Metal Mouth Message Board

Hi everyone,
I would appreciate any opinions of people on this forum about my case.
I posted once before about palatal expansion and received some great information so I thought I would try again.
I have just come back from my second consulation with my oral surgeon this morning.
(Briefly I am 32 yr old male and have a narrow palate with crossbite of c.5/6mm and retrognathic chin - class 2 division 1 apparently )
After taking xrays, cephs and moulds my surgeon recommends that I have no orthodontics and proceed straight to upper/lower jaw surgery and genioplasty. He says my bite is ok (it is - but doesn't look so great) He recommends 5mm forward movement for upper and lower jaw with a 3mm genio movement forward) I think/presume that is 8mm in total forward advancement for my chin then ?

It was rather rushed in his office this morning and he suggested we meet in a week or so to discuss it when he had more time. Now I should add that my case is complicated by the fact that I had orthodontic treatment as a child. (Extractions that made the teeth fit together but left the profile qiute unbalanced.) My oral surgeon says that ideally he would like to move the lower jaw further than the upper but he is constrained becuase he wants my bite to be stable and my earlier ortho work didn''t leave much space to work with)

So my question (after all that ) is do people believe all the hassle of upper/lower/genio is worth it for the movement of 5/5/8mm respectively ? I have taken out my ruler and 5mm is not so much! I have always been conscious of my profile and recessed chin. I am level headed about this but it does bother me. However I am unsure about whether or not it will make a substantial enough improvement to warrant the trouble - cost/time/potential complications, etc
I also have a narrow airway and my GP tells me I have apnea symptoms - this was also one reason I investigated this but my OS didn't mention this today and I forgot to ask if 5mm movement would impact significantly on airway width and improve breathing.
He also told me I shoud not correct the crossbite as the benefits of correcting it would be minor and it would take some years work.

So finally to sum it up:
Is it worth surgery for 5/5/8 mm?
Has anyone had surgery for this distance and had a noticeable improvement in profile ?
Is there anything obvious to ask that I am missing ?

Any advice/comments/input from readers would be very appreciated.
Best Regards,
Tony

Hi Tony,

I just had BSSO surgery two weeks ago for a crossbite and slight underbite. My jaw was moved 5-6 mm from right to left and it makes a big difference in my bite. I couldn't have this fixed Orthodontically and have worn braces in the past and this time for 16 months so far.

I believe my crossbite was causing daily headaches that seem to have resolved. The numbness does bother me and was my major consideration. I wasn't afraid of the surgery or the pain, just not getting the feeling back, mainly in my lips. Since I only had the lower jaw done, it is only the lower lip and chin.

It's good to do a lot of research so you can decide if this is for you. I'd suggest getting another surgeon's opinion and see if he can show you what your face and bite would like post-surgery. That may help you decide.

Best wishes!

Lo

I'm also curious to know just how much difference a few MM's can make. I'm looking at an 8mm upper advancment mainly for aesthetic reasons.

I know with things like cheek implants an extra mm or two can really make all the difference. Guess its the same for orthognatic.

I just had upper, lower, and genio done about 8 weeks ago. My advancements were 3mm on top, 4mm on bottom, and 5mm at chin so 12mm from chinpoint. I did it to cure my sleep apnea and not for appearances, but it has made a huge differencein my appearance too and I'm very pleased with the results. I have a chin now, and my face is balanced. I never used to wear my hair in a ponytail or wear baseball caps as they just always looked really bad due to my recessed chin. Now I can do both of those things and everything looks good.

I know the advancement doesn't seem like much when you look at the measurments on a ruler, but just a few mm can make big difference when it is come to the changes that take place with your facial assymetry and the overall balance of your features.

Brandy

Hi Tony,

I just started in braces 2nd time around and had 4 teeth pulled the first time. I also have a recessed chin and planning on the bsso procedure about a year from now---also 5 mm forward as well as downward a little. We will wait until surgery before they decide for sure on genioplasty. I spent hours researching the surgery and reading the blogs on this website.

I think what is missing for you right now is a candid, unrushed conversation with your ortho where you can ask these same questions. I went back with my husband for a 2nd consult becasue I, too, thought it seemed extreme and asked him to re-explain to both of us why he felt it was worth doing. He wasn't pushing it, he said I could certainly just do the braces, but he felt it was a disservice to me not to recommend what would give the optimal result. Braces alone would #1 never have fixed my deep bite and #2 the stablility of my teeth after braces were off would be questionable. He explained that when you have to move teeth so far forward to get the best bite, they tend not to want to stay there over time. Everything I have read since then seems to concur.

Only you can decide if it's worth it! Keep me posted-I'd be interested in what you decide!

Andi

Hi everyone,
Thanks for the input. Brandy congratulations on your progress. Your blog is extremely detailed and useful and your progress is great.
I will consider carefully what to ask my OS when I see him next and I think I will try to get a second opinion also. I thought about it again yesterday evening and 5mm seems a little more now than I originally thought. Meryaten it's interesting also that you noticed an improvement after this amount of movement.
I need to do more research on this and this forum is a great asset.
One thing I am curious about:
Is it possible to correct a crossbite during the same procedure as moving the jaws forward?
Regards,
Tony

Tony,

Yes, they do it at the same time. I had a crossbite and my jaw was moved back slightly.

Lo

Yes I also had a crossbite fixed at the same time as having my lower straightened and my upper moved forwards, and shortened. I do not know the exact measurements of all my procedures, but they were small. I believe my upper was moved forwards about 2mm, shortened 2mm, and my lower jaw was lengthened 2mm on one side only. Then there was the expansion (of the upper) and that was a bit more substantial. As you can probably guess, I don't look much different. My chin is straight now, and my profile is just slightly different. But my bite is fixed, and that's what we were going for.

I remember my surgeon saying that anything less than 5 mm was more risky than beneficial. Also, my insurance covers jaw surgery with documention of medical necessity. They use 5mm as the minimal amount of movement that would be covered. So it seems that 5mm is a threshhold for many regarding this surgery.

That is very interesting because I know my orthodontist was adamant that I get that lower jaw fixed, and I know it was a pretty small movement - the midline was off by about half a tooth...

smile,

That's interesting. I didn't realize there was a cut-off measurement! It makes sense, though, as jaw surgery is considerd major surgery.

Lo