Double Jaw Surgery Relapse

[backward lowerjaw]

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?

[elysium87]

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.

[backward lowerjaw]

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.

[PloskoPlus]

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).

[elysium87]

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.

[PloskoPlus]

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.

[elysium87]

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.

[FaceDay]

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?

[elysium87]

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.

[backward lowerjaw]

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?

[elysium87]

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.

[Modigliani]

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?

[sean89]

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.

[elysium87]

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.

[elysium87]

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.