Jaw Surgery For Me?

[JayJaw]

After recently trying to correct my oral posture (life long mouth breather... recessed lower jaw/chin and narrow upper palate), but I'm having trouble.

For as long as I can remember, I've had a tongue thrust. As a kid I'd bite my tongue sometimes in sports even. I was never told this was a bad thing (unfortunately), so these bad habits gave me bucked teeth and an open bite. My orthodontist was I was ~12 just gave me a tongue thrust blocker which didn't work... it just gave my tongue even less space. The braces pulled my teeth back (though front and bottoms still tilt outward) and combination of retainer use and hang mouth open and my tongue down low has kept my bite relatively closed (my back teeth and incisors/canine teeth touch and that's all... but bite itself isn't open, just doesn't overlap).

So, now trying to get tongue to top of my mouth, I noticed my tongue on the sides and the front were getting sore. I know my palate is fairly narrow, so the sides made sense... but why the front?

Then I realized the tip of my tongue was sitting between my front teeth! If I take my relaxed tongue and push the back up to the roof (pulling up tongue and tightening neck), the tongue does not fit. It just won't. The tip of my tongue wants to hang in between or behind my bottom teeth for the back portion to be comfortable.

I've been trying to start the tip of my tongue on that spot right behind front teeth but one of two things happens. The portion right after the tip feels tense and bent to fit the back comfortably or I must pull the entire tongue back a bit which noticeably closes my airway. I have to tilt my head up or forward to really breath.


What are the potential fixes for this?

So, obviously there is jaw surgery... which makes me nervous. I also can't afford it without insurance coverage. United Healthcare which does cover jaw surgery under specific circumstances. An open bite where there is no tooth overlap is covered but my braces "fixed" my open bite so I feel like they won't cover it. But I can't posture correctly without making my open bite worse or not being able to breath well. I don't know if I have sleep apnea, but I have always felt the need to sleep a very long time. I could sleep 12+ hours. I'm not a morning person and never feel that well rested waking up. Though I feel fine throughout the day (though have no problem falling asleep whenever). I'm going to get a consult with someone but I just hope insurance covers if the surgeon thinks it'd fix my issues.

If no jaw surgery... What about widening the upper palate with an expander? I assume that the tongue is being pushed longer because it's fitting itself into something narrow. I wonder if giving it more lateral room will "shorten" it and help? This obviously doesn't change my recessed jaw/chin, but maybe it'll allow me proper posture to avoid opening my bite and being able to breath better. I don't know.


Anyway here is a picture of my profile (my head is a bit tilted here... making it look better):

http://imgur.com/nAt6bbN

My insurance company does cover under circumstances listed:

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Orthognathic_JawSurgery_CD.pdf

[JayJaw]

Could someone move this post to the Surgery forum? I think it belongs there. Thanks!

[PloskoPlus]

Both jaws look recessed.  You nee jaw surgery.

[JayJaw]

Does insurance cover jaw surgery if you don't have sleep apnea? At least, I don't think I do... but I do feel like I have a small airway and maybe it will develop, which is a fear of mine.

Also, as I mentioned, I have a very mild open bite (it doesn't overlap but there is no gap) and narrow palate. I wanted to try to see how expanding my palate helps since I assume giving room to my tongue will be better. However, would this make it even more difficult to get jaw surgery covered? Honestly, I can't afford to pay 25k+ for all of that, especially since braces are needed too and aren't covered. So, it makes me nervous "fixing" my bite and palate and then being denied.

Then again... I really am afraid to get jaw surgery. If widening my palate helps... then I'd prefer that. Maybe TADS to impact my front teeth and reduce gummy smile and allow mandible to rotate up and forward? Look at this:

https://www.orthodontisteenligne.com/en/blog/19364/

Honestly, I'd be happy with TADS and palate widening if it helps without surgery.


I don't really know what to do. Any and all help appreciate. Thanks!

[Tiny]

TADS works better on kids, I believe.  Orthodontics can only take you so far.  Your teeth will always be trying to return to their original position.

The issue you face now is that your bite has been somewhat "corrected" via orthodontics - if it hadn't, then you'd certainly fit your insurance criteria to get it covered.

"a. Anteroposterior Discrepancies
1) Maxillary/Mandibular incisor relationship: overjet of 5mm or more, or a 0 to a negative
value (norm 2mm)."

"b. Vertical Discrepancies
Presence of a vertical facial skeletal deformity which is two or more standard deviations
from published norms for accepted skeletal landmarks.
1) Open bite"

After your pre-ortho work you'd fit the criteria as you'd have a proper open bite and probably an overjet of 5mm+

[dantheman]

Tiny,

Do you know what they look at (landmarks) for vertical excess?

[JayJaw]

What do you mean after my pre ortho work? You mean adjusting my teeth before jaw surgery? They would make my teeth worse and then it would fit criteria? If they made my bottom teeth straight I would definitely have big overjet. I imagine still and open bite of some sort due to the crowding of lowers and teeth not matching up.

I did wonder how they would work that out though. I feel like they need to do the surgery on lower jaw first tongive my teeth room to move. The upper has never been crowded but just narrow for my tongue. I guess it could be moved forward a little, but it is mostly low (moderate gummy smile... Though gum recession hides it a bit... ).

Anyway... should I go straight to a surgeon? An orthodontist?  Anyone in NYC that is recommended that takes aesthetics into consideration too? I'd love to go to AG since everyone gives them great reviews but do they take insurance at all? Since I can't afford it otherwise. It is my face though so if there is one thing in life to take care about... It is this.

Anyway. Thanks for help and any more would be great!

I still am scared of jaw surgery honestly but not sure I can get results otherwise. I wonder how likely it is I have sleep apnea or will get it? I guess maybe I should get a sleep sudy done, I suppose it will be required by insurance anyway.

[Tiny]

What do you mean after my pre ortho work? You mean adjusting my teeth before jaw surgery? They would make my teeth worse and then it would fit criteria?

Yes.  Your ortho work partially "corrected" your teeth

Consult a surgeon, NOT an ortho.  Explain the ortho work you already had done.  Get a ceph

Tiny,

Do you know what they look at (landmarks) for vertical excess?

Nope, sorry!

[JayJaw]

What should I expect in terms of pricing for surgeon consultations?

Also, are there any people recommend in NYC (or within 2-4 hour driving distance or within the northeast at least)? I've heard of Dr. Sachs / Schwartz but I don't think they take insurance? Dr. Jamali seems like he takes insurance, but he does more wisdom teeth and genioplasties than double jaw surgery it seems. What other options? I want someone who cares about aesthetics and, ultimately, you get one face... so I guess I'd forego insurance if the costs were "reasonable" I suppose. I could stomach under 20K perhaps. I don't know. I definitely can't see paying 40-50K and all the costs of traveling for someone like AG. Even if they seem to be the best and do CCW, which is what I guess I really need.

Also, what do you guys think in terms of what type of surgery/movement? I know you aren't surgeons, but you all have done research, looked at pictures, had surgery (well, some of you), so be helpful to get an idea before walking in to consultations.

[JayJaw]

That's good. But after reading more it seems like insurance will cover hospital fees but then if the surgeon has high fees, likely at nycoms, this would be higher than insurance feel it is worth. I assume they are "out of network" because of this. So it'll be expensive.

[Tiny]

Also, what do you guys think in terms of what type of surgery/movement? I know you aren't surgeons, but you all have done research, looked at pictures, had surgery (well, some of you), so be helpful to get an idea before walking in to consultations.

Bimax advancement.  BSSO and lefort

Advancement BSSOs are generally in the 5-12mm range with most surgeries being between 7 and 10mm, I feel.  You can get an additional 3-6mm from a genioplasty, depending on the anatomy.

People who are doubly recessed but more in the lower typically get movements of 4-5mm advancement of the upper and 8-10mm of the lower.  Plus sometimes SARPE/other widening of the upper and/or CCW if required

[JayJaw]

That's good to hear. Still, just one result is not necessarily enough for me. I might see him anyway though.