My question thread

[x]

Finally have this thing scheduled for next Thursday. The ENT and the max fax are in the same buiilding, so hopefully I will be meeting with both of them on the same day.

[x]

Ok, the appointment is tomorrow, I'm undecided if I should go in there, and tell him what I think is wrong or just ask him if "something seems off about my face, and what can be done
"?

If I tell him what I think is wrong, I guess I can compile a list of possibilities:
-retruded mandible and maxillary (deficient midface)
-lopsided bite, caused I think by one side of the maxillary being longer (causing asymmetry)
-the ramus of my mandible not growing a proper vertical length (as suggested by tdawg)
-my tongue thrusting and mouth breathing, and how these two may be related to lack of room in my mouth for my tongue
-open bite and occlusion of the teeth on my left side
-long face syndrome
-jaws being too narrow

Thoughts? Would I look like a know it all or come off as obnoxious by asking all these questions if I do?

[x]

well, id wait for his thoughts based on the clinical analysis and xrays. he'll be able to tell if the mandible is retruded pretty easily. as far as the ramus not growing properly, that's sketchy somewhat. surgeons think in the present, not the past. unless the absence of growth is an existing condition, rather than just something that did not happen in the past, the surgeon will say so if he feels like. otherwise, he'll just treat the problem. unless you really want him/her to validate your own self-diagnosis lol.

i wouldn't stress it, keep questions clear and concise. the above list are not questions, but statements. is that what you want to do? i think a wiser approach would be to invite his thoughts beyond yes/no. "how would you treat this x, y z."

but really, it seems, you care about aesthetics the most? right? is that not the gist of your posts? if so, make time for that. you dont need to win the affection of the surgeon, he is providing a service and you should know what that service involves. if he doesn't specialize in aesthetics, or you don't feel comfortable with him...then more consults.

i wouldnt worry about being obnoxious, honestly. i wish i had taken more of an initiative prior to my surgery. go for it.

Thanks for the response. What I most wanted to know was whether he would validate my self-diagnosis or not, because if you think he would then I'm going to avoid bringing any of my 'theories'. What my plan was, was to bring up these statements individually, and then ask him if he sees them in me, and after I've kind of gotten a clear idea of what is the issue, ask him how to effectively treat what is actually wrong.

But you're suggesting I go in there and let him determine what's wrong? I could do that as well, and if he skips over any of the possibilities I listed, I could bring them up in the end just for closure. And aesthetics are indeed important to me, but at this point, I'm kind of going with the idea that you correct the jaw growth issues / air passageway issues, and the aesthetics will fix themselves. If not, I can always worry about that later. At the moment though, I'll just focus on fixing what is wrong.

[x]

Yeah I see your point about finding a doctor who places emphasis on aesthetics. And I may do that, but if I do I'll no doubt have to wait a few years until I have a steady income. If I do this, I'll probably just go with Arnett or Gunson. And you are correct that if not for the aesthetics, I wouldn't be going through all this trouble, it's definitely not debilitating or anything.

Minor update: I didn't get a chance to see a max-fax surgeon today, though I did see the ENT. I guess I have a deviated nasal septum on one side. He also told me mouth breathing and forward head posture aren't related, which goes against what I've read. Yet another irritating thing. This may be arrogance, but sometimes I feel like I know more about some of these subjects than doctors. Or they're all on different pages, it really is hard to tell which.

ENT also told me there wasn't much he can do about tongue thrusting, as he is only capable of bringing the tongue forward, not back. So he suggested I talk to a maxillofacial surgeon about it.

At this point, I'm just getting frustrated with the lack of definitive-ness in everything. I think we have a long way to go when it comes to fully understanding this kind of stuff.

[x]

a tongue thrust can be helped with jaw surgery but speech therapy is often needed to truly correct it. lots of doctors have their own views and philosophies. may have something to do with the palate as well and how much space your tongue has in the mouth.

Yeah, I had that theory too and brought it up with him and he thought it was possible, but wasn't in the position to say so. My guess, there's not enough room because both of my jaws have retrognathia. He even said my tongue was on the small to medium end of sizes, so it's definitely not the tongue that's the issue.

[x]

well one of my dentists recommended speech therapy (who i saw, didnt help) and exercises (helped some). tongue thrusts suck definitely.

Yeah people always tell me "don't show your tongue when you're smiling" for pics. As if I can help it 

Having trouble pronouncing some words sucks to. I'm hoping the issue will just go away if I get surgery, Marisama said it might.

[x]

Is cracking or crunching of the jaws when you open them an early sign of TMJ or is it perfectly normal?


I hate not having a frame of reference to compare my experiences to.

[CK]

Is cracking or crunching of the jaws when you open them an early sign of TMJ or is it perfectly normal?


I hate not having a frame of reference to compare my experiences to.

from what i know about 40% of people experience
cracking or noises. Not necessarily a sign of tmj.

For people on the border yeah it can be difficult because most case studies focus on the extreme or not ordinary op. Jaw surgery is definitely evolving in terms of how it is viewed condition wise. Essential to research and try and get a handle on what you feel is wrong and what is actually wrong and can be addressed surgically.

[x]

Essential to research and try and get a handle on what you feel is wrong and what is actually wrong and can be addressed surgically.

Exactly. I'm trying to gather as much info as possible cause I'm afraid that if I don't bring up an issue, the surgeon won't address it.

Oh, and the Fluticasone Propionate I'm taking for my deviated right nasal septum is actually making it harder for me to breathe. I guess steroids won't be doing the trick. 

[x]

Hmm, well I noticed my lips are positioned further over to the left side than the right, and I'm starting to understand how the asymmetry is developing. One side of the maxillary being longer than the other has pushed my mandible askew and my whole face seems to be following the pattern, as is evidence by the deviated nasal septum.

If assymetry existed prior to surgery, how is it affected by a proper bite alignment?

[Hellojoe]

well, you dont really know if it's the upper jaw or just your lips (soft tissue). hard tissue isnt always the issue.

Dude, what are you on about? If he can see that his maxillary is longer on the one side, that's what it is. It's not rocket science figuring out what skeletal asymmetries one has. This is how you do it: You position yourself in front of a mirror, then you put your face really close to it and open your mouth really wide. Now, it should be no problem figuring out if it's the maxillary itself or just the soft tissue. If you find this technique hard, then take a close up-photo of yourself with your mouth wide open (so that you can clearly see both rows of teeth in the photo). Then upload this photo to your computer, open it in a photo editing program, zoom in on your midface and check how far the distance from each of your teeth row is from eyes/eyebrows/whatever.

Still find it hard to decide whether it is the soft tissue or the bone structure itself? Then employ a professional photographer to take the photo for you.. Actually, why don't you throw in a marine biologist while you're at it. Might as well get a bunch of different experts in the mix, since this is such an advanced and highly complex task. After all, we have to MEASURE the DISTANCE between PARTS OF OUR FACE... That's some serious scientific s**t right there.

[x]

Well, I'm not sure of the distinctions between soft tissue and bone structure causing asymmetry, but from observation: one side of the maxillary is indeed longer, and it's noticeable when I open my mouth. The left eye is positioned ever so slightly above the right eye, although the difference is so negligible that only someone looking for flaws would ever notice it. And I also have overall left/right facial asymmetry similar to what you have I believe CK. The mandible comes down lower on the right side, one side appears to project further away from the middle of the face than the other, and a lot of my face seems to be deviating to the side (deviated nasal septum being the only part of this diagnosed).

[x]

So are you telling me that the upper half of the face is never affected by misalignment of the lower half of the face, or just the eye positioning? Are you 100% sure of this?

[x]

no. upper half of the face is too general, what areas are you specifically referring to? the eye positioning can't be changed, ive read briefly about eyelid surgery or something but i doubt it is worth pursuing and not sure how it applies to your case.

the eyes are so far from the jaw. features like those can't really be manipulated by a jaw surgeon but correcting the jaws might make the eyes harmonize better. i dont know what you mean by misalignment of your lower face, you mean jaw? you need to see a legit surgeon and get xrays. he can then clinically evaluate you and tell you what's up. might consideri hunting for a jaw surgeon that specializes in PS, as rare as they are where you might live.

Nah I'm honestly fine with the way it looks, like I said it's not noticeable at all. Just at this point I've always attributed it to asymmetry caused by jaw misalignment. If it's corrected by jaw surgery cool, if not I'm pretty nonchalant about the whole thing. What I was saying though that since one side of the face seems slightly more elevated than the other because one side of mandible comes down further, I thought that if they evened out the vertical lengths of them it might adjust my eye height or something.

I have noticed in the afters though that eyes seem to appear more bright and wide open after surgery, should be interesting to see if that is a result.

[Hellojoe]

no, there is no way to tell if it is bone or soft tissue without an xray and clinical evaluation.

Oh, so how was it possible for me to tell then? I figured all this out prior to my consultation and at the consultation after the x-ray, the surgeon confirmed 100% of my self-diagnosis. Guess I'm either an undercover jaw-surgeon or some kind of super human, right?