Relapse.. how would you know?

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#1 Post by **dubnobass** » Fri Sep 14, 2007 4:35 am

I'm really curious about the idea of post-surgical relapse, and how/why this occurs. Does anyone know much about the topic?

I know stability depends on the type of movement, in which case my maxillary impaction and 10mm mandibular advancement should be 'stable'.. but I also had correction of assymetry ('unstable'). I'm just curious as to how you would know you had relapsed, what sort of timescale this occurs on.. whether it's skeletal resorption or muscular..

I don't think I have relapsed, but I can't be sure. I was quite shocked post-surgery at how far forward my lower teeth were - they seem to be virtually touching my upper teeth, and now this does not seem as obvious, though the upper teeth look as though they're resting on the tops of the lower brackets. I don't know if this is because I have got used to it, or because the lower jaw has moved back by half a mm or so. I also don't know if they deliberately overmove the jaw to allow for a little bit of relapse.

Anyone got any good references?

#2 Post by **SandraJones** » Fri Sep 14, 2007 7:38 am

I'm sorry I can't post any links, but I did see a lot of info about relapse on the 'net. I think if you search on your type of surgery with the word "relapse" you will find a lot. Or "othognathic" and "relapse".

I did read that there can be relapse, and that the surgeons can take that into account. I read that the relapse was worse when, a long time ago, they did not completely detach the bones during the surgery.

I had my LeFort I posterior impaction 26 years ago to correct an anterior open bite big enough to shove the tip of my tongue through, and I have had minimal relapse all of this time. I did not have braces at the time of my surgery so after the surgery that was it, there was no more attempt to close my bite further (which is what the surgeon wanted to do) ... but look at my avatar and you will see that I have retained a closed bite although not ideal.

If I come across relapse info again, I will post links !

#3 Post by **Karigan** » Fri Sep 14, 2007 9:23 am

I have had a relapse. I had a bad Class III maloclussion and had a Le Fort I bimaxillary osteotomy including a mandiular sagittal split and genioplasty with bone grafts in 1990. Within a year of the op my jaw position started to move and now it is well out of position although nothing as bad as before the operation. They wanted to do more surgery to fix it and talked of removing part of the tongue and so forth but I never bothered with any more. If you are relapsing badly enough for it to effect your bite you will know. Within 5 years post op mine had moved significantly. Why it moved I have no idea. I am going to ask the OS next week about how they would fix it these days although I don't know if I'd go through with the op or not.

#4 Post by **john21** » Fri Sep 14, 2007 11:57 am

Karigan,did u have screws in your jaw to hold it?when you saw that it relapses,didnt you asked your surgeon why?

#5 Post by **Karigan** » Fri Sep 14, 2007 12:44 pm

I assume I had screws put in to hold it, I've just recently had the last maxilla plate removed due to infection 18 years down the line! I think I still have some fixations in the mandible and at the joints. Unfortunately when I had mine done all those years ago they never told you anything, for example, there was no mention back then about numbness or anything like that. I find it is still difficult to get straight answers! However back then it was near impossible!

I did ask why it started to move but never got definite answers. I got varying sort of assumptions, one that it might be the extent of the shift, also that my tongue was pushing the teeth out, I felt after the op that my mouth felt to small for my tongue! Thus they suggested removing part of the tongue but that was a no no for me. Another suggestion was that I was still growing when they did it. I really don't know why but now being much older I want answers to these questions and I'm going to ask them next week.

The result is that the lower teeth are pushed forward and the mandible has come slightly back out but over to the left! It is noticeable if I smile but not otherwise and as I said compared to pre-op it is still an improvement. I attended for post op checks for 10 years and then when I said no to further surgery they decided I didn't need to go back. I hadn't been back since until this year when this last plate had to come out.

#6 Post by **phil** » Fri Sep 14, 2007 2:37 pm

Karigan,

How old were you in 1990? If you had not stopped growing by then, it is quite possible that your relapse was caused by mandibular growth.

My mandible has shifted out post-operatively, but it is because I had to discontinue elastics temporarily, due to a maxillary delayed union. My orthodontist assures me that the mandible will go back where it belongs when I go back to elastics.

#7 Post by **SandraJones** » Fri Sep 14, 2007 3:42 pm

There's some info about relapse in that complications section of the Peterson book Phil posted a link to in another thread. I got 10 hits on the word during a search.

http://dentistry.tums.ac.ir/Files/lib/M ... s/ch60.pdf

For mandible in particular, they mention among other possible causes "pushing the proximal fragment back during surgery".

A PubMed summary mentioned proximal segment as a factor in relapse: Seventeen cases of mandibular advancement surgery were evaluated for skeletal relapse; 12 included long-term evaluation. Inferior movement of the proximal segment with displacement of the condyle occurred at the time of surgery or in the immediate postoperative period. This movement was closely associated with subsequent skeletal relapse of the distal segment. This may represent a cause-and-effect relationship mediated through the soft tissue attachments of periosteum and muscle that are stretched at the time of surgery.

#8 Post by **Karigan** » Fri Sep 14, 2007 3:51 pm

Phil, I was just 17 when they did it, I wanted it done then as I had just finished school, I was desperate for it to be done!!! I think I maybe hadn't quite stopped growing so you could be right. It will need braces and surgery to correct it now.

Sandra, thanks I have read that article too. The internet allows you to research it nowadays which is good, whereas back then when you and I had it done it was not so easy to find these things out!

#9 Post by **phil** » Fri Sep 14, 2007 6:07 pm

Karigan,

I had a colleague who had surgery for open bite at about that age, and the same exact thing happened to her--the bite changed post-op, becuase the bones continued to grow.

If you are a true prognathic (mandible grew too much, instead of maxillary deficiency), that could very well be the case. It was for me--my profile REALLY changed between 18 and 25, although I think girls mature earlier than boys.

#10 Post by **Karigan** » Sat Sep 15, 2007 2:52 am

Phil, yes I was a prognathic, my lower jaw was very far forward. I could get fingers in between my jaws and underneath the top teeth into my mouth with my jaws 'together'!

Once the braces were removed the teeth alignment started to move very quickly and then the jaw position started to move within a year I'd say. I never had elastics on apart from for a few weeks after they unwired me, then nothing at all and the braces came off about a year/ 8 months post op.

As I say it has moved in an odd way, kind of out and to the side. I think it is largely due to the bones still growing afterwards and the muscles shifting as it was such a big change all in one go. I wonder if I got another op now to fix it would it relapse again? I am going to ask the OS this next week.

#11 Post by **phil** » Sat Sep 15, 2007 7:17 am

Karigan,

First of all, DISCLAIMER...I am not a professional (put I am a prognathic!).

If you had that genetic predisposition, it would make sense that perhaps you were a little too young for the surgery, and your mandible continued to grow for the next few years.

As I said before, a LOT of my mandibular growth occurred when I went to college--looking back at my high school pictures, my profile was much less distorted then.

Even though females mature earlier than males, I think it's quite possible that your problems came from a surgery done too soon, and continued mandibular growth.

Just my two cents!

Sat Sep 15, 2007 8:38 am

I think we've solved the mystery behind your relapse: premature surgery.

My underbite/openbite is such that I can stick my tongue out between my upper and lower set of teeth even when they are closed.

But I was not able to do this until the summer before I turned 21, when I had a growth spurt. At the time I thot it had something to do with wisdom teeth. NOT!

#13 Post by **Karigan** » Sat Sep 15, 2007 9:50 am

Yes, should probably have waited. It was such a long time ago. I guess these days they would make me wait longer. Still it can't be helped now and despite the relapse it is still much much better than it was before the op. Still I'm going to find out what they would do now to re correct it.

#14 Post by **john21** » Sat Sep 15, 2007 12:52 pm

1,5 years ago i send e-mail to an orthodontist who is very known here in greece...he said that the lower jaw can grow until late twenties...i am 22 and i can say that my jaw was not so protruding when i was 18.and that one of the goals of surgery is to avoid the growth.interesting...

#15 Post by **SandraJones** » Sat Sep 15, 2007 6:41 pm

Meryaten, that's a fabulous article ! Thanks for posting it !