What are some side effects of 3-piece surgeries?

[molestrip]

When the front segment is moved down, do you feel a ridge on your palate? Is there scarring there too? I've read the morbidity rate is 20%. Based off anecdotes, is that really true? I've met a few people who had them and everything seems fine for them.

[buzzhead]

I had my maxilla split lengthwise, moved forward and down.  Do you mean only having the the anterior segment moved down, not detaching the posterior maxilla?  Is this even done? 

[buzzhead]

And widened.

[Lazlo]

Sinn said it was no problem, teeth wouldn't die or anything. I'm having multi-segment. I will ask him about risks again.

[Tom2]

my upper jaw was split in two and widened.

only impact from that part of the surgery i know of 5 months post op is loss of feeling in my two front teeth and upper palette - both of which im told might return 12-18 post op.

[Lazlo]

my upper jaw was split in two and widened.

only impact from that part of the surgery i know of 5 months post op is loss of feeling in my two front teeth and upper palette - both of which im told might return 12-18 post op.

are the teeth dead? i.e. loss of colour/loose or anything, loss of interdental papilla/black triangle where the cut was made? or do you just not feel them? any complications speaking eating?

[molestrip]

I decided to come back and edit this to paragraph to simplify things. The odds of major complications are very small and minor complications small, under 10%. The main minor complications are periodontal defects and devitalized teeth needing root canals. Both have surgical error as factors but the latter also depends on age, general health, and bad luck. Shifting is also possible. Surgeons say it comes down to technique and they're probably right. I'm still trying to figure out if there's any cosmetic implications, such as ridges in the mouth or stuff like that. Otherwise, the main factor limiting it's usage is simply what it can accomplish, it can only expand the arch so much before SARPE is needed.

[Lazlo]

Yeah so I'm vaguely aware of all this and it makes sense. One of the patients had teeth die after surgery with Arnett. They turned black cause they were dead and then she had to have them bleeched but they still "worked". Sinn brushed off that there would be ANY problem lol.

I'll confront him directly and use your very message. I'll be seeing him in a month.

[molestrip]

Maybe edit it a little first? I was kidding about the burial ground stuff and I'm sure Dr Sinn cares about your long term health too. Just meant you won't be able to run back to him.

[buzzhead]

Well.......I am three weeks post op, feeling coming back on upper lip.  My palette has feeling.  It was split in a V front to back.  have tingling in lips and chin, hope that is a good sign.

[Tom2]

are the teeth dead? i.e. loss of colour/loose or anything, loss of interdental papilla/black triangle where the cut was made? or do you just not feel them? any complications speaking eating?

The teeth are alive but I can't feel them.  At this point, while sometimes strange, I hardly think about it and no other difficulties....ie chewing and speaking.   If they got a cavity/crack/infection, I would not feel it so thats an issue to some degree.

There are no visible dark spots or cosmetic abnormalities from that part of the surgery.   

There was concern about relapse after the surgery.    It was watched closely - particularly after the splint came out.   No issues have developed related to relapse.   My upper palette is now wider and the bite is good. 

[Tom2]

Well.......I am three weeks post op, feeling coming back on upper lip.  My palette has feeling.  It was split in a V front to back.  have tingling in lips and chin, hope that is a good sign.

Tingles and lighting strikes of feeling and or slight pain is how my feeling returned into my lips and chin.

My upper lip and cheeks returned fully - 100%

Lower lip and chin well - I can feel them but not like pre op.

[molestrip]

I haven't ever seen a case of CPRS. Is it less likely in the face for some reason?

Just to clarify from earlier, losing teeth can be that they die. It can also mean that they fall out and an implant is needed. I've only come across one case of that so far. The risk of this seems to be about .05% per tooth or about 1/100 surgeries, estimated from numbers given to me by two surgeons.

@Tom2 Glad to hear you're recovering well. I wouldn't worry about the lost feeling to the teeth. It's nice but not a big deal at all. Between the two, I'd rather have the reverse though, to have feeling but need a crown.

@FaceNit There's two types of relapse, short term and long term. Short term relapse happens when fixation fails and that's in the first 8 weeks. Long term relapse happens when bones remodel. I've come across both cases but long term relapse seems much more common. ICR is one cause but it can also be due to muscles and surrounding bones. Think about it, you've moved bones to a new location but connective tissue has grown to accommodate the old location so either the bone needs to remodel back to the old location or the connective tissue needs to change to accommodate the new bones. This is one reason why non-surgical palatal expansion often fails in adults. Even when successful it often relapses years later, zygomas are the suspected culprit I've read. Cases I've seen form long term relapse are over a few years. There are no 100-year studies on these surgeries, though they were done starting in the 1800s anything resembling a modern surgery is really only about 30 years old. Bones change considerably starting at about age 40, essentially undoing much of the forward growth experienced during childhood. You aren't fixed for life with these surgeries but you should be close to most of your peers at least, which means you'd be good for most of the life you'd expect to enjoy.

[terry947]

Tom2 is you whole upper palate numb? Can you feel your tongue resting on it?

Also solid post above molestrip.

I've seen cases of orthodontists closing open bites. Would it be smarter to first close the open bite through orthodontics then get JS?

[molestrip]

@terry947 Alignment and leveling is typical prior to surgery. If a 3-piece is a planned, then the surgeon will ask for a step in the archwire. I've read some stuff about decompensation, I don't see how it works though. I can see utility in decompensating teeth in model surgery for determining where to place the jaws to ensure the most stable outcome. Still going to be align and level at the end though.