I've been told I definitely need my palate expanded and my maxilla impacted to fix my smile and open bite. I won't be seeing my ortho again for another month, and I have some questions.
First of all, my lower jaw is apparently "normal" (I actually hate it, it's too wide for my face and protrudes beyond my cheekbones), yet it's in fairly good occlusion with my upper, despite my upper jaw needing expansion. How is it possible that my palate would need expansion, yet not my lower arch?
Secondly, I'm having my upper jaw moved forward in order to "compensate for the expansion" (which presumably would move my teeth backward somewhat). From what I understood of what I was told, and I may be wrong, once the maxilla is impacted and moved forward, the lower jaw should rotate into place correctly, and shouldn't need to be advanced, nor should there be any reason for a genioplasty. Is this correct? Does anyone here have experience of having a Lefort I on its own?
Finally, how long should I expect to wait between expansion and Lefort I? The answer seems to be "a few months", which worries me since I'm due to resume studies in mid-october next year. Can expansion and Lefort I be done at the same time?
How long between expansion and Lefort I? And is BSSO needed?
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Neverloved
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Hi, can they not do the expansion and the moving of the maxilla forwards in one operation? I mean if they're going to detach the whole maxilla in a le fort I to move it forwards could they not split it down the middle as well and do the expansion there and then?
I think I read somewhere that this is a two piece le fort I - allows anteroposterior movement and widening?
With the impacting bit does that mean that you currently have a bit of a gummy smile - so they'd be moving your maxilla upwards?
I think that you probably have to have your maxilla advanced to fix the open bite. When your lower jaw is able to close up fully it'll come further forwards than it does now. If they were somehow able to get it closed without moving the maxilla forward you'd probably end up with an underjet/anterior crossbite.
I think I read somewhere that this is a two piece le fort I - allows anteroposterior movement and widening?
With the impacting bit does that mean that you currently have a bit of a gummy smile - so they'd be moving your maxilla upwards?
I think that you probably have to have your maxilla advanced to fix the open bite. When your lower jaw is able to close up fully it'll come further forwards than it does now. If they were somehow able to get it closed without moving the maxilla forward you'd probably end up with an underjet/anterior crossbite.
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Neverloved
- Posts: 39
- Joined: Sun Oct 31, 2010 3:02 pm
They've probably done a tracing from a lateral radiograph, and on measuring things on this found your lower jaw to be correctly - or near enough - proportioned in relation to other cephalometric landmarks. So best leave it alone, I guess. They can do all the correction by working with the upper jaw.
They'd know just where your lower jaw will close to when it has the freedom to do so. For that matter, I'd imagine the surgeon would use it to simulate the final bite in the op. and to get the anteroposterior position of the maxilla correct.
They don't do this in a hit-and-hope basis! They wouldn't blindly have a go at one jaw and then discover they'd need to come back and butcher the other, if ya get what I mean. It'd all be analysed in the round during surgical planning.
Oh, don't mean to pry but I hope your username isn't a reflection on yourself. It's just that it hit me that it might be and that made me rather sad.
I'm sure/hope someone out there loves you. Then again, maybe it's just a random song title from an album you liked or something. Or so I hope.
They'd know just where your lower jaw will close to when it has the freedom to do so. For that matter, I'd imagine the surgeon would use it to simulate the final bite in the op. and to get the anteroposterior position of the maxilla correct.
They don't do this in a hit-and-hope basis! They wouldn't blindly have a go at one jaw and then discover they'd need to come back and butcher the other, if ya get what I mean. It'd all be analysed in the round during surgical planning.
Oh, don't mean to pry but I hope your username isn't a reflection on yourself. It's just that it hit me that it might be and that made me rather sad.
I'm sure/hope someone out there loves you. Then again, maybe it's just a random song title from an album you liked or something. Or so I hope.It's going to depend on how much expansion you need. You could do a 2-piece LeFort and get some widening, but significant widening during a true LeFort I is the most unstable procedure in orthognathic surgery. That is why you will see many people on here go through an expansion procedure such as a SARPE, followed by an upper procedure LeFort I.
I don't know what constitutes "significant" widening, but my guess would be anything more than 3 to 4 mm.
I'd say at LEAST 6 to 8 months need to go between the two surgeries. You need to go at least 4 to 6 months with the expander in to stabilize the expanded jaw. To be realistic, it is probably more like a year.
Best of luck to you. There are many people on here (myself included) that have been through this process...
Regards
Chicago29
I don't know what constitutes "significant" widening, but my guess would be anything more than 3 to 4 mm.
I'd say at LEAST 6 to 8 months need to go between the two surgeries. You need to go at least 4 to 6 months with the expander in to stabilize the expanded jaw. To be realistic, it is probably more like a year.
Best of luck to you. There are many people on here (myself included) that have been through this process...
Regards
Chicago29
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Neverloved
- Posts: 39
- Joined: Sun Oct 31, 2010 3:02 pm
What do you mean "the most unstable procedure"? Surely it can;t be worse than a Lefort 2 or 3? How much expansion is 3-4mm anyway in practical terms? Enough to see an aethetic improvement and alleviate minor crowding?
If this is my palate, how much expansion do you believe would be required? Would 4mm be sufficient?
http://img709.imageshack.us/img709/784/img0157pz.jpg
(sorry for the terrible quality, it's an iphone camera)
The other thing is that I plan on having cheek implants after, since apparently that's the only thing that can fix the fact that my mandible is wider than my cheeks. How long would I have to wait after the Lefort I? I was guessing around 6 months?
Oh yeah, bout my username...don't worry about it, I was just feeling in a pretty bad way when I signed up. I have a pretty bad case of cyclothymic disorder, which for those who don't know, is like having a major depressive episode every few days. Then again, with this freakish face, it's hardly surprising.
To be honest, I'm hiding it from my surgeon... the last thing I need is to be refused treatment due to psychiatric factors.
If this is my palate, how much expansion do you believe would be required? Would 4mm be sufficient?
http://img709.imageshack.us/img709/784/img0157pz.jpg
(sorry for the terrible quality, it's an iphone camera)
The other thing is that I plan on having cheek implants after, since apparently that's the only thing that can fix the fact that my mandible is wider than my cheeks. How long would I have to wait after the Lefort I? I was guessing around 6 months?
Oh yeah, bout my username...don't worry about it, I was just feeling in a pretty bad way when I signed up. I have a pretty bad case of cyclothymic disorder, which for those who don't know, is like having a major depressive episode every few days. Then again, with this freakish face, it's hardly surprising.
To be honest, I'm hiding it from my surgeon... the last thing I need is to be refused treatment due to psychiatric factors.
Oh, that's tough about the cyclothymic disorder. I have to say that your upper arch looks really good in that pick. No crowding to my eye and I love the way it flares out nicely in the posterior direction. Look at my narrow, and comparitively wonky, upper arch in this pic: http://farm4.static.flickr.com/3099/311 ... 0a7d5d.jpg
I supose the thing you could always bear in mind is that the better the start point the even more impressive the end result. With an upper alignment as great as yours you should have a fantastic smile when finished.
By the way, if you don't mind me enquiring, are you male of female. The reason I ask is that it could have a bearing on the aesthetics of your mandible width. What may not look so good in a woman's face may be perfectly acceptable for a man, and vice versa.
I supose the thing you could always bear in mind is that the better the start point the even more impressive the end result. With an upper alignment as great as yours you should have a fantastic smile when finished.
By the way, if you don't mind me enquiring, are you male of female. The reason I ask is that it could have a bearing on the aesthetics of your mandible width. What may not look so good in a woman's face may be perfectly acceptable for a man, and vice versa.
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Neverloved
- Posts: 39
- Joined: Sun Oct 31, 2010 3:02 pm
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Neverloved
- Posts: 39
- Joined: Sun Oct 31, 2010 3:02 pm
Yeah, I guess it doesn't look that bad on its own. The problem is that the teeth (except incisors) on my lower arch are all bent slightly inward, from the brace treatment I had years ago, because the arch is wider than the upper arch... I suppose you could all it a pseudo-crossbite (or just an averted crossbite I guess).
The other issue is lip incompetence, which expansion is supposed to help, but I haven't a clue how.
As for the mandible thing, here's an example. Take a look at Brad Pitt, who isn't known for having high cheekbones:
http://climateprogress.org/wp-content/u ... d_pitt.jpg
Ignoring the fact that he doesn't have a hypoplastic gonion and that his face is generall square rather than long, his mandible is far wider than mine, yet if you notice, his zygomatic arch protrudes out further than his jaw. And like I said, he's not known for having particularly prominent cheekbones, and he has an enormous jaw.
My problem is that when I chew, you can literally see my jaw muscles moving next to my cheekbones, instead stopping at the cheekline. If that isn't a malar deficiency then I really don't know what is.
The other issue is lip incompetence, which expansion is supposed to help, but I haven't a clue how.
As for the mandible thing, here's an example. Take a look at Brad Pitt, who isn't known for having high cheekbones:
http://climateprogress.org/wp-content/u ... d_pitt.jpg
Ignoring the fact that he doesn't have a hypoplastic gonion and that his face is generall square rather than long, his mandible is far wider than mine, yet if you notice, his zygomatic arch protrudes out further than his jaw. And like I said, he's not known for having particularly prominent cheekbones, and he has an enormous jaw.
My problem is that when I chew, you can literally see my jaw muscles moving next to my cheekbones, instead stopping at the cheekline. If that isn't a malar deficiency then I really don't know what is.
You bring up a lot of things I'd like to comment on.
1) Expansion done with a LeFort is statistically the most unstable procedure - meaning, it is the one most subject to relapse (i.e., your expansion doesn't last long term). Don't quote me exactly, but I believe the success rate is 70% long term stability. That's pretty low for something that is an elective and invasive procedure.
2) How much is 3 to 4 mm? It sounds minuscule, but it can make a huge difference. I cannot answer how much expansion you need. I'm not an orthodontist or an oral surgeon. Leave stuff like this to the professionals. That being said, I would venture a guess that you need very little expansion, and perhaps none at all. It all depends how things will relate to the mandible as well (which, we can't see here). Nobody on here can replace the advice of an experienced professional.
3) LeFort II and LeFort III procedures are out of the question. These are not typical procedures for occlusion concerns! These words should be banned from this message board
4) I highly, highly recommend you deal with the psychological issues before you proceed with any treatment. I cannot possibly stress this point enough. This is true for anybody, but it is especially true for somebody that admittedly suffers from a mental disability. If there is one thing you take from this message board, please let it be this one. Lying to your surgeon is setting yourself up for a disaster.
Listen, I share a lot of similarities with you in how you're going about this. You're researching and self-diagnosing, and I have to tell you from experience that you better lay off. Otherwise, you're going to drive yourself crazy. I am not waxing poetic here...I'm speaking from experience. I'm not saying this to be mean - I am saying it because I don't want to see anybody else put themselves through mental anguish that is quite frankly unnecessary.
My advice is get your psychological concerns under control. Then, go visit 2 or 3 orthodontists and oral surgeons and approach their opinions with open minds and stop diagnosing yourself. Research your findings, and then make a decision.
I wish you the absolute best...
-Chicago29
1) Expansion done with a LeFort is statistically the most unstable procedure - meaning, it is the one most subject to relapse (i.e., your expansion doesn't last long term). Don't quote me exactly, but I believe the success rate is 70% long term stability. That's pretty low for something that is an elective and invasive procedure.
2) How much is 3 to 4 mm? It sounds minuscule, but it can make a huge difference. I cannot answer how much expansion you need. I'm not an orthodontist or an oral surgeon. Leave stuff like this to the professionals. That being said, I would venture a guess that you need very little expansion, and perhaps none at all. It all depends how things will relate to the mandible as well (which, we can't see here). Nobody on here can replace the advice of an experienced professional.
3) LeFort II and LeFort III procedures are out of the question. These are not typical procedures for occlusion concerns! These words should be banned from this message board
4) I highly, highly recommend you deal with the psychological issues before you proceed with any treatment. I cannot possibly stress this point enough. This is true for anybody, but it is especially true for somebody that admittedly suffers from a mental disability. If there is one thing you take from this message board, please let it be this one. Lying to your surgeon is setting yourself up for a disaster.
Listen, I share a lot of similarities with you in how you're going about this. You're researching and self-diagnosing, and I have to tell you from experience that you better lay off. Otherwise, you're going to drive yourself crazy. I am not waxing poetic here...I'm speaking from experience. I'm not saying this to be mean - I am saying it because I don't want to see anybody else put themselves through mental anguish that is quite frankly unnecessary.
My advice is get your psychological concerns under control. Then, go visit 2 or 3 orthodontists and oral surgeons and approach their opinions with open minds and stop diagnosing yourself. Research your findings, and then make a decision.
I wish you the absolute best...
-Chicago29
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Neverloved
- Posts: 39
- Joined: Sun Oct 31, 2010 3:02 pm
*sigh*
I know what you mean about psychological issues. The problem is that I honestly don't think it's going to get much better. This is the best I've been for a long time.
I'm currently on a ocean of citalopram, xanax, wellbutrin and abilify, and even my psych has admitted that short of putting me on lithium (which I refuse) or cycling me through antidepressants I've already been on (which he doubts will do any good at all), there's not much he can do to help. Cycothymia, at least in my case, seems to be chronic. I've come to terms with the fact that I'll probably never be rid of it entirely, and that I'd be wasting my life away by waiting.
If my case is relatively minor (no crossbite, 2mm open bite, relatively good occlusion to start with; the vertical excess and maxillary hypoplasia are the only major problems), is it possible that I could have it the lefort done within a year or so of now?
Can the SARPE be done after the lefort?
I know what you mean about psychological issues. The problem is that I honestly don't think it's going to get much better. This is the best I've been for a long time.
I'm currently on a ocean of citalopram, xanax, wellbutrin and abilify, and even my psych has admitted that short of putting me on lithium (which I refuse) or cycling me through antidepressants I've already been on (which he doubts will do any good at all), there's not much he can do to help. Cycothymia, at least in my case, seems to be chronic. I've come to terms with the fact that I'll probably never be rid of it entirely, and that I'd be wasting my life away by waiting.
If my case is relatively minor (no crossbite, 2mm open bite, relatively good occlusion to start with; the vertical excess and maxillary hypoplasia are the only major problems), is it possible that I could have it the lefort done within a year or so of now?
Can the SARPE be done after the lefort?
Well, SOMEBODY is going to find out about your issue, and you don't want it being the anesthesiologist the day of the surgery. I don't mean any offense (I have mental health issues in my family and I so absolutely feel for you), but those are some heavy meds and they're bound to raise questions.
The standard is SARPE then a standard LeFort, but the reality is there is no "normal". It depends what the surgeon feels is best.
Your case does sound relatively minor. And, if you could live with only having the "gummy smile" addressed (I assume this is what you have if you say maxillary excess), you can get that solved with a LeFort I. The open bite of 2 mm can almost certainly be addressed by the orthodontist.
You're going to need braces first though, so it comes down to whenever the surgeon feels your teeth are in the best position for surgery. From what I can see of your bite, that shouldn't take long at all.
Good Luck
Chicago29
The standard is SARPE then a standard LeFort, but the reality is there is no "normal". It depends what the surgeon feels is best.
Your case does sound relatively minor. And, if you could live with only having the "gummy smile" addressed (I assume this is what you have if you say maxillary excess), you can get that solved with a LeFort I. The open bite of 2 mm can almost certainly be addressed by the orthodontist.
You're going to need braces first though, so it comes down to whenever the surgeon feels your teeth are in the best position for surgery. From what I can see of your bite, that shouldn't take long at all.
Good Luck
Chicago29
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Neverloved
- Posts: 39
- Joined: Sun Oct 31, 2010 3:02 pm
