Jaw regressing after 8 years...

[lizzies91]

Hello all,

I am looking for some advice. I had orthignathic surgery in 2008 at the age of 16. I had a horrible overbite, trouble speaking, eating -- the whole shebang. I had the surgery with a chin implant and everything went well and looked good for years. My quality of life improved exponentially. Long-term, both my surgeon and my orthodontist urged me to wear a retainer for three years after the removal of my braces, after which my jaw would be set. I wore my retainer religiously, until 2011. After I stopped using the retainer, my teeth felt fine for two years. If there was any movement of my jaw at all, I didn't consciously notice it.

In 2013, I noticed a small difference in my jaw, but it was so small I just brushed it off as a natural byproduct of no longer wearing braces. However, now it is two and a half years after that, and my jaw is well on its way to being as bad as it was before surgery. My bite is open (not as wide as before my surgery but it could get to that point again), my teeth do not line up with each other, and I can feel my lower jaw regressing and I notice changes day-to-day. My speech is becoming a large struggle again, and many people often tell me they can't understand what I'm saying. I'm sure other people who have had this surgery understand what a terrifying prospect this kind of regression is.

What I want to know is: is this something others are experiencing? If so, were there any steps you took to repair, or at least slow down, the regression? I visited my surgeon in July 2015 to discuss this with him, and he said the regression was unusual but would not get worse (it has most definitely gotten worse since visiting him). He also told me that another surgery was not an option and that braces (again) might help. I think, ultimately, the moral of the story is you should be wearing a retainer at least part of the time for the rest of your life to prevent teeth from moving, but also want to know if there's anything anyone recommends doing to help fix things at the stage I'm at right now.

Thanks!

[stupidjaws]

scary.

[needadvancement]

Very unfortunate. It really makes me ponder wether this would not have happened had you worn your retainer consistently.

[april]

I guess you have to figure out if it's ortho relapse or skeletal/surgical relapse and then go from there. Did your surgeon taken any new x-rays? New cephs should be taken as well as a CBCT to see if there's been any condylar resorption.  8 years is a long time for condylar resorption to have been induced by the surgery, although there probably are cases. But you might have always been 'on the edge'. Have you had any recent changes to your health? Sometimes resorption can be stirred up by a whole combination of things: hormones (the pill, pregnancy, parathyroid problems), bruxism, nutritional deficiencies, autoimmune diseases, trauma. Have you had any TMJ symptoms? It might not be condylar resorption, but if it is, I'd be pretty pissed at my surgeon for not telling me so.

[chinnychinchin]

Sorry to hear Can I ask what your tongue posture was this entire time? Was it resting on the bottom of your mouth, roof of mouth, or between your teeth?

[kjohnt]

You need to get more x-rays so you can compare now to post-surgery.  Please follow up after doing so.

[Picollo30]

lizzie you should've waited till 20/21 to do the jaw surgery, that's when the jaws stop developing.

you need to see another maxfac or two to check their opinions on what to do. you need new ceph and orthopantomography to know what's really going on.

[lizzies91]

Thanks for the suggestions. I'm making an appointment to visit the orthodontist (who I have not seen in several years) to get some new x-rays taken and see if, on a minor level, braces (again - UGH) or a retainer could stall the regression while a cause for this is determined. I'm going to call the surgeon to notify him of the continuing and worsening problems since I saw him last July to both get his opinion and to request that his office forward my medical records along to the orthodontist.

Bee18, thank you for the information. I have not had any TMJ symptoms (which were a huge problem before I had the surgery). I had never heard of condylar resorption before you mentioned it but reading about it was very thought-provoking and something I will bring up at my next meeting with either the surgeon or the orthodontist.

Chinnychinchin, my tongue posture had been very good until fairly recently. I had a major tongue thrust before surgery (I've wondered if the tongue thrust was the cause of all my job problems initially) but after my surgery my tongue rested neatly on the roof of my mouth behind my teeth like it was supposed to. It's only since the jaw has been moving that my tongue has posture has worsened and I now struggle to keep my tongue on the roof of my mouth. It's a very odd situation to say the least.

Picollo30, I don't remember there ever being any objections raised when I was 16 by the surgeon, my mother (who was an extremely intelligent nurse), the orthodontist or a periodontal surgeon I went to. I even knew a few others around my age who had the surgery done as well. I'm not disputing your comment -- looking back on it, I wish I would have waited until I was older although at 16 waiting that long would have seemed nearly impossible -- but my situation, to the best of my knowledge, was far from unusual.

Will post when I have updates.

[kjohnt]

Also do you still have the plates and screws used for fixation attached to the bone or did you have them removed at any point post-surgery?

[chinnychinchin]

Chinnychinchin, my tongue posture had been very good until fairly recently. I had a major tongue thrust before surgery (I've wondered if the tongue thrust was the cause of all my job problems initially) but after my surgery my tongue rested neatly on the roof of my mouth behind my teeth like it was supposed to. It's only since the jaw has been moving that my tongue has posture has worsened and I now struggle to keep my tongue on the roof of my mouth. It's a very odd situation to say the least.

My surgeon has mentioned that thrusting your tongue through your teeth will cause an open bite over time, even after jaw surgery. The tongue is in fact quite a strong muscle indeed. I do think it has something to do with your initial deformity and possibly your regression. It's obviously too late to do anything about it but definitely keep in mind about fixing that habit post-op! Best of luck!