at all regarding asking about the consult! I am so

excited to tell you!

First, the consult was great. He took like 2 hours or more with me

about this! He is totally nice, which I had already heard. He

answered all my questions, and I had them typed up! lol I even had

other peoples questions from the orthognathic board. lol He answered

them all.

First, my problem is that I have limited space between my jaws. I

have a really deep bite and a small overbite. My arches are flat and

my teeth small. My jaw is receded, but have a button on the end of

my chin, so my profile is normal looking. My teeth are straight and

even. Even though my jaw is " z " shaped, the body is amazing and

likes to be symmetrical. It has compensated with extra fat on one

side, so that in looking at me straight on, you don't know that I

am " Z " shaped at all. When I tip my head back, THEN you can see it

clearly. I never knew I had this problem until Dr Rashi mentioned

that I had a jaw problem. No one ever said that to me before. Then

my dentist mentioned it to me. He took over from my old dentist, and

the new one had this type of surgery himself, so he was really in

tune with it.

I cannot fit a bite of food in my mouth with my teeth closed. I have

no room at all, even for a relaxed tongue. To clench my teeth, I

have to pull my tongue back into my throat, and glue it to the roof

of my mouth about 1/3 of the way back from my upper teeth, due to

the shape of my palate. I pocket food into my cheeks and feed very

small pieces of food into the back molars to chew and swallow. I

choke really often (my throat is constricted a bit too, from thyroid

cancer surgery 15 years ago this month). I have callouses on the

inside of my cheeks from eating this way! lol

Okay, enough background. I have been to three orthodontists after

speaking with my dentist. They all said the same thing and

recommended the same orthognathic surgeon. Dr West in Seattle. He

was amazing.

I did have, from one of my consults with the OD's, a set of molds

and panoramic x-rays for Dr West.

The first thing he said to me, after introductions and all, was that

he thought I needed a functional rhinoplasty. I think so too, but I

have never had any doctor tell me this. My right septum is so bad

about midpoint, that the right side is completely blocked. When my

left side swells from a cold or whatever, I am a total mouth

breather! Dr West will repair the base of the septum with the

maxilla repair (the base is separated when the upper jaw is broken

and sawn), but he said I would need the rhinoplasty after the jaw

surgery to correct the upper septal blockage. And he said my

deviation is so obvious (from the inside only, the outside looks

fairly straight), that is should be covered by insurance. I didn't

even ask him about this. Amazing! He was going to recommend it for

me.

He is recommending that I have both upper and lower jaw work. For

the upper, he will saw the maxilla lengthwise, then segment it - I

am not entirely sure what this part means, but I think it means he

will also break it in two places vertically to contour it - lower it

and move it out toward the tip of my nose. He will use bone graft

from my hip to fill in the spaces, screw it and plate it with

titanium. He will fix the base of my nasal septum with this part of

the procedure. He said bringing this forward and down will improve

significantly the NL fold area. He also said it would balance my

face. What I have hated all my life, thinking my cheeks were too

full, is not the case. The cheeks are fine, it is the upper jaw that

is receded and flattened (I think this is what he was referring to

anyway). By adjusting them, it will balance and give symmetry to my

face. I am thrilled with this part of it!!! I have always hated my

chipmonk cheeks. And it was never them from the start!! I am amazed!

The lower will be broken past the vertical part of the jaw, and

split anterior to posterior (kind of a slice), moved forward, down (

the same amount as is moved downward on the upper maxilla), to the

right and rotated to the right. It will also be held with titanium

and then banded for recovery and healing. It will add length to the

lower part of my face and allow my tongue to fit, my lips to fit

normally without scrunching (the upper anyway), and hopefully I will

be able to chew in a more normal fashion. He is hopeful that it will

free up my tongue enough to help me with the frequent choking.

I will start braces, which I will be in for about 18 months to 2

years. Then the surgery, followed by more braces. When they are

stabile, they will crown all of my front and front molar teeth. He

thinks we can avoid having to crown all of my back molars, by having

the OD move the teeth up from the root. This will add length to them

so they will be able to support the new jaw positions. The fronts

are already too short, and cannot be moved that much to make up the

difference, so they will just space them a little, lightly abrade

them and add the crowns. Because all of the visable ones will be

done, my dentist says I can go really white. I will never need

bleaching again! YEAH!!

Of course, this is a lot to do, and a long process and longer

recovery. I am looking at 3-4 years total. The surgery and most of

the crown expense will be handled by insurance. Unfortunately, the

orthodontia will not be covered. It is excluded for adults with our

policy, even for medically necessary reasons. So that is $5500 out

of pocket, and the $1000 for the co pay on surgery, and the copay

for crowns. It is going to be spendy. But the OD will take payments

on the braces, and I am going to try to work out a deal with my

dentist who will be doing the near full mouth rehab and crown work,

as I will be one of his first cases with this. We will see.

I have decided to do it. I think, long term, that it will be very

beneficial, and even life saving. I will let you know how it

progresses. And keep me posted as to your situations too!

Hugs,

Fran