Seeking Advice on IVRO vs. BSSO for Lower Jaw Setback

[volodymyrp]

TL;DR: I’m choosing between BSSO and IVRO for my double-jaw surgery, leaning toward IVRO to reduce the risk of permanent numbness. If you’ve had IVRO, how was recovery and stability? Any unexpected drawbacks compared to BSSO? Does IVRO require specific surgeon expertise since it’s less common? Any insights would be much appreciated!

---------

Hey everyone! I’m scheduled for double-jaw surgery soon to correct my underbite and crossbite, and I’m exploring options to avoid long-term complications.

I know this is a long post, but I’m really trying to make the best choice for my upcoming surgery. Any insights, even partial or subjective, would be incredibly helpful. Thanks so much in advance!

A bit of context: The plan is to advance my upper jaw and retract and rotate my lower jaw. My surgeon initially suggested a 3-piece Le Fort I with a BSSO for the lower jaw, but I shared that I already have a paresthesia from a previous wisdom tooth extraction and that I would prefer to explore everything to reduce the chance of another paresthesia. Because of this, my surgeon offered me the option of IVRO (instead of BSSO) for the lower jaw to reduce the risk of permanent numbness (from ~30% with BSSO down to 2-5% with IVRO).

I realize that IVRO would mean my mouth would be wired shut, but I’m okay with temporary limitations if it lowers the risk of permanent complications. I’ve done a lot of reading, and from all the articles I read, none said that IVRO was worse than BSSO in any way apart from the patient discomfort of mouth being wired shut. This keeps me wondering if I am missing something?

Also, I’m quite anxious about this whole process, so any insights from people with experience would be really appreciated.

My questions:

- Recovery & Mood: How was your overall recovery after IVRO? I know the first two weeks are likely rough for both BSSO and IVRO, since both involve limited movement initially. But did the wired-shut aspect significantly impact your mood or recovery experience in those first 6 weeks?

- Wiring Process: When they wired your mouth shut, did they use the existing braces, or did they add screws or additional elements to secure the upper and lower jaws?

- Wire Discomfort: How much did the wires themselves irritate the inner side of your lips? Any tips on managing that?

- Technical Aspects of IVRO: I came across a presentation that mentioned IVRO is a “blind procedure” compared to BSSO. Does this mean that IVRO requires more precision or is more complex for the surgeon?

- Popularity of IVRO: It seems that BSSO is more commonly chosen for lower jaw surgery. Does this suggest that fewer surgeons have experience with IVRO? Could this lack of familiarity lead to less optimal results or a higher risk of complications?

- Long-term Stability: From a stability standpoint, is there a difference between IVRO and BSSO in terms of long-term resilience (e.g., if I were to fall skiing in the future and land on my face, would one method heal in a way that’s more robust for impact)?

- Fixation & Healing Process: How does fixation work with IVRO? I assume that after IVRO, the lower jaw is essentially in three parts: two small parts connected to the muscles on the sides, and one large middle section fixated to the upper jaw. What’s keeping everything stable in those early weeks if there’s no rigid fixation, and I assume I will be able to move the outer small parts of the jaw?

- Aesthetic Differences: Do BSSO and IVRO produce noticeably different aesthetic results? If so, how would you describe the difference?

- Jaw Positioning While Wired Shut: When they wire or band the jaws, do they leave any gap between the teeth to relieve tension, or do the teeth touch? Currently, my teeth don’t touch when I relax my jaw — there’s about 4mm of space between my upper and lower incisors, so I’m concerned about muscle strain if I have to clench to keep the mouth fully shut.

- Any Other Drawbacks of IVRO Compared to BSSO? Besides the wiring aspect, are there any drawbacks to IVRO compared to BSSO that I might not have considered?

- Any Other Reasons to Prefer One Procedure? Is there something you wish you’d known beforehand, or any reason that led you to prefer one procedure over the other?

I appreciate any insights, advice, or experiences you can share — thanks in advance for helping me navigate this big decision!