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General Category => Emotional Support => Topic started by: elysium87 on May 06, 2014, 11:22:24 AM

Title: Double Jaw Surgery Relapse
Post by: elysium87 on May 06, 2014, 11:22:24 AM
I had double jaw surgery in September 2009. My bottom jaw was moved backwards 6mm and the top jaw was moved forwards 3mm. The result was fantastic. Fast forward 5 years and my bite has now almost completely relapsed to the pre op state (well not entirely). I am now in a situation where my top teeth clash directly on the bottom teeth. I am feeling upset, angry and down about how this has happened to me. I feel that I wore braces for 4 years, attended yearly maxillofacial clinics on an annual basis, all the effort and dedication for nothing. To be exactly in the same position as I was before all of this started.

The thing is, I was not made aware of the risk of relapse at any point during the decade for which I was admitted to the maxillofacial clinic. Not one time. It was never mentioned to me that this could happen. In the last few months I have been doing some basic research and it seems that relapse is a fairly common issue. I am therefore posting on these forums to attempt to ascertain the long term prognosis of these procedures by engaging fellow members who have had the same or similar surgeries.

I am currently awaiting a review appointment at the hospital where I had the surgery, by the surgeon who performed the procedure. Have other members experienced such relapses? My top retainer no longer fits so I can say that my teeth have moved some what, although the bottom retainer fits pretty good. I understand that you can get either surgical or orthodontic relapses, there is always an outside chance that my teeth have moved and not my jaws, but only an Xray can confirm this. I plan to have Xrays taken and compared to my post op x rays taken soon after the procedure. This is the only conclusive way to confirm the position of the jaws and see if this has differed.
Title: Re: Double Jaw Surgery Relapse
Post by: nrelax11 on May 06, 2014, 11:48:16 AM
Sorry to hear about this :/ I didnt know your jaws could relapse that long after.  This is one of my main concerns now after my surgery. Someone with more knowledge on this can help you more, but I cant believe they didnt warn you of the possibility of relapse.
Title: Re: Double Jaw Surgery Relapse
Post by: pekay on May 06, 2014, 01:46:45 PM
Are you male or female? How old were you when you had the surgery?

Class 3 patients (especially females) should wait til their mid 20s (23-24) to have surgery

Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 06, 2014, 01:56:00 PM
Are you male or female? How old were you when you had the surgery?

Class 3 patients (especially females) should wait til their mid 20s (23-24) to have surgery

I am a male, I was 22.5 at time of surgery.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 07, 2014, 09:47:21 AM
So, are there any other people with similar stories?
Title: Re: Double Jaw Surgery Relapse
Post by: treevernal on May 08, 2014, 12:54:20 PM
My surgeon is so concerned about relapse and my joints that im still in braces nearly 1.5 years after surgery.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 08, 2014, 01:35:08 PM
My surgeon is so concerned about relapse and my joints that im still in braces nearly 1.5 years after surgery.

How do braces prevent the jaws moving? I understand that they may prevent orthodentic relapse. I was in braces for 3 years prior to surgery and one year after, so 4 years in total.
Title: Re: Double Jaw Surgery Relapse
Post by: treevernal on May 08, 2014, 01:49:00 PM
With the braces on im able to wear bands that hold the teeth together at night.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 08, 2014, 01:53:55 PM
With the braces on im able to wear bands that hold the teeth together at night.

Ahh I see, I did wear bands but only for a few months after operation. I was told that these were only required to hold things in position whilst bones healed.
Title: Re: Double Jaw Surgery Relapse
Post by: treevernal on May 08, 2014, 03:00:37 PM
That is true.  In my case though, if the lower jaw starts to "slip" back extra bands can provide bite-reinforcement while the tmjs stabilize.  For some reason my joints have taken longer than average to stabilize but so far no relapse which is good.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 08, 2014, 03:45:25 PM
That is true.  In my case though, if the lower jaw starts to "slip" back extra bands can provide bite-reinforcement while the tmjs stabilize.  For some reason my joints have taken longer than average to stabilize but so far no relapse which is good.

Ah ok, so you had a class 2 ?
Title: Re: Double Jaw Surgery Relapse
Post by: treevernal on May 08, 2014, 05:26:27 PM
Yeah, and a narrow palate with open bite.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 09, 2014, 11:27:55 AM
Is it possible that my teeth moving could cause my top and bottom teeth to bite on top of one another? Or does this imply jaws moved?
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 16, 2014, 03:37:06 PM
Here is a pic of my bite immediately after surgery and my bite as of now.

[attachment deleted by admin]
Title: Re: Double Jaw Surgery Relapse
Post by: pekay on May 16, 2014, 04:04:50 PM
Wow that is an obvious relapse :(

Did you wear your retainer religiously for the first year? I'm talking about 15 hours+ per day.
Title: Re: Double Jaw Surgery Relapse
Post by: PloskoPlus on May 16, 2014, 04:15:17 PM
The lower jaw could have simply grown more again after the surgery.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 16, 2014, 09:57:12 PM
Wow that is an obvious relapse :(

Did you wear your retainer religiously for the first year? I'm talking about 15 hours+ per day.

I wore my fixed braces for 12 months after surgery then retainers full time for 3 months and then part time for a couple of years....
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 16, 2014, 10:03:22 PM
The lower jaw could have simply grown more again after the surgery.

I was 22.5 at time of surgery so I think it is unlikely to have grown more but more of a case that the muscular forces have pulled the jaw forward a touch. Discrepancy between top and bottom was about 10mm before op. Top jaw was moved forward 3.5mm and upwards 2mm whilst bottom jaw was moved back 6.5mm on one side and 5.5 mm on the other.
Title: Re: Double Jaw Surgery Relapse
Post by: PloskoPlus on May 17, 2014, 12:32:24 AM
I was 22.5 at time of surgery so I think it is unlikely to have grown more but more of a case that the muscular forces have pulled the jaw forward a touch. Discrepancy between top and bottom was about 10mm before op. Top jaw was moved forward 3.5mm and upwards 2mm whilst bottom jaw was moved back 6.5mm on one side and 5.5 mm on the other.

Hmm, AFAIK, usually in Class III cases they try move the top jaw more than the bottom.  But every case is different, of course.  And if the discrepancy pre-op was 10 mm and the total movement was 10 mm, you should have ended up with an edge-to-edge bite immediately post-op.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 17, 2014, 10:16:05 AM
Hmm, AFAIK, usually in Class III cases they try move the top jaw more than the bottom.  But every case is different, of course.  And if the discrepancy pre-op was 10 mm and the total movement was 10 mm, you should have ended up with an edge-to-edge bite immediately post-op.

Sorry I was not very clear in what I wrote. I actually meant that the total combined movement was 10mm, I am not sure what the discrepancy itself was but you can tell at those movements, it was certainly significant. Please do not get me wrong, my profile has changed drastically, my chin no longer looks like I am sticking my tongue behind my bottom lip....I have a normal exterior look, but my bite has moved. I have to say if the jaws have moved, I believe it cannot be more than a couple of mm. I am not so sure that they would have been able to move my top jaw forward more than the bottom jaw was moved back, my bottom jaw was very "overgrown" it would not have looked right unless they moved it back a rather drastic amount. I am seeing my surgeon in the upcoming weeks and without x-rays all of this is pure speculation.

Unfortunately, the harsh reality is that us individuals who were not blessed with good bites / profiles need to understand that this is dynamic tissue we are dealing with. Our bodies will always have this tendency to attempt to revert back in to their original position. I do question the  impact of such surgeries when clearly there is an issue with long term stability of these operations. The same muscular-skeletal forces which caused these deformities to occur during growth periods, are clearly still present. I had always assumed that my jaws had not "grown correctly" but perhaps the real answer is to do with the muscles which surround these bones.

I await the result of any X-rays which I assume my surgeon will send me for, I do hope that this is the maximum extent of the relapse but honestly, who knows. I was not informed at any point prior to my operation about the risk of relapse but I sure as hell know a lot about it now.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 24, 2014, 11:21:08 AM
OK so, I have had my review appointment with the surgeon. He did not seem too concerned. We took an Xray and it did not show bone resportion which is a common cause and occurrence from these procedures. He said that often when a relapse occurs you see "funny things" going on at the jaw joints. Such as shortening of the height of the jaw and causing wonkiness and a shortened appearance. None of this occurred to me. My Xray was completely clear of this. He says that if my jaws have moved, it is by such a small amount that he cannot actually see it on the Xray. However, the orthodontist came in to the room for a few minutes to take a look at me. He says that he cannot correct my bite fully without another Bimax surgery involving removing the upper premolars, moving my top teeth back to fill the gaps, creating an underbite and decompensating. Then performing another surgery....obviously I am extremely reluctant to do this. The surgeon did not seem 100% confident with the ortho's assessment as he could not see a problem with the relationship of my top and bottom jaws from the Xray.

The surgeon noticed from old pics and how I am now that some gaps which were left in my bottom teeth around the canines...have closed up which indicates that the teeth have moved out of their post op position and he initially felt that my teeth have moved and caused this problem. The ortho (who by the way is not the same guy who treated me since he has moved on) thinks otherwise....despite xray not showing a problem.

I am now in the process of obtaining all of my medical records from the hospital and then I am going to see one of the UK's leading orthodontists in London to see what he thinks and if this can be corrected with braces especially if no apparent skeletal malocclusion is present. The surgeon did say that if any jaw movement has occurred it is so marginal and accompanied with some tooth movement which is resulting in my present day bite. He did say that if I were to have an operation...again (which by the way he does not advocate) it will not change my profile since any discrepancy between jaws is so marginal.
Title: Re: Double Jaw Surgery Relapse
Post by: pekay on May 24, 2014, 11:35:41 AM
What do think they caused you to have a minor relapse? Upper or lower jaw grew and threw everything off? bite was slightly off?
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 24, 2014, 12:20:11 PM
What do think they caused you to have a minor relapse? Upper or lower jaw grew and threw everything off? bite was slightly off?

Well they cannot be sure, the surgeon was leaning towards the teeth moving. He could not see any movement in the jaws from the xray. I understand that the muscular forces that were pulling on the jaws and cause these defects are still present after surgery. He could not see a reason to operate from my xray. I did have a pallet expander during my orthodontic treatment and I do wonder if I have lost some of the horizontal expansion through not wearing my retainers enough as the top retainer seems too wide and i cannot even get it to fit. I don't believe my jaws continued to "grow" as I was almost 23 by the time of my op. If a change in jaw position occurred, it is down to muscular forces, otherwise teeth have moved. Actually my bite looks worse in pic, i get a slight overlap on top teeth.
Title: Re: Double Jaw Surgery Relapse
Post by: Ben on May 26, 2014, 03:07:36 AM
What about oral posture, did you make sure your tongue sat in the right position after the surgery?
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 26, 2014, 06:48:18 AM
What about oral posture, did you make sure your tongue sat in the right position after the surgery?

everything seemed normal after surgery. My teeth fitted together so well that surgical splints were not required to be left in position. I have another friend who had a bimax and he says his bite has changed also, he was operated on at a totally different hospital by a different team. I think relapse is part of these surgeries and it happens to everyone to some degree, whether it be an immeasurable amount or indeed in severe cases returning back to the original position. The annoying thing is, my bite is the just out by a marginal amount and I am very happy with my profile.

The hospital ortho is adamant that to achieve proper occlusion i require another bimax procedure, but ultimately one has to consider if the juice is worth the squeeze. It won't yield the dramatic improvement in my appearance like the first op and it will just help my teeth mesh together that little bit better. That is all. Plus he wants to go down the route of extracting premolars and I just think it is ridiculous given that my teeth are all straight and healthy.
Title: Re: Double Jaw Surgery Relapse
Post by: Ben on May 26, 2014, 02:34:02 PM
Yeah this whole relapse thing is no good. Having teeth mesh together is quite a big deal though it is an important part of complete oral health in my opinion.
Even though it causes me discomfort I've been keeping my teeth meshed as much as possible since surgery. When I wake up at night if my jaw is relaxed and hanging down I close again. Hopefully this and keeping my tongue constantly pressed into the roof of my mouth and into the back of the alluvial# ridge will limit any relapse to a minimum.

Surely if in your last surgery they had properly decompensated your dental arches then there should be something to play with in tooth angles which will again give you an overbite. I doubt looking at your picture it will take much.

Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 26, 2014, 02:56:52 PM
Yeah this whole relapse thing is no good. Having teeth mesh together is quite a big deal though it is an important part of complete oral health in my opinion.
Even though it causes me discomfort I've been keeping my teeth meshed as much as possible since surgery. When I wake up at night if my jaw is relaxed and hanging down I close again. Hopefully this and keeping my tongue constantly pressed into the roof of my mouth and into the back of the alluvial# ridge will limit any relapse to a minimum.

Surely if in your last surgery they had properly decompensated your dental arches then there should be something to play with in tooth angles which will again give you an overbite. I doubt looking at your picture it will take much.

Yes that is what I thought too but the hospital orthodontist who is some new guy is basically saying it is a whole new op if I want to correct my bite. The surgeon though was not convinced as I mentioned previously, he could not see any skeletal abnormality from X ray. I am going to have my post op and current Xrays super imposed over one another to actually see if there has been a noticeable improvement. Problem is, if I do have another surgery then there is still the risk of relapse after all of that, and there's nothing to say that my bite won't be even worse. I will wait and see what the private ortho in London has to say next week. I did have a severe underbite to begin with and I guess having my jaws in the correct position was almost unnatural for me. I don't believe I could have done anymore other than not been so slack in wearing my retainers.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 27, 2014, 12:46:42 PM
Have many people had jaw surgery 2 times?
Title: Re: Double Jaw Surgery Relapse
Post by: Ben on May 27, 2014, 01:15:00 PM
Yeah just find out your current skeletal base, and proceed from there. Still even if you are class 3 there's still every chance an orthodontist could make an overbite for you dentally.

Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 28, 2014, 01:19:34 AM
Yeah just find out your current skeletal base, and proceed from there. Still even if you are class 3 there's still every chance an orthodontist could make an overbite for you dentally.

Well that is what is confusing me, surgeon is saying he cannot see anything abnormal from Xray
Title: Re: Double Jaw Surgery Relapse
Post by: Ben on May 28, 2014, 01:56:28 PM
Think about your teeth and jaws, consider the angles involved. Look at attractive people and see how there teeth fit together. Look and think about your teeth and bite, then workout what needs to be done.
There is more to a bite, as I'm sure your aware, than just where the front teeth meet. I have a friend who has an edge to edge bite at the front but his front teeth meet at exactly the same time as all his other teeth so he finds his bite comfortable and really likes it.
Surgeons and Orthodontist can be quite ignorant when it comes to the function of a bite.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on May 31, 2014, 10:23:31 AM
The attached pic shows my bite before the operation, as you can see it was pretty severe.

[attachment deleted by admin]
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on June 05, 2014, 12:15:40 AM
I had a consultation in London with an orthodontist and I am going to see his recommended surgeon, Piet Haers, in a couple of weeks. I am happy with my aesthetics and the orthodontist said I looked great and that aesthetically the op had been a success. He felt I may need upper jaw advancement to close the bite but he felt this was an extreme solution and it may be best to just leave things where they are. I guess I have to weigh up the risks of a second surgery against just dealing with an edge to edge bite. I am not prepared to take any of the orthodontic options without a surgery because they involve removing teeth and attempting to "mask the problem". I would rather leave my bite where it is than just patch things up with a half hearted orthodontic attempt. I am not really sure why I had this slight relapse as the post surgical result was excellent, my teeth meshed together so well that I had doctors visiting my hospital room and commenting on how excellent the results were. Other maxillofacial surgeons were giving me winks and thumbs up as I lay in my bed recovering. I think that a large part of relapse is down to the individual and how the body deals with, I had a very severe bite pre-op and this operation has improved things 85%, I have lost 15% through the relapse. It is a shame when after the operation, my teeth and bite were so damn perfect, I fail to see what else could have been done.

The only thing the ortho did comment on was why I did not have SARPE before my BI-max, he felt that using the quad helix to expand upper arch was not the same and that this may have compromised stability. Like I said, it is such a shame considering how excellent my post operative bite was.
Title: Re: Double Jaw Surgery Relapse
Post by: Ben on June 05, 2014, 03:11:34 PM
Can you have your other teeth built up so that they all hit at about the same time as the clashing front teeth? This would at least make your bite functional/comfortable.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on June 08, 2014, 03:14:08 AM
Can you have your other teeth built up so that they all hit at about the same time as the clashing front teeth? This would at least make your bite functional/comfortable.

Orthodontist has recommended a consultation with professor Piet Haers and himself to review me and give me all the options. They have taken an X ray of my current bite which I am waiting for the clinic to email over to me. One of the options is an SAPRE of my pallet and an op to bring my upper jaw forward to resolve the bite.

Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on June 15, 2014, 02:16:38 AM
Are there many people who have had a second surgery? Am I likely to suffer severe nerve damage?
Title: Re: Double Jaw Surgery Relapse
Post by: Modigliani on June 15, 2014, 05:32:30 AM
Are there many people who have had a second surgery? Am I likely to suffer severe nerve damage?

I don't know but I'll find out. Have another couple of consults coming up so I'll ask.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on June 15, 2014, 06:08:56 AM
I don't know but I'll find out. Have another couple of consults coming up so I'll ask.

Who are you seeing? I have a consult with Piet Haers coming up.
Title: Re: Double Jaw Surgery Relapse
Post by: Modigliani on June 15, 2014, 06:26:30 AM
Who are you seeing? I have a consult with Piet Haers coming up.

He's supposed to be good but make sure you get him to nail down exactly what's achievable. Your case seems pretty straightforward so that probably won't be in issue.

I'm seeing Paul Johnson, again and Sneddon at East Grinstead...and praying for a miracle  :)
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on June 15, 2014, 07:24:44 AM
He's supposed to be good but make sure you get him to nail down exactly what's achievable. Your case seems pretty straightforward so that probably won't be in issue.

I'm seeing Paul Johnson, again and Sneddon at East Grinstead...and praying for a miracle  :)

Cool, thanks for the advice. I will be seeing him in 8 days.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on June 28, 2014, 04:16:24 PM
He's supposed to be good but make sure you get him to nail down exactly what's achievable. Your case seems pretty straightforward so that probably won't be in issue.

I'm seeing Paul Johnson, again and Sneddon at East Grinstead...and praying for a miracle  :)


I have had my meeting with Professor Haers. I found him to be very good and an extremely nice man. He believes that I have had an orthodontic relapse, mainly on my top jaw in the transverse direction. Basically, when I had my previous orthodontic treatment they did not expand my upper jaw. I have a fairly narrow upper jaw and instead of doing a SARPE, the NHS orthodontist decided to expand the arch with an orthodontic appliance known as a helix, unfortunately this appears to have relapsed within 18 months of the braces coming off. I don't think he was impressed with my orthodontist using this approach. The collapsing of the upper arch has resulted in a cross bite and my top jaw now biting within the bottom, front teeth are edge to edge.

The only way to correct this, should i opt to, is to perform a SARPE to properly laterally expand the upper jaw. This will then cause the top teeth to fall behind the bottom, opening up an underbite. We will then advance just the top jaw. He also recommend a slight reduction in the vertical height of my chin to correct lip incompetence. Furthermore, a further 3mm of impaction of the top jaw was recommended to reduce length of the lower third (i had 3mm impaction during the first operation).

If I choose not to do anything, I risk losing my front teeth within the next 10-15 years, which is sad. I am annoyed at myself for not being so disciplined with my retainers, but ultimately I blame the incompetence of the NHS surgeon/ortho team who agreed not to perform a SARPE on me in the beginning, even though was this best option for long term results. Professor Haers does not believe that my jaws have actually moved, although he has not measured them. It clearly points to orthodontic relapse of top jaw in the transverse direction. I believe had I continued wearing my retainers, that this would have still happened as the only way to increase width of upper jaw in an adult is to perform SARPE. He did say that the helix devices only really work on growing patients.

I am having another meeting with him in August and then I will make my final decision.
Title: Re: Double Jaw Surgery Relapse
Post by: Modigliani on June 29, 2014, 04:35:04 AM
What a pisser that the whole thing was compromised due to ortho incompetence, these guys are something else!

This sounds like a sensible plan that will, most importantly ensure stability in the long term. The only thing I'd be a bit wary about is having another 3mm impaction - that's 6mm in total, quite a lot. How much tooth show do you have currently when the lips are at rest? Ideally you want a good 3 or 4mm showing, it's youthful so be careful with anymore impaction.

Are you planning on seeing anyone for another opinion?
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on June 29, 2014, 07:55:20 AM
What a pisser that the whole thing was compromised due to ortho incompetence, these guys are something else!

This sounds like a sensible plan that will, most importantly ensure stability in the long term. The only thing I'd be a bit wary about is having another 3mm impaction - that's 6mm in total, quite a lot. How much tooth show do you have currently when the lips are at rest? Ideally you want a good 3 or 4mm showing, it's youthful so be careful with anymore impaction.

Are you planning on seeing anyone for another opinion?

Yes it is frustrating to say the least, however, he did say I have a very large tongue also and that a strong tongue push on the bottom incisors has also pushed them outwards contributing to an edge to edge bite. He feels that the NHS surgeon has moved my jaw back a couple of mm too much as this has further reduced space for my very large tongue and exacerbated the problem. I am to blame to a degree for stopping wearing my retainers, although medical records show that I had relapsed when they took pictures of my bite 2 years after my operation, nobody noticed it though until I finally saw those photographs back in May!! I guess they just got filed in to my medical records without ever being studied.

I agree with your point about the impaction to a degree. I did have 2 mm at the front and 3 mm at the back impaction (open bite). I did have quite a long face because of this and I still do to a degree. I have quite a bit of tooth show still and I have very long teeth. He feels my face is still a bit concave in this region and I will benefit from further advancement of the top jaw. Decompensation will arise from expanding my pallet with a SARPE and then pushing the top teeth backwards. I will discuss this further in the second meeting. I am not thrilled about a revision surgery but I am less thrilled about leaving it and losing my front teeth.

Professor Haers did mention that if we do all of this, I will need to be carefully monitored and if the strong tongue push is still forcing my bottom incisors out....I may need a tongue reduction surgery. He recommends this for less than 1% of his patients. He showed me results of patients who had severe underbites but where he had only moved the bottom jaw back 2mm and moved the top jaw forward much more, the results were impressive. I had 5.5mm of net movement backwards, he feels this should have been limited to 2 or 3mm and then top jaw moved forward significantly. When I look back at my case, we were all under the impression my bottom jaw had overdeveloped significantly, but actually I feel that my top jaw had majorly underdeveloped. He says that we should be able to avoid touching the bottom jaw, which is good news. He described my bottom jaw as short and I cannot afford any further backwards movement.
Title: Re: Double Jaw Surgery Relapse
Post by: Modigliani on June 29, 2014, 08:17:22 AM
'Tongue reduction surgery' sounds fucking horrific!

 :o
Title: Re: Double Jaw Surgery Relapse
Post by: Gregor Samsa on June 29, 2014, 09:24:10 AM
'Tongue reduction surgery' sounds fucking horrific!

 :o

WTF!  :o
Title: Re: Double Jaw Surgery Relapse
Post by: backward lowerjaw on June 29, 2014, 11:10:00 PM
If Hears is saying 1% chance for tongue reduction the chances of this is very unlikely so I wouldn't worry too much about that

I will be seeing Haers in a couple of months, like yourself i'm very concave but I will also get a second opinion very likely with Paul Johnson.  Are you happy with what Hears has offered you or will you also be getting a second opinion?

Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on July 04, 2014, 03:55:07 PM
If Hears is saying 1% chance for tongue reduction the chances of this is very unlikely so I wouldn't worry too much about that

I will be seeing Haers in a couple of months, like yourself i'm very concave but I will also get a second opinion very likely with Paul Johnson.  Are you happy with what Hears has offered you or will you also be getting a second opinion?

Yes, it is unlikely. I may consider a second opinion after seeing him again in early August. I am going through a phase of blaming myself for not wearing my retainers, however, I do not believe that this would have stopped my upper arch collapsing. I feel angry towards the NHS. I would not describe myself as "very concave" as I actually have cheeks whereas before my op I did not.
Title: Re: Double Jaw Surgery Relapse
Post by: backward lowerjaw on July 05, 2014, 03:39:39 AM
I was the same blaming myself and the nhs, thing is you can't turn back the clock which I've come to accept.  Just try and look forward knowing you're doing something getting it sorted, it's just the waiting which is frustrating  I'm going to make sure the surgeon I have knows exactly what I want and what is achievable instead of being shipped in and out like I was on the nhs and not having any say so in what was being done.

It's interesting you say you have cheeks while before you didn't that's good to know.
Title: Re: Double Jaw Surgery Relapse
Post by: PloskoPlus on July 05, 2014, 05:01:04 AM
Yes, it is unlikely. I may consider a second opinion after seeing him again in early August. I am going through a phase of blaming myself for not wearing my retainers, however, I do not believe that this would have stopped my upper arch collapsing. I feel angry towards the NHS. I would not describe myself as "very concave" as I actually have cheeks whereas before my op I did not.

I remember you saying that your lower jaw was moved back more than the upper was moved forward.  I think that's the problem.  Usually they try to do the opposite: move the upper forward as much as possible and make up the rest by moving the lower jaw back as little as possible (if at all).
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on July 06, 2014, 01:45:49 AM
I remember you saying that your lower jaw was moved back more than the upper was moved forward.  I think that's the problem.  Usually they try to do the opposite: move the upper forward as much as possible and make up the rest by moving the lower jaw back as little as possible (if at all).

Well my jaws have not actually moved, it is mainly the collapsing of upper arch because the skeletal aspect was not increased, just my teeth were pushed outwards. Now all my top teeth bite within the bottom and the front teeth edge to edge. my upper jaw was moved forward 4mm and the lower moved back 5mm.
Title: Re: Double Jaw Surgery Relapse
Post by: PloskoPlus on July 06, 2014, 01:55:52 AM
Well my jaws have not actually moved, it is mainly the collapsing of upper arch because the skeletal aspect was not increased, just my teeth were pushed outwards. Now all my top teeth bite within the bottom and the front teeth edge to edge. my upper jaw was moved forward 4mm and the lower moved back 5mm.

I mean the surgeon should have moved the upper forward more and the lower back less.  I'm a class III as well (pre-op).  The plan thus far is to only move the upper forward.  I just realised that my tongue just fits in my mouth.  I can't imagine moving the lower back.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on August 17, 2014, 09:08:46 AM
OK so I have had a second review with Prof Haers and also my NHS surgeon.

NHS Review
Basically, now that they are aware I have requested copies of my medical records, the NHS have gone in to self defence mode and they are now denying anything is wrong with my bite. Despite previously offering me braces or even another surgery to correct this. It is not good form from them. It seems they are irked by my request for medical records.

Prof Haers
He thinks he can correct this by performing upper jaw surgery only, however, a SARPE is needed first to expand upper arch by 6mm or so. He thinks I only need 6 months of orthodontics to prepare me for the operation.

I am still deciding what to do.
Title: Re: Double Jaw Surgery Relapse
Post by: FaceDay on September 06, 2014, 04:58:43 PM
Does your tongue actually not fit in the top of your mouth, or have you just been holding it in your bottom teeth from habit?
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on September 21, 2014, 02:16:20 PM
Does your tongue actually not fit in the top of your mouth, or have you just been holding it in your bottom teeth from habit?

It does not fit properly in the the roof of my mouth. I am lacking width by about 6mm.
Title: Re: Double Jaw Surgery Relapse
Post by: backward lowerjaw on September 24, 2014, 01:26:15 PM
Any info on the 2nd consultation with Haers? I'm due to see him in a few weeks. What was the overall cost of the single surgery he quoted you?
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on October 26, 2014, 10:10:34 AM
Any info on the 2nd consultation with Haers? I'm due to see him in a few weeks. What was the overall cost of the single surgery he quoted you?

I am going to be seeing him for a third  review next week. I am pretty certain I will go ahead with his plan of SARPE surgery then further impaction and advancement of the top jaw to correct excessive long face and edge to edge bite. He will also reduce height of my long chin. I had previously been impacted 2 mm at front and 3mm at back on my top jaw in first bimax procedure. But he thinks the open bite is still there, a bit. Plus my face is really long still. The SARPE will widen my mid face and the impaction and chin reduction will shorten lower third. Prof Haers is suggesting another 3mm impaction, so I will have had 6 mm (or 5mm if we just use the 2mm front impaction previously). This sounds a lot but I had/have a very long face. Haers showed me pics of people with similar facial profiles to mine and he has given them cheeks and much shorter faces.
Title: Re: Double Jaw Surgery Relapse
Post by: Modigliani on October 27, 2014, 03:52:27 AM
Be very careful with that much impaction, it's very common for European (not including UK in that) trained surgeons tend to 'overcook' their movements in general, be absolutely sure before you agree to anything.

Did you have any other consultations to compare it to?
Title: Re: Double Jaw Surgery Relapse
Post by: sean89 on October 27, 2014, 09:11:59 AM
I am going to be seeing him for a third  review next week. I am pretty certain I will go ahead with his plan of SARPE surgery then further impaction and advancement of the top jaw to correct excessive long face and edge to edge bite. He will also reduce height of my long chin. I had previously been impacted 2 mm at front and 3mm at back on my top jaw in first bimax procedure. But he thinks the open bite is still there, a bit. Plus my face is really long still. The SARPE will widen my mid face and the impaction and chin reduction will shorten lower third. Prof Haers is suggesting another 3mm impaction, so I will have had 6 mm (or 5mm if we just use the 2mm front impaction previously). This sounds a lot but I had/have a very long face. Haers showed me pics of people with similar facial profiles to mine and he has given them cheeks and much shorter faces.

Have you asked him about undergoing a segmental le fort to widen your maxilla? This would save you having two operations, an extra six months in a palatal expander with all the speech/eating problems associated with it, and will save you a lot more money.

35-70% of the expansion you will get from SARPE will be dental. As you are already well aware, this is prone to relapse.




Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on October 28, 2014, 12:19:41 PM
Have you asked him about undergoing a segmental le fort to widen your maxilla? This would save you having two operations, an extra six months in a palatal expander with all the speech/eating problems associated with it, and will save you a lot more money.

35-70% of the expansion you will get from SARPE will be dental. As you are already well aware, this is prone to relapse.

There are other issues which need fixing to reduce relapse risk. I am a mouth breather, I cannot breathe through my nose - most of the time. This will be corrected by advancement of upper jaw. Mouth breathing has a large effect on relapse, if this is not corrected I will still have no option but to breathe through mouth. I have lip incompetence etc which all effects tooth stability. I am going to have to wear lingual retainers on upper and lower incisors and retainers for life in order to keep this stable. I cannot really comment on statistics of either procedure, however, he is very confident this will solve the problem. He has performed numerous revisions over the years.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on November 18, 2014, 07:01:28 AM
Just a quick update, I am booked in for SARPE surgery in December. Followed by 6-8months of orthodontics with a view to Maxillary advancement and reduction of chin height in Summer 2015.
Title: Re: Double Jaw Surgery Relapse
Post by: GJ on November 18, 2014, 11:13:35 AM
When he said you'd lose your front teeth, was this due to them wearing down via the edge to edge bite, or trauma to the roots?
Title: Re: Double Jaw Surgery Relapse
Post by: Modigliani on November 18, 2014, 11:16:20 AM
Must feel good to have a plan of action finally nailed down, all that waiting around knowing things aren't right is just the worst, so mentally draining.

Onwards and upwards!
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on November 18, 2014, 02:11:27 PM
When he said you'd lose your front teeth, was this due to them wearing down via the edge to edge bite, or trauma to the roots?

Both pretty much. Ortho told me that trauma to the roots is one thing but it is also apparent that my teeth have worn already where the limited contact is made.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on December 21, 2014, 12:20:52 PM
I had my SARPE surgery with Prof Haers a couple of days back. All going well.
Title: Re: Double Jaw Surgery Relapse
Post by: MaxilloMandibular on December 21, 2014, 01:55:32 PM
I consulted with him and he gave me by far the best treatment plan of all the five maxillofacial surgeons I've seen.

Traumatised in what way?
Title: Re: Double Jaw Surgery Relapse
Post by: MaxilloMandibular on December 21, 2014, 02:31:24 PM
Serious professionals don't usually mince words. He analyzed and criticised my face in minute detail as well. That's a good sign because it means that he sees what the problem is. My impression is that he's sincerely passionate about the work he does.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on December 22, 2014, 01:22:54 AM
Serious professionals don't usually mince words. He analyzed and criticised my face in minute detail as well. That's a good sign because it means that he sees what the problem is. My impression is that he's sincerely passionate about the work he does.

I have found him direct but very pleasant. He just doesn't do all the "British Niceties". He is very direct. I have found him very good, a damn site better than the NHS treatment I received.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on December 28, 2014, 02:30:32 AM
Expansion going very well had about 4mm of expansion now. I have another 3 or 4mm to go.
Title: Re: Double Jaw Surgery Relapse
Post by: kaylie14 on March 24, 2015, 01:34:22 AM
Are you male or female? How old were you when you had the surgery?

Class 3 patients (especially females) should wait til their mid 20s (23-24) to have surgery

Can I ask why is it best to wait until 23-24 for surgery?
Title: Re: Double Jaw Surgery Relapse
Post by: PloskoPlus on March 24, 2015, 03:26:00 AM
Can I ask why is it best to wait until 23-24 for surgery?

Supposedly the mandible can grow until 25 in males.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on April 07, 2015, 01:59:02 PM
Supposedly the mandible can grow until 25 in males.

Hmm maybe but I think that would be extreme. My surgery did not relapse due to this, it was lack of lateral expansion of the top jaw.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on February 01, 2016, 01:41:16 PM
OK so I have now had my second stage surgery with Prof Haers which involved a mild impaction and small advancement of the maxilla since I ended up almost not needing surgery due to excellent results from SARPE widening meaning that this almost resolved my bite alone.

I also had a sliding genioplasty to reduce excessive chin height.
Title: Re: Double Jaw Surgery Relapse
Post by: strongjawman on February 16, 2016, 01:54:08 AM
How is everything going?
Title: Re: Double Jaw Surgery Relapse
Post by: JawKid7 on February 18, 2016, 04:19:31 AM
if you don't mind me asking who performed your first surgery under the nhs?
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on December 18, 2016, 12:46:23 AM
Everything has gone quite well so far. No hint of relapse thus far, bite remains stable.

Not sure if having surgey was a bit extreme though as I could have got away with braces after the SARPE, it was very close though and the surgeon felt that surgery was more stable.

I had 3mm impaction and 3mm advancement.
Title: Re: Double Jaw Surgery Relapse
Post by: marcus3415 on January 12, 2017, 06:45:10 AM
Your situation reminds me of mine. I have a feeling this is going to happen to me in a few years. Bite is narrow, 100% needed expansion and they didn't do it.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on July 23, 2017, 09:02:30 AM
The main outstanding issue now is that there seems to have been an overfill of the para-nasal area after the SARPE expansion. This makes the skin either side of my nose look a bit puffy. Why did this happen?  Even the surgeon was not sure :/
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on October 18, 2017, 04:06:58 PM
Anyone know what causes this?
Title: Re: Double Jaw Surgery Relapse
Post by: Adonia on October 18, 2017, 04:20:53 PM
how is it even possible that after cutting bone, moving in, screwing back into its new position, and the bone healing that you relapse. This idea seems impossible to me. Maybe your teeth move and that slightly changes your bite but I can understand how its possible to relapse
Title: Re: Double Jaw Surgery Relapse
Post by: Framboise on October 18, 2017, 10:44:21 PM
A relapse is possible because of your TMJ especially condylar resorption.
If you are missing several teeth in the back, you have not enough bone in this area and you are lacking support.
My TMJ haven't bear my upper WT removal (I have a bone remodelling) and my jaws have moved backward as a result (too much forces for the anterior teeth).
You have to know that condylar resorption is a common side effects of jaw surgery, making a relapse a possibility.
Title: Re: Double Jaw Surgery Relapse
Post by: elysium87 on October 19, 2017, 02:51:43 AM
how is it even possible that after cutting bone, moving in, screwing back into its new position, and the bone healing that you relapse. This idea seems impossible to me. Maybe your teeth move and that slightly changes your bite but I can understand how its possible to relapse

My relapse was due to the fact that the original ortho / surgeon team did not expand my upper jaw properly. They used a quad helix expander to increase the width of the top jaw, this cannot be used on somebody who has stopped growing as the palette will have already fused together. I was 19 going on 20 when they installed this device. They should have performed a SARPE.

Upon noticing the relapse (i was actually unaware for a few years that it had relapsed), my only solution was to either have the bottom teeth filed to make them fit under the top, leave the bite as it was but accept damage to top and bottom front teeth over the years or have a SARPE and Le Fort I.
Title: Re: Double Jaw Surgery Relapse
Post by: secondtimearound on December 25, 2017, 01:41:02 PM
I had a 50% relapse on my class 3 open bite bsso and lf1. In my problem it was that there was too much movement attempted through orthodontics, and unless you have incredible maxillary/mandibular bone, too much orthodontic movement will predispose to relapse or gum recession (which I also have mildly).

In my case the relapse was evident within months of taking off the braces. It stabilized within a year.

Probably most late phase relapse like what you describe is orthodontically mediated.

If you have an open bite you probably had a narrow upper jaw like me with possibly some crossbite like I had too. If that is the case, surgical arch widening via multipiece lf1 or sarpe are the only "ideal" ways to correct the problem.

Braces are only good for fine alignment. Gross misalignments must be corrected through bone cutting and repositioning.

Bones heal within a month or two so any relapse after that is not likely bone related unless you develop a subluxation of your TMJ or condylar resorption.

It's amazing how many orthodontists and surgeons don't "get" this. I went to the surgeon who was renowned as the best in my city (Tocchio) and I still ended up in this position.
Title: Re: Double Jaw Surgery Relapse
Post by: nqrse on February 10, 2018, 05:49:02 PM
Are you male or female? How old were you when you had the surgery?

Class 3 patients (especially females) should wait til their mid 20s (23-24) to have surgery

Why's that? Does the jaw continue to grow for that long?