Relapse.. how would you know?

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#31 Post by **phil** » Sun Sep 30, 2007 10:34 am

Karigan,

Again, keeping in mind that I am not a professional, I would like to respond to your last post.

In my humble opinion, I don't think it's intelligent for a surgeon to rule out late mandibular growth as your reason for relapse, unless he had radiographic proof that you were done growing by 17 (for instance, sutures in the skull are completely fused--that would be an indicator, I think).

Like na2r4 says, I think it's time for a second opinion. And, your surgeon shouldn't be able to rule something out without explaining to you WHY he's ruling it out.

#32 Post by **Karigan** » Sun Sep 30, 2007 12:06 pm

The OS I am seeing this time is one of the top in this field and world renowned so I would trust him totally and to be honest I could ask a few more of them and I doubt I'd get a straight answer! Literally he is like the head guy here. None of them like to answer these questions. He kind of side stepped it without saying absolutely one way or another. But he is a great guy and the best so I have no problem believing he knows exactly what he is talking about.

This OS was not the one who did my first op and as it was so long ago they no longer have my notes so I can understand why he felt he couldn't give me an exact answer but I am sure there must a general idea why bimaxillary surgery on class III malocclusions relapse. Also that wasn't the reason I was there to see him and kind of ambushed him by asking him!

I have read that it is not unusual to do this surgery at 17 on females. Personally in my case I feel it is a number of factors one of which may be growth. I am hoping to speak to my original OS next time I visit and I shall ask him why he thinks it relapsed. If only they still had my records and models but as it was 18 years ago they seem to have misplaced them or lost them altogether which is not unusual. Personally I think it has even moved within the past 5 years and I am in my 30s so I'm going to say that next time and see what I can get from them. I'll keep you posted.

#33 Post by **Karigan** » Sun Sep 30, 2007 1:22 pm

I had bookmarked this article whilst researching this subject a few weeks ago and have just got round to reading it. It would seem to suggest that growth is not the primary factor in relapse in my type of surgery. I thought I'd had bimaxillary surgery to correct my bad class III malocclusion which included a sagittal split of the mandible but actually I think it was one of the other types mentioned in this article, possibly the IVRO type. I honestly can't say for sure exactlly what they did but that seems to be more likely for my type of problem. Anyway, this article says that in large movements like mine relapse is expected and also the way the segments are placed and also the type and strength of fixing can play a big part in relapse. This would tally with what the OS seemed to hint at. I always wondered about the growth theory, it seemed most likely but then they were very thorough at the time in determining if I had stopped growing so looking back I probably had. Whereas I always felt that the extent of the shift was so big that my jaws did not like being in the new position and were trying to go back!! I think the size of the shift along with the other possibilities mentioned in this article and my tongue pushing out my teeth have all contributed to the relapse.

'Relapse following a mandibular osteotomy depends on the amount of mandibular movement and the type of fixation. Relapse is expected with mandibular advancements greater than 7mm (van Sickels et al. 1997) In the study of Panula and co-workers, severe relapse was seen in 3% and mild relapse in 8% of the patients (Panula et al. 2001). One method to prevent skeletal relapse include orthodontic over correction. Also the type of fixation plays an important role in preventing the relapse. If no internal fixation is used between the proximal and distal fragments in a BSSO, then significant skeletal and occlusal relapse will occur (SÃ ndor et al. 1984). Bicortical screws either alone or in combination with a plate work better than a plate and monocortical screws (Murphy et al. 1997).'

Anyway, this is a good article, perhaps it has already been posted on the board but here is the link if you want to read it in full.

http://herkules.oulu.fi/isbn9514267508/html/c237.html

#34 Post by **PCPFORMULA** » Sun Sep 30, 2007 6:05 pm

is it quite easy for the jaws to move position post op? if they do, how long do you normally have to wait under surgery can be performed again?

What happens to all the screws, plates etc, are these removed altogether and they start again?

#35 Post by **WhiteLurcher** » Mon Oct 01, 2007 1:37 am

I had my jaws repositioned a fortnight after the initial bimax surgery. They apparently repositioned my jaws three times before they were finally happy!

Alas my bite still relapsed even after all that!!!!

#36 Post by **Karigan** » Mon Oct 01, 2007 11:04 am

Meryaten, yes I thought you had probably quoted that artcle before, you do such good research! It is very interesting going through it all, I'm going to ask all about this when I go back and hopefully the original OS will be able to shed some light on my particular relapse.

Whitelurcher, is your bite still out of position now and if so why did they say it has continued to relapse even after correction? Are you contemplating anymore surgery? I wonder because I am thinking of going back now after 18 years to get mine corrected but I would be worried it might relapse again and so then there'd be no point doing it. That is why I want to pin them down on exactly why my jaw position and bite relapsed.

#37 Post by **WhiteLurcher** » Mon Oct 01, 2007 12:05 pm

Karigan, my bite still looks much like the last pictures I posted here:-
viewtopic.php?t=19113&postdays=0&postorder=asc&start=30
With the wonders of elastics my ortho has managed to extrude my right molars, so I do have some contact now and my bite is functional.

It's just not how it was meant to turn out! My ortho said relapse was the cause due to my open bite. My surgeon hasn't given any explanation and I'm not sure he actually has one

As you know getting answers from a surgeon is like juicing a stone!

You will just have to make it clear that you need answers before you can make any decisions about surgery, unfortunately the answers you get might not help.

Good luck and all the best!

#38 Post by **Karigan** » Mon Oct 01, 2007 12:32 pm

Whitelurcher, I looked at your pics, it doesn't look too bad although not as you'd hoped of course. Mine is much worse although it has gradually gotten worse over the years. I have contact between two molars on the right side and one on the back left and that is it now. The gap between my lower jaw (pronathic) and top jaw is about 5mm on the left and then gradually reduces as you go round to the right. My original position pre surgery all those years ago was over 7mm. As I say it is noticeable but compared to pre op it still looks good!

It is so difficult to pin them down on this topic and they all seem to avoid it if possible as you say! I really did think for a while it must be the growth theory mixed with other reasons but now I don't think that is the case with me so I will have to really put them on the spot this next time. I gather they are monitoring your bite closely? They moitored mine for over 10 years post op and it gradually got worse over that time. I do actually wonder if it is still moving over the past 5 years or so which would indeed scupper the growth theory and also now that I have been giving it a lot of thought, which I haven't done for years, I had stopped growing by my mid 20s and still it moved during that time.

If yours continues to move, would you go in yet again to correct it?

#39 Post by **WhiteLurcher** » Mon Oct 01, 2007 1:09 pm

Karigan, I agree it don't look too bad, guess initially I was rather disapointed, after seven years treatment including two years in braces and three jaw surgeries you kind of expect near perfect results. I'm just happy and hopeful the pain and locking is gone. Asthetic improvement was only ever an added bonus really! The wonky face I wish I'd been warned about but I'll get use to it, eventually!

As to the monitoring I fully expect my next apointment to be my last, maybe not but it wouldn't surprise me. If things started to go wrong again and surgery was recommended then yes I probably would consider it.

I really hope you get anwers next time!

#40 Post by **dubnobass** » Tue Oct 02, 2007 12:03 am

In defence of surgeons, mine answered all the questions I could throw at him, until I ran out of things to ask. I suspect they're not giving you a clear answer because they don't know what's caused the problem. They can't tell you what they don't know.

#41 Post by **Karigan** » Tue Oct 02, 2007 7:59 am

Whitelurcher, I hope yours stays as it is and doesn't move anymore so you don't need to go through it again! What do you mean by wonky face? Do you feel it has changed other areas of your face? Because I thought that, my nose looked squint for example afterwards! Then over the years I look different, I know some of that will be general getting old!

It is disappointing when you have been getting treatment for so long and you build it up to the op and then it doesn't stay as perfect as it was when they did it. I went from when I was about 7 years old until 17 years when they did the bimax and then until I was about 28 years old for monitoring. I built my op up that it was this life changing thing, there was no question I wouldn't have it, I was brought up knowing I was going to have it! However, no one ever told me it could relapse, I don't remember even being told about numbness or anything. Now they do at least tell you that but as many people have noted they are not as informative as they could be. There is a reluctance to answer the difficult questions and this has always been the case as far as my experience goes anyway.

I remember at 17 the week before the op when the OS was there with all his little followers my mum saying that I had questions for him, I then produced my carefully written out questions and the look on all their faces was comical!!! I don't think they were used to anyone asking and he did try and answer them with a tolerant amusement I think. Having gone back into the system again 18 years later, nothing much has changed, they still are extremely diificult to pin down on anything. i don't ever regret getting the op, best thing I ever did but I wish it hadn't relapsed so much. Ah, well, I'll see what they say when I hit them with all my questions this next time and I'll use some of Merayten's research!!!!

That'll put them on the spot!

#42 Post by **WhiteLurcher** » Wed Oct 03, 2007 3:44 am

Karigan, wonky in that the right side of my jaw/face appears/is fuller than my left. I think it is, as phil said somewhere, to do with how my mandible has been rotated.

Mr K prefers not to discuss it!

My relapse must have happened between them closing up and me waking up, as I never saw the perfect bite.

I hope it stays put too!

Armed with all that research you might just get your answers this time!

#43 Post by **PCPFORMULA** » Wed Oct 03, 2007 5:03 pm

so is it possible for the screws, plates to move post op? to a certain extent that it badly affects the bite?

what could be a factor in the screws moving, tooth grinding in your sleep?

Im due for my 2nd check up post op in 2 weeks<I ll be 8 wks post op> I take it the OS would be able to tell right away comparing x rays from then to now?