Nonunion of the maxillary - I'm desperate :-(

[Raindrop]

I've had impaction of the maxillary 4 month ago and it was the worst mistake of my like.

Not only that I hate the face this surgery gave me (nose broadened a lot, upper lip got thinner, you can't see enough of my upper teeth when I talk or smile) I now have a serious medical problem called nonunion or malunion, which basically means that the bone did not heal properly and my jaw jiggles (upper jaw mobility). Apparently it is a very rare complication, especially with impactions - but I have it.

I'm desperate and in the process of searching for a surgeon who can fix it, as I don't want to go back to the surgeon who did the initial surgery. My surgeon told me I need another operation where they would change my plates and screws. I don't trust him to do it, I don't trust him at all.

I'm scared and don't know what would be the right approach. I also wonder if something could be done about my nose and lips, since they would be affected by a revision as well. I hate my lack of tooth show but I guess with my problem of nonunion a down grafting is out of question.

I would appreciate any advise or experiences anyone would have. It would be great to exchange any experiences - I feel so isolated at the moment.

[snapdresser]

A number of folks on here have experienced a non-union. Often times it seems that the bone broke during/shortly after the surgery contributing to it. You should take comfort knowing that follow-up corrective surgeries have a high success rate. If they want to use a graft anyways, you may be in luck and get an opportune time to slightly down-graft your maxilla. May I ask what about your surgeon makes you distrustful of them? Is it the non-union and over impaction alone or is there something else about them? Were they willing to hear out your complaints? A surprising number of patients on here are ignored or talked over when they try to voice concerns to their surgeon. Hopefully yours is better than that! Good luck and keep us posted as things develop!

[Raindrop]

I saw a different surgeon today and his opinion is that I should wait another 3 month, because the bone will most likely heal itself (soft food diet, no elastics, take calcium supplements). He made it seem like the jiggling is no big deal.

I'm quite confused, as this is the total opposite of what the surgeon that did my operation told me (he said I definitely need revision surgery as otherwise the bone won't heal). From the information I get online it also seems that non-unions usually require revision surgery (I'm 4 month post-op!)

I distrust my surgeon because he never took my concerns seriously. He seems to be more concerned about defending himself than my wellbeing. Or simply cuts me off and leaves without giving any answers (Example from last week: Me: "I have pain in my jaw joint", Surgeon: "Yes, that's possible.I have another appointment now. Think about if you want the revision surgery or not." Then he left. Sadly really happened that way...). Plus in the pre-operation discussion he never mentioned that my nose and lips could change. He did exactly the opposite - told me that apart from my jaw my face wouldn't change and that I would still have a slight gummy smile after surgery as he wouldn't be able to correct it 100%. (let's just say it that way - I don't have a gummy smile anymore...)

I will see another surgeon on Friday, and yet another one next week. Will be interesting to hear what they have to say. It seems like if you ask 3 surgeons you get 4 opinions
A different problem seems to be that all of these surgeons know each other and no one wants to talk bad about a colleague (which was quite obvious today). So I question if anyone is even willing to help me... (vibe of today's appointment was: your surgeon did everything right, jiggling is not a big deal, go back to your surgeon...)

[snapdresser]

I think you’re making a good call seeing some other surgeons besides those two. I’m a bit surprised to hear that second surgeon’s suggestion that it will ossify nicely after 16 weeks.

[Raindrop]

This is getting more and more confusing....

To sum it up I had appointments with 4 maxillofacial surgeons and each one has a different opinion about my non-union:
- Surgeon A that did my operation wants to change the plates immediately as the bone otherwise won't heal
- Surgeon B says to wait another 3 month and the bone will heal 100%
- Surgeon C says to wait another 6 month. He is not sure if the bone will heal or not, but if it won't heal he wants to do a bone graft
- Surgeon D says the reason for the non-union is that my lower front teeth bite on my upper front teeth which causes trauma (as I probably also press the teeth together at night). If my orthodontist fixes this (and I get bite blocks in the meantime) the bone should heal in the next 3 weeks.

By the way I mentioned the problem with my bite to ALL of the other surgeons and also my orthodontist multiple times, but they all tried to convince me that my bite is fine? Although I definitely feel that it's off and I do have pain in my upper front teeth.

I guess I'll go with the opinion of surgeon D for now and try to convince my orthodontist that there is indeed a problem with my bite.

Would be interesting if anyone could fix their non-union that way, without another surgery? Honestly I haven't heard of it, but who knows.

I'm just so baffled about how different these opinions are? Is this just incompetence or is it really that hard???

[snapdresser]

Well, the hardware is there to fix the bone in a certain position. It shouldn’t matter if the teeth are hitting each other, as the hardware should be keeping the bones rigidly fixed in position regardless. For some reason your hardware is not keeping the bone rigidly fixed. It’s allowing some movement that’s preventing ossification. I think that’s usually caused by the bone cracking around some of the screws during surgery or shortly thereafter. If that’s the case, there’s 2 approaches: get the bone to stay in place long enough for ossification (perhaps via orthodontic work so your teeth don’t hit), or replace the cracked bone via a graft so that the hardware stays fixed. Otherwise, as long as your teeth are continuing to hit, it’s hard to imagine the bone ossifying by itself after this amount of time. The normal time for bone to ossify is about 12 weeks.

[jawbreakermtl]

Hi raindrop, first of all I am so sorry you are going through this. Especially since you weren’t made aware by your surgeon of the risks and aesthetic consequences, I can imagine this has been very upsetting.
Based on what the 4 surgeons said, I would urge you to wait until 6 months post op to make any decisions. Keep eating soft foods, take care of your body, make sure your ortho is in the loop. Also, please don’t go back to your original surgeon.
Do you know if the surgeon who presented the downgraft option said this would improve your lack of tooth show? In the end, that can definitely work in your favour.