Jaw Surgery - Your opinion please

[slysurfz]

Hi

I am 35, male and have a deep bite, class II malocclusion and moderate sleep apnea. I also have impacted wisdom teeth which will need to be taken out. I am currently in braces and headed towards jaw surgery.

I have consulted with a prominent surgeon in North California  as he is one of the prominent names in that area. During the consult he said the jaw will have to be moved by 10mm and that he will basically fix the bite and sleep apnea there was no facial analysis or considerations that he talked about. I asked him about the nose upturning and chipmunk look and he said he will take care of it with his technique and the chipmunk look is not going to be an issue as my maxilla is flat. I did not feel the consult was thorough enough for me to be comfortable. He also said he can just move the jaws forward without getting braces but my bite will be same or after braces. The other consideration was getting wisdom teeth which could be done either 6months before surgery or also during surgery.

After that I went to another surgeon in New York for wisdom teeth removal who was very nice and considerate and advise me I should get the wisdom teeth removed at the same time of the jaw surgery. We ran it past surgeon in CA and he agreed.

I started the ortho treatment to get the ball rolling, CA surgeon did not provide any specific instructions to the ortho after we reached out to him.

6 months into the ortho and reading a million blogs and forums I asked CA surgeon  for a surgical plan and what surgeries he would be doing specifically. He is very prompt in responding but not very clear. He basically said the jaws will be advanced 10mm and there will be no CCW as my mandibular plane is flat he will make adjustments for deep bite.

Now, I am worried about the facial outcome and the sleep apnea being resolved. I do see that the mandible is too flat and CCW is not feasible but I also see that chin is overprojected and would need to be handled maybe a little CW rotation or a reduction.

I am now thinking of consulting with Arnett/Gunson, Posnick and Neugarten. A/G seem to have the most professional and streamlined consultation process based on their website

Pics in the link  below. Please weigh in. Pics are taken neutral setting by ortho


Thank you.

[slysurfz]

ubsanders thank you for the response.

Did you have sleep apnea before surgery? did that get resolved after?
 
I don't have a 10mm overbite its the forward movement of the jaw he wants to do. I am pretty sure he has not simulated the surgery yet.

I am definitely going to get some more consults

[LyraM45]

I just sent you a PM, Slysurfz.  I think I know what surgeon you're talking about.  And I got the same feeling from him in consult-- way too rushed, wasn't giving me the time/attention, and he was awfully arrogant feeling to me.  Just not my cup of tea.  I consulted with a few other CA surgeons, including Gunson, and I ended up choosing a guy in Walnut Creek.  Definitely hit the pavement and go on the consuls.  Your surgeon should be taking with your ortho in great amounts.  You should be able to have a plan.  I didn't get this with my first surgery and it was a huge mistake and red flag.  It definitely contributed to my botched result that needed to be redone (original surgery was with felice o'ryan with kaiser oakland).  But for sure, go on as many consults as possible.  If you are feeling in your gut things aren't right with the one guy, then you're probably right. My gut has been right EVERY single time in this process.

Gunson is for sure worth the drive down to consult with.  It may take a while to get in with him though.  Last I heard his wait time was about 4 months.  If you want to call my revision surgeon in walnut creek (nestor karas), last I heard he was not taking new jaw patients.  Explain your situation to him and tell him you found my blog and wanted to see him and hopefully they can squeeze you in for consult.

Best of luck, but in general, do follow your gut on this!  I wish I had the first time!

[ditterbo]

I just sent you a PM, Slysurfz.  I think I know what surgeon you're talking about.  And I got the same feeling from him in consult-- way too rushed, wasn't giving me the time/attention, and he was awfully arrogant feeling to me.  Just not my cup of tea.  I consulted with a few other CA surgeons, including Gunson, and I ended up choosing a guy in Walnut Creek.  Definitely hit the pavement and go on the consuls.  Your surgeon should be taking with your ortho in great amounts. You should be able to have a plan.  I didn't get this with my first surgery and it was a huge mistake and red flag.  It definitely contributed to my botched result that needed to be redone (original surgery was with felice o'ryan with kaiser oakland).  But for sure, go on as many consults as possible.  If you are feeling in your gut things aren't right with the one guy, then you're probably right. My gut has been right EVERY single time in this process.

Gunson is for sure worth the drive down to consult with.  It may take a while to get in with him though.  Last I heard his wait time was about 4 months.  If you want to call my revision surgeon in walnut creek (nestor karas), last I heard he was not taking new jaw patients.  Explain your situation to him and tell him you found my blog and wanted to see him and hopefully they can squeeze you in for consult.

Best of luck, but in general, do follow your gut on this!  I wish I had the first time!

I'm in DC but visited like Gunson and it seems California in general is where a lot of the better US max facs are at.  Gunson literally doesn't know any ortho's in DC, but I know of a local ortho that seem willing to work with him, at least on the face of it.  Is that too much trouble and/or risk, and I should instead stick with max facs that have established relations with local orthos?

[CCW]

I'm in DC but visited like Gunson and it seems California in general is where a lot of the better US max facs are at.  Gunson literally doesn't know any ortho's in DC, but I know of a local ortho that seem willing to work with him, at least on the face of it.  Is that too much trouble and/or risk, and I should instead stick with max facs that have established relations with local orthos?

I don't think the ortho matters too much as long as s/he is willing to follow Gunson's instructions and knows who's running the show and doesn't try to fix the bite orthodontically.

[PloskoPlus]

I don't think the ortho matters too much as long as s/he is willing to follow Gunson's instructions and knows who's running the show and doesn't try to fix the bite orthodontically.

I used to think the same, but some orthodontists simply can't work with surgical cases. Surprising, but true. A good ortho is also very important.

[CCW]

I used to think the same, but some orthodontists simply can't work with surgical cases. Surprising, but true. A good ortho is also very important.

Do good orthos even exist? Most of them are useless morons.

[LyraM45]

I'm in DC but visited like Gunson and it seems California in general is where a lot of the better US max facs are at.  Gunson literally doesn't know any ortho's in DC, but I know of a local ortho that seem willing to work with him, at least on the face of it.  Is that too much trouble and/or risk, and I should instead stick with max facs that have established relations with local orthos?

A good ortho is key. I know a few gunson patients who have done surgery with him with an east coast ortho.  He'll be doing video chats and keeping tabs and checking in that way.  If you have an ortho who is willing to do it, then it's for sure an option!

[LyraM45]

I used to think the same, but some orthodontists simply can't work with surgical cases. Surprising, but true. A good ortho is also very important.

SO. MUCH. YES!!!!!  A good ortho is key.  My first ortho destroyed my teeth and did EVERYTHING wrong to set me up for surgery and everything wrong post op as well. I am losing 7 front teeth now because of him.  So, get yourself a good ortho.  For revision I wanted one that was not only familiar with surgical cases, but was familiar with a tough revision case AND worked with the surgeon I wanted to get my work done with.  I was very fortunate enough to satisfy everything I was looking for and they did a phenomenal job. 

[PloskoPlus]

SO. MUCH. YES!!!!!  A good ortho is key.  My first ortho destroyed my teeth and did EVERYTHING wrong to set me up for surgery and everything wrong post op as well. I am losing 7 front teeth now because of him.  So, get yourself a good ortho.  For revision I wanted one that was not only familiar with surgical cases, but was familiar with a tough revision case AND worked with the surgeon I wanted to get my work done with.  I was very fortunate enough to satisfy everything I was looking for and they did a phenomenal job.

Fwiw, Wolford was full of praise for my ortho. Apparently he did a great job.