Metal Mouth Message Board

Hi all,

I'm due to see my surgeon on 2nd Nov after braces for 18 months and have been compiling a list of questions I need to ask. I'm due to have Lefort 1, BSSO and genio to treat an open bite and long face. I did see a surgeon before I got braces, but that was a different one to the one who'll be operating on me and it was so long ago and at a different hospital that I feel I need to start all over with even the basic questions, just for my own peace of mind. Questions I have so far are:

1. What outcomes can I expect? I'm hoping for a perfect bite (though possibly after more tweaking at the orthos), cured lip incompetence, a shorter face and an end to my gummy smile. Does that sound realistic?

2. If my top jaw is impacted, will I end up with saggy skin around my jowls?

3. If my chin is shortened, will the ratio from under nose to lips and lips to bottom of chin look odd?

4. What are the chances of my nose getting wider?

5. What is the likelihood of nerve damage?

6. What is the long-term stability?

7. Any other risks? Could I develop TMD?

8. What exactly is a splint?

9. Chances of being wired shut vs elastics? Will I be eating through a syringe, straw or a spoon?

10. How long should I arrange childcare for?

11. What if I don't have surgery? Will my teeth just go back to their old positions? Will they wear out?

Does all that sound like too many questions? It's NHS so your appointment time is limited, to say the least, and your chances of getting hold of anyone to answer questions you think of after you leave are pretty remote. Or are there other questions I need to be asking? It's taken almost three years to get to this stage and I just need to be sure I'm not about to make some almighty decision that I'll end up regretting.

And of course if anyone who's already been there, done that, bought the T-shirt has any answers, please let me know! Thanks a lot.

I think you're being very thorough which is great. I had an upper and lower jaw surgery around 2 yrs ago, and asked my surgeon a few of these questions. Here are the answers he gave me:

5. there was a 10% chance that I would lose all feeling in my lower jaw due to nerve damage. it is still kind of numb, but I do have some feeling here.
6. results for new jaw position are permanent as per my surgeon

Hope this helps

I thought of something else you may want to ask him. If the implants (plates and screws) that will hold your jaw in place, can cause bone loss if kept there permanently. I would definitely be interested to hear what he would have to say.

This is a great list of questions, almost identical to my own. I'm also having NHS surgery at East Grinstead but the waiting list to see the surgeon is february. My consultant is going to try to get them to 'pop in' to my next tightening to try and speed up the process, so i think my question time will be limited. So do you think you could post the answers that you are given by the surgeon? Thanks!

Yikes - hadn't heard of the bone loss issue. I've heard that other people have had the plates removed, but never really understood why. And yes, I'll happily report the answers back, assuming that I get them...! I have a really bad habit of thinking I've got all the info I need, then realising too late that I didn't ask something or fell into a kind of hypnotic 'yes doctor', 'no doctor' mentality and not actually absorbed any of the information I was given. I'm taking my husband to the meeting as he's a lawyer and so he's good at remembering what people have said and retaining facts! Even thinking about the meeting is bringing me out in a cold sweat. How on earth am I going to cope when the day of the surgery itself draws near...? Perhaps that's another question to ask the surgeon!

So the answers are:

1: The surgeon seems confident he'll fulfil my wishlist - the moulds look as though occlusion will be good immediately post-op, but obviously they'll assess again a few days after I've come out of surgery to see if they need to wire my mouth; my smile isn't that gummy and has never bothered me, but the surgeon says if he's going to move my upper jaw he may as well take a few mm off it and bring my smile closer to the norm; lip incompetence should be much better, though it's kind of hard to tell when braces are still on what the final result will be; and yes (hallelujah!!!) my face will definitely be shorter as he is definitely going to do genio as part of the op.

2: There won't be enough excess skin for it to sag as impaction will probably only be about 5mm.

3: Forgot to ask about this - to be honest my chin is so long I don't think I even care about this 'ideal' any more.

4: He can take measures to stop my nose changing, but it's narrow to start with so no need to worry on that account. He seems to think it won't tip up at the end, which is good because it already tips up more than most people's.

5: Nerve damage does occur in about 10% of patients, though it's very mild for the vast majority of them.

6: Long term stability is good, provided you do as you're told re retainers.

7: Darn - forgot this one too!!

8: Turns out splint and wafer are the same thing - thin bit of plastic that'll be hooked on the brace and sit between the upper and lower teeth. Still can't quite get my head round how it all fits in but guess it'll become clear.

9: Being wired shut didn't sound likely, but you just never know...

10: He recommended six weeks off work, which is a lot longer than I'd anticipated. He seemed to think that most patients have a dramatic improvement once the first fortnight has passed, so I think I'll give myself that long as see how it goes - can't keep the kids at my mum's and off school for six whole weeks!

11: Basically, without surgery teeth will return to their old positions. He told me that lots of patients are duped into thinking at this stage that their teeth are fine now they've had braces, then get a nasty realisation a few months later that all their time and effort has been wasted and they should have had surgery.

So now I have to try not to think about it until next year, when I have a mass of appts for yet more photos, moulds, measurements etc, and then the big day is 23rd Jan. At least it'll be good weather for soup!

Thanks for sharing this info! Are you excited for your surgery?

Mr November - I forgot to say yesterday, my surgeon says plates nearly always stay in place and it's very rare that there should be a need to remove them.

I'm not sure I'd say I'm excited about the surgery... I'll definitely be glad when it's all over. It's not that I mind all the time-consuming appointments and hassle of braces, it's more psychological than that. After years of feeling miserable about my long face (or increased anterior height, as the professionals so kindly phrase it!) I kind of feel like the surgery will enable me to feel more positive and improve my confidence. That sounds a bit contradictory, because in a way I think we're all a lot more confident than we take credit for because we've all been brave enough to get braces as adults and mark ourselves out as 'different'. But this still feels like a transitionary stage for me and while I'm under no illusions that I'll come round from the anaesthetic a whole new person, surely something this major will have an impact on a person's state of mind in the future? What were you treated for, and did the surgery have more than just a physical result for you?

I've read that in North America, almost everyone keeps the plates, but in Europe almost everyone removes them. I think I am leaning towards having mine removed.

I know exactly what you mean about feeling like you're in a transitional stage.. The main objective of my surgery was to lower the right side of my upper and lower jaw to match the left side (to improve symmetry). But the result of the surgery definitely fell short of what I hoped it would achieve. I think (hope) that I did get some benefit from it, after investing so much time and money! At some point I will get a hold of the images from my original CT scan and do a proper comparison.

I have no doubt that your surgery will have a positive effect on your well being. Whatever benefit I got from mine did make me feel somewhat better, and by the sounds of it your surgery will produce a more drastic change than mine.

Also, I didn't need braces to have the surgery. I had these things called ortho tads screwed into my gums to hook the elastics onto after the surgery.

Anyway, I look forward to hearing how your surgery goes. Keep us posted!

sorry, I meant I had the ortho tads put in before the surgery..

Regarding #11, you're saying that even if you wear your retainer, the teeth will go back? What would be the point of ever getting braces if that were true?