Metal Mouth Message Board

Hello,

I am new to this board, but thought I would make an account in order to get some advice regarding these two particular lower jaw procedures. I have visited several surgeons and orthodontists, and there has been differing opinions over which procedure to get.

The Intraoral Vertical Ramus Osteotomy (IVRO) originally caught my eye because of it's decreased chance of nerve impairment. However, after reflection I did not really like the idea of a) my ramus being completely split (which seems very intrusive) and b) the ridge that would form from the two segments of bone being stacked on each other. Also, being wired shut for 6 weeks seems like quite an intimidating concept. My main concern is I want to be able to feel that my post operative jaw has a natural feeling (if I were to feel it with my hand) and look, and the ridge at the site of operation really bothers me.

Now I am tending towards the Bilateral Sagittal Split Ramus Osteotomy (BSSRO - you guys know these acronyms anyways, just thought Id include them to be thorough). It seems like for the most part this procedure is less invasive and it seems as far as my own judgement is concerned, somehow more controlled and predictable (the result) as visibility and the region of the mouth they access is far easier to view than in the IVRO. To put it simply, a BSSRO seems to me alot less ominous than an IVRO, and it avoids the jaw ridge that kinda bothers me. Of course, this method the nerve is at direct risk, but it seems like the majority of patients under 30 have very few nerve issues long term, and for those that do, it is typically a small patch on the chin etc.

So I guess I just wanted to get some opinions on these two procedures directed at people that have had one or the other and their experiences with them, as well as maybe some words of wisdom your surgeons disclosed regarding the two procedures.

For anyone who takes the time to provide some input, I will be phenomenally grateful :]!

Best,

Sean

Sean,

I just had IVRO done to correct underbite 3 days ago. As you've noted, there are pro and cons to IVRO and BSSO. I think it comes down to the individual. First, my number 1 concern was not to trade solving my TMJ issues with potential permanent nerve damage. Some people can live with "some" numbness, some can't. And who can guarantee how much and where numbness is? My surgeon couldn't. That said, he said in my case, I could choose either and my underbite can be corrected. Yes, my face would be more "squarish", but give my face shape, the added angle wouldn't be unattractive and would be okay. So, if esthethics is a concern for you, you need to ask your surgeon, given your face shape, would the added angle be okay for you?

My recovery has been going okay. Within hours of surgery, I was able to drink with cup, with my jaws banded shut. This is because I didn't lose any feelings of my mouth, lips or chin. I don't know the final facial result, of course. But my surgeon said, if the angle of the face bother me too much, I can get it taken care of in his office. I assume, he can do some bone "shaving" to round things out a bit.

I think in any procedure, it is down to the individual. Their preferences and what they can live with. I hope you can gather enough info for your own case. There is no right or wrong way to do this, I think. I wish you the best of luck. I know I am glad I am on the other side and on the road to recovery.

Jan

Hey Jan thanks for your reply,

First off, congratulations on a successful surgery, it must be thrilling to be on the other side of it! :] I have no doubt the aesthetic and functional results will be amazing, and I am so glad that the IVRO has effectively circumvented any nerve issues.

Originally, I was determined to have IVRO, but lately I have been considering the BSSRO. Somehow, albeit my knowledge is limited, the IVRO seems like a more invasive surgery as they must access the farthest reaches of your jaw, and completely split your ramus. Despite removing a section of bone, the BSSRO seems less extreme. Of course its proximity to the IAN is distressing.

The main thing that made me question my own preference of the IVRO is the way the bone is layered on top of each other. I am unable to post an image, but a basic google image search kinda shows the way the bone heals.

It seems as if you were to feel along your jaw line there would be a sort of depression/ridge in which the bone was layered. I guess in time the bone mends into a solid piece, but would it still not feel kind of thick or stacked? I'm wondering if your surgeon mentioned anything regarding the bone mending?

Thanks again for your response, and congratulations on being on the other side :]

Sean,

Regarding "ridge", after 5-6 months, the bone would "smoothen" to some degree. My surgeon said, after swelling goes down and bones are healed, I could opt to have the bone "shaven" or rounded out during a in office visit. Not at all a difficult thing to do.

I really think IVRO is no more extreme of surgery than BSSRO. A cut is a cut. Actually, with IVRO, the cuts are made inside. With BSSRO, there are small cuts through outside. Given how much nerve damage that one may avoid using IVRO, it is worth considering. Again with each case and person, there is no guarantee of how much or location of nerve damage. All one can do to consider all options and make the decision that you can live with. I know it is hard with so many things to consider, but you'll make the right decision for yourself.

Good luck to you.

Jan