As per the title, I'll be having double jaw surgery to correct my Class 3 malocclusion in ~2 weeks.
I had my final visit with the surgeon a couple of days ago and he gave me the treatment plan, based upon my initial recommendations, along with the numbers. What I need are some suggestions because I feel that the values might be a little low.
- LeFort 1, 3 pieces (CPT code 21147): He will widen the maxilla along with moving the maxilla down a bit as he noticed a discrepancy with how the upper teeth meet with the lower teeth (the orthodontist cannot correct this), along with my lower third being a little short. He also mentioned performing a high LeFort 1 and moving my maxilla forward by 4 mm along with a CCW rotation (this involves the BSSO below).
- BSSO (CPT code 21196): He said he will only perform this procedure to correct an alignment issue; my midline is off a few mm. If my midline was not off (due to a previous childhood accident), he said he wouldn't need to do this.
- Genioplasty (CPT code 21120): He wants to perform a sliding genioplasty. He mentioned either 4 mm or 6 mm. He mentioned that the tools that he has vary in 2 mm increments, hence the jump from 4 mm to 6 mm. This will be paid for out of pocket.
My concerns are below:
- Moving the maxilla only 4 mm forward. Based upon my lateral ceph., how much would you (the experts) recommend? Also,
what is my current occlusal plane angle and what do I need to shoot for? 5-6 degrees? - BSSO only for alignment. If the maxilla gets moved more than 4 mm, I would imagine that the mandible would need to be lengthened as well. Also, my insurance covers CPT 21127 ("Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft," when medically necessary). Would this be something to look into due to my large gonial angle?
- Genioplasty. I understand that there is tissue ontop of the bone which provides projection, but is 6 mm sufficient? Would 8 mm be a better choice? Especially since this is coming out of pocket. Also, I would like him to widen (insert bone/graft) the chin as well.
This surgery date is not set in stone and I can call it off or postpone it. It is already in jeopardy since I'm coming off from a pretty bad cold.
Also, if anyone can recommend a qualified surgeon that I can pass my x-rays on to, that I can pay for an opinion/suggestions, that would be greatly appreciated.
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