Stability Questions, LeFort I--Life with a delayed Union

Message

Tue Sep 25, 2007 10:18 pm

Phil, what, exactly, does this mean:

"He attributes the problems to post-operative torque on the Ramus which resulted from the attempted correction of asymmetry."

That the elastics turned your lower jaw in the wrong direction?

I'm glad you feel more confident about the treatment plan Team Phil has dramed up. It sounds like your self-advocacy helped train their attention on your errant mandible.

#122 Post by **dubnobass** » Tue Sep 25, 2007 11:54 pm

It's good that you have a few options. Hopefully one of them will work!!

You've got me curious now, though. By how much do your teeth/maxilla move, under pressure?

I ask only because I'm a night-time clencher and this morning, things felt a bit 'spongy'. If I push my upper front teeth with a thumb, they move up and down a bit

What I can't tell is if this is orthodontic wobbly teeth moving, or my maxilla..

Is it all the way round for you? Just at the front?

#123 Post by **SandraJones** » Wed Sep 26, 2007 6:54 am

I thought a splint was used with total IMF ?

Hey phil, I was just thinking this morning that even if you had total non-removable IMF, you could still teach. Your speech would be a bit muffled and you wouldn't be able to project well, but you could get a little microphone and amp setup and speak through that.

You could even do some special effects, like reverb.

#124 Post by **phil** » Wed Sep 26, 2007 8:57 am

I had impressions and a facebow (AGAIN!) this morning for my occlusal splint. It will be removable, and just fit over my upper teeth. All went very well--the assistant was EXTREMELY careful in taking the upper impressions.

#125 Post by **HighandLo** » Wed Sep 26, 2007 10:22 am

Hey Phil,

I'm glad to hear things went well. It sounds like a good idea your guys have this time. I know with my Essix retainer in, my teeth do feel all of a piece.

So, with your NEW plan, if you bite down on one side of your teeth, then the force is distributed across all your teeth. Less shock, more healing for you?! Here's hoping this is your answer!

Sending prayers, positive vibes and karma your way (or are they mutually exclusive?).

Lo

#126 Post by **WhiteLurcher** » Wed Sep 26, 2007 11:38 am

Glad to hear things are finally moving, hopefully literally, in the right direction for you at last.

Wishing you all the best!

#127 Post by **phil** » Wed Sep 26, 2007 1:51 pm

Lo, and Lurcher, thanks for the posts.

The idea behind the splint is that it will more evenly distribute the force from the mandible when I DO clench, and also prevent my incisors from having any contact at all, which has been putting torque on my maxilla.

It can be removed at will, and will be held in place with wire clasps on my 5s. My orthodontist says he wants me to wear it 24/7.

My fitting is Monday afternoon.

Thats all I know for now. Onward and upward!

#128 Post by **SandraJones** » Thu Sep 27, 2007 10:54 am

Hopefully you will feel all nice and comfy and stable in your splint ! And hopefully it will help you feel better psychologically too.

I can relate to this in a very minor way ... my increasingly misaligned teeth were bugging me for a long time, and when the braces were put on and I felt the pressure of the arch wire I felt like this burden was lifted from me, I knew that my teeth were no longer going to be getting further out of whack. When the archwire was removed I actually didn't like the feeling, and I'm actually fearing that at the end of my treatment I won't want my braces to be removed because the archwire is providing such comfort !

It's nice that you will be able to remove the splint when necessary. After the fitting I hope it's just a very short time before it's ready to go and you can start wearing it.

#129 Post by **phil** » Thu Sep 27, 2007 1:52 pm

SandraJones,

I should be able to wear it Monday when I get it! I'm looking forward to implementing some sort of plan that should help to set things right. Things aren't going to well right now!

#130 Post by **phil** » Thu Sep 27, 2007 2:07 pm

4beauty4symmetry, and dubnobass,

I just read back a bit today, and realized that I hadn't responded to some of your posts. So here goes:

"He attributes the problems to post-operative torque on the Ramus which resulted from the attempted correction of asymmetry."

When performing a BSSO with correction for asymmetry, the mandibular arch is rotated to make the correction. The ramus is still pointed in the same position (this explains why my right side sticks out a bit more than my left). When put back together, the bone is stretched a bit when screwed back together. Logically, a surgeon would over compensate a bit, understanding that the ramus (being a bigger, thicker, and thus stronger bone) would tend to pull the arch back from whence it came. Because of this torque when I was put back together, my midlines are now off by about a half a milimeter. One might surmise that in surgery, there was not quite enough compensation. I will not make that judgment call, leaving that to the professionals! "Dr. X's" recommendation was that this discrepency can certainly be corrected orthodontically, so as long as the mandible has healed (and we believe that it has), there is no reason to try to do anything about this minor problem surgically.

Based on questions I've read from people on AW, I would guess that most people don't understand this about corrections for asymmetry. I know I didn't, until "Dr. X" explained it! The dental arches become symmetrical, but that doesn't mean that the whole mandible is made symmetrical.

dubnobass, you might want to have that checked out. Mine move less than a milimeter, but it is visible, and I can really FEEL it.

#131 Post by **dubnobass** » Thu Sep 27, 2007 2:17 pm

phil wrote:dubnobass, you might want to have that checked out. Mine move less than a milimeter, but it is visible, and I can really FEEL it.

Well it's off to the jolly ol' orthodontist on Monday for me, so I will ask them al aboutit then. Maybe you'll find yourself with a IMF/re-op buddy

#132 Post by **phil** » Mon Oct 01, 2007 3:05 pm

Hello, all!

I'm just back home from the orthodontist. I have a hunk of acrylic in the roof of my mouth. I think it's going to help--things feel different when I bite on it, so I don't think clenching will be as much of a factor in delaying my healing now. In the words of my orthodontist, "we just wanted to remove this factor from the equation." He told me that I need to wear it at night, and when I'm stressed. When I said that to the assistant, she said, "so, when are you stressed?" I laughed and said all the time right now. I guess that means I'll be wearing it 24/7! Seriously, there is no way I can teach in this silly thing. It would make things extremely entertaining for the children.

Now, speaking of math, the days are ticking away, and on my next visit, the OD wants to take a CT scan of my maxilla, to see where I have union and where I don't (why haven't they thought of this before???). He also said that the post-surgical window for benefit from elastics is six months, and we are at three, so we don't have much time left to get me healed before he can start working on getting my bite back together. He also said the words I didn't want to hear today. Yes, he agrees that all of my relapse (at this point about 2 mm) has been maxillary. Nobody's willing to venture a guess as to why (either that, or nobody wants to claim culpability). If it doesn't move any more than it has (I am hoping this is the case), no further surgery will be necessary. If the relapse worsens, they'll have to reoperate. Please pray that things at least STAY PUT for now!

Here's a picture so that you can all see my new toy:

That's all for now.

Phil

#133 Post by **phil** » Tue Oct 02, 2007 6:04 pm

Well, I made it through day one of the splint. Even with teaching, I kept it in all day, except to eat. I did amazingly well with my speech. I did get a little tired by the end of the day, but all in all, I think I will adjust well. Let's hope that it HELPS ME HEAL!!!

#134 Post by **HighandLo** » Wed Oct 03, 2007 11:59 am

Wow, Phil, that's great! I can't believe you can wear it all day. I have enough trouble remembering my retainer

. You must be really motivated

.

And your latest picture shows a very nice bite! I certainly hope nothing moves in the wrong direction, so that you won't need further surgery.

Take it easy. It's almost Friday....

Lo

#135 Post by **SandraJones** » Wed Oct 03, 2007 1:16 pm

Hey phil, that splint looks really cool. I hope you feel nice and comfy in it. I couldn't even see it until I enlarged the photo.

Btw, your teeth and bite look great !