Re: Relapse

[Eroica]

Surgeons will often over-correct the bite/profile as a precaution against relapse if relapse seems likely.

Most bite relapse, unless severe, can be corrected orthodontically in the post-surgical fine-tuning period.

[Eroica]

Often. Alot of this depends on the natural characteristics of your mandibular condyles. People with a gracile, narrow or delicate facial structure to begin with tend to have thin condyles which make them more prone to condylar resorption.

[neferkitti]

Often. Alot of this depends on the natural characteristics of your mandibular condyles. People with a gracile, narrow or delicate facial structure to begin with tend to have thin condyles which make them more prone to condylar resorption.

Thanks. That's what I thought and was confirmed by some of my doctors. I have what they consider "beefy" bones so no relapse here.

[Sharptoys]

the idea that one could relapse one year after surgery doesn't make sense since i was told, numerous times, recovery is essentially done by year 1.

Osseous recovery at the osteotomy site is essentially entirely done at 8-12 months.

However, osseous remodeling at the condylar head is a constant, lifelong phenomenon, which begins at birth and ends only at death. The level of activity at the condyle may vary throughout life, but ideally--and in most circumstances--condylar remodeling is a healthy and adaptive process, where the rate of resorption roughly matches the rate of bone deposition.  While essentially all patients undergoing orthognathic surgery will also consequently undergo at least a minimal amount of condylar remodeling, most of the time these changes are only academically significant, and are largely irrelevant to the patient. However, changes in the condyle-articular disk-fossa dynamic (due to orthognathic surgery or not) can cause mal-adaptive condylar changes, i.e. condylar resorption. As the condylar head remains active throughout life, post-surgical changes therein may continue for up to several years at any given rate, although they are likely to slow with time.

This phenomena should not concern the majority of patients, as it is normally only a risk for those who demonstrate a very particular type of facial morphology. As stated previously, these risk factors include, but are not limited to:

1. High mandibular plane angle
2. Anterior open bite
3. Thin, narrow, spike-shaped condyles
4. Bisaggital split osteotomy advancement
5. Low posterior-anterior facial height ratio

It should be noted that these risk factors *may* be exacerbated if the patient is female, and catastrophic and continued resorption occurs somewhat less frequently in male patients. The large majority of patients have demonstrate none of the above factors, or only to a minor degree. For these patients, any non-academic interest in the subject is unnecessary.

[Marisama]

Osseous recovery at the osteotomy site is essentially entirely done at 8-12 months.

However, osseous remodeling at the condylar head is a constant, lifelong phenomenon, which begins at birth and ends only at death. The level of activity at the condyle may vary throughout life, but ideally--and in most circumstances--condylar remodeling is a healthy and adaptive process, where the rate of resorption roughly matches the rate of bone deposition.  While essentially all patients undergoing orthognathic surgery will also consequently undergo at least a minimal amount of condylar remodeling, most of the time these changes are only academically significant, and are largely irrelevant to the patient. However, changes in the condyle-articular disk-fossa dynamic (due to orthognathic surgery or not) can cause mal-adaptive condylar changes, i.e. condylar resorption. As the condylar head remains active throughout life, post-surgical changes therein may continue for up to several years at any given rate, although they are likely to slow with time.

This phenomena should not concern the majority of patients, as it is normally only a risk for those who demonstrate a very particular type of facial morphology. As stated previously, these risk factors include, but are not limited to:

1. High mandibular plane angle
2. Anterior open bite
3. Thin, narrow, spike-shaped condyles
4. Bisaggital split osteotomy advancement
5. Low posterior-anterior facial height ratio

It should be noted that these risk factors *may* be exacerbated if the patient is female, and catastrophic and continued resorption occurs somewhat less frequently in male patients. The large majority of patients have demonstrate none of the above factors, or only to a minor degree. For these patients, any non-academic interest in the subject is unnecessary.

Do you copy and paste from a textbook or are you just always that articulate?

[CK]

Osseous recovery at the osteotomy site is essentially entirely done at 8-12 months.

However, osseous remodeling at the condylar head is a constant, lifelong phenomenon, which begins at birth and ends only at death. The level of activity at the condyle may vary throughout life, but ideally--and in most circumstances--condylar remodeling is a healthy and adaptive process, where the rate of resorption roughly matches the rate of bone deposition.  While essentially all patients undergoing orthognathic surgery will also consequently undergo at least a minimal amount of condylar remodeling, most of the time these changes are only academically significant, and are largely irrelevant to the patient. However, changes in the condyle-articular disk-fossa dynamic (due to orthognathic surgery or not) can cause mal-adaptive condylar changes, i.e. condylar resorption. As the condylar head remains active throughout life, post-surgical changes therein may continue for up to several years at any given rate, although they are likely to slow with time.

This phenomena should not concern the majority of patients, as it is normally only a risk for those who demonstrate a very particular type of facial morphology. As stated previously, these risk factors include, but are not limited to:

1. High mandibular plane angle
2. Anterior open bite
3. Thin, narrow, spike-shaped condyles
4. Bisaggital split osteotomy advancement
5. Low posterior-anterior facial height ratio

It should be noted that these risk factors *may* be exacerbated if the patient is female, and catastrophic and continued resorption occurs somewhat less frequently in male patients. The large majority of patients have demonstrate none of the above factors, or only to a minor degree. For these patients, any non-academic interest in the subject is unnecessary.

interesting. i had a bsso, my condyles are fine i beleive - i was never told they were thin or narrow. i did have an anterior open bite before my first round of braces, but that was corrected. does that still count today post-surgery? im concerned the relapse could affect or alter the shape of my jaw, particularly lower jaw. can diet, such as acidic drinks, have any influence over this process?

[Sharptoys]

Do you copy and paste from a textbook or are you just always that articulate?

Just paraphrasing what is essentially common knowledge among the medical community. While I haven't read much current research since I decided on a surgical plan a few months back, for further reading I'd recommend the following papers:

Condylar remodelling and resorption after Le Fort I and bimaxillary osteotomies. Theo J.M. Hoppenreijs, et al. 1997

Long-term evaluation of patients with progressive condylar resorption following orthognathic surgery. Hoppenreijs TJ, Stoelinga PJ, Grace KL, Robben CM. 1999

Progressive mandibular retrusion--idiopathic condylar resorption: Parts 1 & 2 Arnett GW, Milam SB, Gottesman L. 1996

Non-surgical risk factors for condylar resorption after orthognathic surgery. Hwang SJ, Haers PE, Seifert B, Sailer HF. 2004

Idiopathic condylar resorption: current clinical perspectives. Posnick JC, Fantuzzo JJ. 2007

Condylar atrophy and osteoarthrosis after bimaxillary surgery. H.C.J. Kerstens, D.B. Tuinzing,, R.P. Goldingb, W.A.M. van der Kwast. 1990

Surgical orthodontic treatment of skeletal anterior skeletal open bite using small plate internal fixation. C.S. Haymond, P.J. Stoelinga, P.A. Blijdorp 1991

The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: An update and extension. W.R. Proffit, T.A. Turvey, C. Phillips. 2007

Stability of open bite correction with sagittal split osteotomy and closing rotation of the mandible.  Stansbury CD, Evans CA, Miloro M, BeGole EA, Morris DE. 2010

Read Wolford's work if you like, but keep a container of Morton handy, as most surgeons (the surgeons I spoke with, and all of the above) reject some of Wolford's core suppositions.

[Sharptoys]

interesting. i had a bsso, my condyles are fine i beleive - i was never told they were thin or narrow. i did have an anterior open bite before my first round of braces, but that was corrected. does that still count today post-surgery?

Certain factors, like an open bite, are really only indicative of an increased risk if they present themselves along with others;  an open bite is not necessarily bad, but if it is secondary to an unusually high mandibular plane, then precautions should be taken.

im concerned the relapse could affect or alter the shape of my jaw, particularly lower jaw. can diet, such as acidic drinks, have any influence over this process?

It is possible, although highly/extremely improbable. Post-surgical dynamic and static changes provide far more stimulus than any beverage, acidic or otherwise. Of course, many acidic drinks are not necessarily healthy, so it might not hurt to abstain from them, if only temporarily.

[Marisama]

Read Wolford's work if you like, but keep a container of Morton handy, as most surgeons (the surgeons I spoke with, and all of the above) reject some of Wolford's core suppositions.

Almost lol'd.

[Marisama]

I really liked Wolford when I consulted with him. It's just that his treatment plan involved joint surgery which was far too aggressive for my liking.

[Kristen]

I really liked Wolford when I consulted with him. It's just that his treatment plan involved joint surgery which was far too aggressive for my liking.

Did he want to do the mitek anchor with prosthetic ligaments after reseating your condyles?    What did he find on your MRI?

[Marisama]

Yes.  I have slightly displaced discs.

[Sharptoys]

I really liked Wolford when I consulted with him.

I imagine I would as well. He quite obviously extremely intelligent and incredibly prolific.

It's just that his treatment plan involved joint surgery which was far too aggressive for my liking.

That's exactly what I'm referring to. Wolford's inclusion of open joint surgery as part of a standard treatment plan is not wildly accepted. He is also far to quick to promote total TMJ replacement. In fact, I'm fairly certain that in cases similar to mine, Wolford would recommend TMJ replacement regardless of the existence of otherwise completely functional joints.

While medical technology has come quite a long way, the life and morbidity of artificial joints still pales in comparison to their natural counterparts. A person as young as myself would require at least 3-5 replacement TMJ's over his or her lifetime (assuming, of course, that medical technology remains in it's current state, which is of course unrealistic, but it is equally likely that replacement joints-and experts to replace them-will become unavailable of the course of that time period).

[Sharptoys]

Surprised to read you wouldn't get a consult with Dr Wolford.     Are your condyles/ joints perfectly fine?

No grinding, cracking, pain, or limited opening at all. Popping occurs occasionally, but is far from indicative of permanent joint problems.

[CK]

is there a difference between soft tissue relapse and joint/bone relapse? can one occur without the other?