Re: Need Advice please

[Guest guest]

Hi Dan,

I only had my top moved forward 4mm and what a difference. I got

similar advice, and I am glad I went for it. I think if you are going

to go through the pain of the bottom surgery you might as well do the

top a well, becaue if you don't, what if you are not happy with the

outcome. My bottom was moved forward 18mm also, but I am very happy

withe reult and recovery so far. I am 7 weeks post op and apart from a

bit of swelling still on my cheeks and numbness on my bottom left

chin, I am doing really well.

Good luck with your decision, but even if its only a couple of mm, it

can make all the difference. Its the type of operation you only want

to do once in your life time, so I say get it right the first time

around.

>

> I am supposed to have surgery in December to expand my upper jaw and

> move it forward and move my lower jaw backward. My oral surgeon said

> that I should think about not doing the upper because he would only

> move it 2 to 3 mm forward. He said it would not be worth the pain

and

> recovery and that only my back upper teeth would not meet the lower

> teeth correctly if the upper doesn't get expanded. My orthodontist,

> however, says that I should do it. He doesn't think I will be happy

> with my bite if I don't get the upper done. I am tending to agree

with

> him, because the upper is slightly narrow and slightly too far back.

> Insurance approved me for both the upper and lower, so it is all the

> same to me financially. I guess recovery is the big issue here. Does

> any one have any advice for me?

>

[Guest guest]

Hi Dan,

Oh boy, I feel for you and that dilemma! I had a very similar

situation. The OS and OD probably could have made it work without

doing the upper, but for optimal results, upper should be done too in

my case. I saw 3 diff. OS for consults. One was very young and new to

the practice- he didn't see anything going on with my upper to begin

with! Another one said that he could see going either way and that it

was my choice. The third also said that.... when they did my preop

(after I decided for surgery for both jaws) the

models/pictures/measurements really did indicate that upper should be

done too.

But, that was after I decided. Before I decided, I twisted in the wind

for a good couple weeks I think! Here is some background for context:

my upper was slighly vertically long- and a little canted (one side

longer than the other), it was also assymetrical with my midline

shifted left off center. Lastly, it was narrow. Individually, each of

those factors wasn't much and wouldn't result in a lot of movement and

change in anyone direction. But, add up the movement in each

direction, though, and adds up to a significant change!

My ortho also encouraged me to have the upper done as well. He sat

down with me for a heart to heart when I was totally in a quandary.

And he was very perceptive about it. I had braces in H.S. and that

ortho never mentioned my at least definite need for lower jaw surgery

not to mention the upper. Here I was 8 years later going through the

great expense and trouble of braces a second time and now surgery too,

to finally get it right once and for all. I definitely didn't want

braces again for a 3rd time! I had decided to have the surgery to

begin with because I wanted my problems fixed, not just masked with

only doing ortho (which didn't really mask anything!). So, I really

felt that since I was already investing so much to get it right, why

not do that 100%?? The idea of coming out of surgery and recovering

from only lower jaw surgery, only to then be unhappy with the outcome

and wish I had done upper too sounded horrible. My thinking was also

that I'd be recovering anyway, so what's one more jaw!?!?! That's

rather simplistic and niave, but recovering from a double jaw surgery

was a better option than A. possibly living with regret afterwards

and/or B. ending up going back in there for a second surgery. I wanted

to only have one surgery- I wanted it done the right way the first

time! I'd read about people going back in after one jaw was done to do

the other. Some cases indicate separating the surgeries, but if I

could do both at once and have ONE recovery, that worked for me. So,

when I had my first prebraces consult, I was initially only told about

my obvious need for lower jaw surgery. So, in the beginning, I thought

I was only going in for lower jaw surgery. For two years, I

anticipated just that. It was only in the months prior to my actual

surgery that my problems with upper became very evident because my

teeth were finally aligned and ready to go. The cant became obvious

along with the skewed midline. Both really started to bother me as

well. So, what started out as a commitment to lower only, ended up

including upper AND genio! I got the works!

I can't decide for you and I don't know what your specific case is (I

think we're opposites (my lower jaw was retrognathic). I just wanted

to write because your dilemma sounded so similar to mine. There are

those on this board who would say that if something isn't absolutely

necessary, then don't do it. My decision wasn't made that way. I

agreed with my ortho that if I didn't have upper done, the problems

with my upper that were already noticable and bothersome to me preop

would only be more noticable and bother me more post op. And, as I

said before, I wanted to get everything right the first time. I was

commited to it all the way. I wondered why I should bother with the

pain and expense and all of the surgery in the first place if we

weren't going to do it right.

As it turned out, doing the upper really was indicated with my preop

work up. At that point, I'm not sure what my surgeon would have told

me had I been decided against the upper surgery! In my upper was

vertically shortened, the cant was corrected, the jaw was rotated to

correct the midline, and it was expanded. Oh and one wisdom tooth was

pulled.

Best wishes as you sort it out and decide for yourself. I was tortured

for days and feel for what you must be going through right now

figuring it out. I hope sharing my decision making process and some of

my reasoning/justifications/thoughts will be helpful for you too. Good

luck and let me know what you ultimately decide!

Take care,

Katja

>

> I am supposed to have surgery in December to expand my upper jaw and

> move it forward and move my lower jaw backward. My oral surgeon said

> that I should think about not doing the upper because he would only

> move it 2 to 3 mm forward. He said it would not be worth the pain

and

> recovery and that only my back upper teeth would not meet the lower

> teeth correctly if the upper doesn't get expanded. My orthodontist,

> however, says that I should do it. He doesn't think I will be happy

> with my bite if I don't get the upper done. I am tending to agree

with

> him, because the upper is slightly narrow and slightly too far back.

> Insurance approved me for both the upper and lower, so it is all the

> same to me financially. I guess recovery is the big issue here. Does

> any one have any advice for me?

>

[Guest guest]

Hi Dan,

I would consider having it done. I was told with mine (but my bottom

is coming forward) that if my top wasn't done, it messes up the way the

jaw comes together (the something, something plane) and its worth it to

have everything line up correctly.

Just my thoughts....maybe another consult?

Sandy, PA

(upper, lower, genio for OSA)

>

> I am supposed to have surgery in December to expand my upper jaw and

> move it forward and move my lower jaw backward. My oral surgeon said

> that I should think about not doing the upper because he would only

> move it 2 to 3 mm forward. He said it would not be worth the pain and

> recovery and that only my back upper teeth would not meet the lower

> teeth correctly if the upper doesn't get expanded. My orthodontist,

> however, says that I should do it. He doesn't think I will be happy

> with my bite if I don't get the upper done. I am tending to agree

with

> him, because the upper is slightly narrow and slightly too far back.

> Insurance approved me for both the upper and lower, so it is all the

> same to me financially. I guess recovery is the big issue here. Does

> any one have any advice for me?

>

[Guest guest]

Dan,

If insurance is covering both then I'd say go for both. The recovery

can be rough but not unbearable. If you're confident in your surgeon,

then I'd say get it all done. When I was debating on whether to do

both jaws, my surgeon told me " You only get one chance to make a SMART

decision. " I decided it was worth it since I'd be going through the

effort anyway - might as well make everything function the right way

instead of fearing about problems again in the future.

JT

>

> I am supposed to have surgery in December to expand my upper jaw and

> move it forward and move my lower jaw backward. My oral surgeon said

> that I should think about not doing the upper because he would only

> move it 2 to 3 mm forward. He said it would not be worth the pain

and

> recovery and that only my back upper teeth would not meet the lower

> teeth correctly if the upper doesn't get expanded. My orthodontist,

> however, says that I should do it. He doesn't think I will be happy

> with my bite if I don't get the upper done. I am tending to agree

with

> him, because the upper is slightly narrow and slightly too far back.

> Insurance approved me for both the upper and lower, so it is all the

> same to me financially. I guess recovery is the big issue here. Does

> any one have any advice for me?

>

[Guest guest]

Thanks for the advice and info, JT. I saw my OD today and he said I at least

need the upper widened a bit if not moved forward some too. He is going to call

my OS and talk to him about everything and hopefully everyone will be on the

same page here soon since my sugery is fast approaching (Dec 12). I told my OD

today " I just don't want to look like a freak when its over! " because I'm

starting to get kinda nervous! I'm worried what I'm going to look like. I am

definitely leaning towards doing the upper, but I have a feeling my OS will try

to talk me out of it when I go back to see him Nov 23. Oh well, I'm sure

everything will work out (fingers crossed).

johntolena wrote:Dan,

If insurance is covering both then I'd say go for both. The recovery

can be rough but not unbearable. If you're confident in your surgeon,

then I'd say get it all done. When I was debating on whether to do

both jaws, my surgeon told me " You only get one chance to make a SMART

decision. " I decided it was worth it since I'd be going through the

effort anyway - might as well make everything function the right way

instead of fearing about problems again in the future.

JT

>

> I am supposed to have surgery in December to expand my upper jaw and

> move it forward and move my lower jaw backward. My oral surgeon said

> that I should think about not doing the upper because he would only

> move it 2 to 3 mm forward. He said it would not be worth the pain

and

> recovery and that only my back upper teeth would not meet the lower

> teeth correctly if the upper doesn't get expanded. My orthodontist,

> however, says that I should do it. He doesn't think I will be happy

> with my bite if I don't get the upper done. I am tending to agree

with

> him, because the upper is slightly narrow and slightly too far back.

> Insurance approved me for both the upper and lower, so it is all the

> same to me financially. I guess recovery is the big issue here. Does

> any one have any advice for me?

>

[Guest guest]

Christee-

My heart goes out to you and Lilee-poor thing. With the shoe

reduction, my son david has been at 55 degrees since September to

help his ligaments tighten up-kind of the opposite problem most

clubfoot kids have. I do have to say-it has helped tighten up

david's feet-so maybe this would help tighten up Lilee's extra skin.

It scared me to move the shoes in and even after talking with Dr P I

was still hesitant. My son when standing has a perfect 2nd position

ballet stance-ie his feet go 180 in a nice little line. Since the

move in-his feet at rest standing go more to first position in

ballet-like a v-more normal. I hope this makes sense for you!

best wishes,

kathleen

>

> Oh, where to begin! (

> Lilee has gotten another sore (her 2nd) on her feet from her

P/M.

> It's really not the make of the shoes, its her foot. She has a

very

> pudgy foot, and alot of extra skin. She gets the sores on the

inner

> side of her foot where the middle strap goes. Turns real redish,

> sometimes purplish, then the skin peels off and theres an open

> sore/blister. We tried to alter them a little with no luck. I

emailed

> Dr. Ponseti, and the pics of this and whats going

on.

> and Dr. Ponseti have ordered me to take them off her. Dr.

> Ponseti isnt happy about her not being in a healing cast, but we

dont

> have much choice. is making her a new pair of shoes with a

> sliding bigger tongue to try and pull the pressure away from the

> middle strap. He said if it doesnt work, hes got another idea.

Didn't

> ask what. And if they dont work, then we will need to make a

trip to

> Iowa so they can do hands on with her foot to make it work. Dr.

> Ponseti said the Dobbs brace would NOT work for Lilee. Said that

it

> wouldnt hold her foot securley enough. He said in some pictures

(the

> ones of her standing), that her foot looks perfectly corrected.

In

> others he said that the deep crease in the heel area concerned

him

> because that generally means that there isnt enough correction.

He

> wants us to turn her brace in with the new shoes down to 40-50

> degrees! WOW! Has anyone else had to do this? He said maybe her

heel

> was a little too corrected, and that turning it in will help the

body

> tighten that extra skin and pull the crease, extra skin away. He

said

> if she continues to have issues and/or she loses correction we

will

> need to go any see him again. She will get her new shoes on

Monday,

> so that is 5 days total with NO brace. They want her to heal the

> sore. I have to admit it, that scares me! I have been doing the

Dobbs

> stretches 2X daily. So far so good I think! God, I hope things

will

> be Ok and work out! Anyone else having issues? Anyone else had

to

> turn the shoes back in? I'm scared. It seems like a neverending

> battle. Thanks to all in advance!

>

>

> Christee

> Mother of...

> *Josh~Learning/Speech Delays (9)

> **Aspen~ Bilateral Metatarsus Adductus (6)

> ***Dylan~PTSD/Anxiety (4)

> ****Lilee~A-Typical UCF w/Plantaris ® & Metatarsus Adductus (L)

> *P/M Brace 16-18/24.Struggling w/pressure sores (8 months)

> Concidering Dobbs bar & braces

>

>

>

>

>

>

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