Poor aestethic results from double jaw surgery

[Snackan1986]

Hi everybody

Had double jaw surgery September 2012 to correct open bite, overbite and also correct a little of asymmetry. I don?t know my exact measures from surgery but the lower jaw was advanced about 10 mm and then the upper jaw was impacted downward (I think that?s the term). No genioplasty yet however I guess I will have to do that as well. Just that I am not really pleased about the aesthetics netither the bite, since I only bite together with 2 teeth on my left side, and 4 on the right. Also I have begun to wonder if I did not have needed a counter clockwise rotation instead. That way the chin should also have come forward more I guess. What do you say about the pictures below, is a genio enough to do to get a quite good profile and hopefully "cure" lip incompetence and mentalis strain and also what do you say about my theory on counter clockwise rotation? (The front pics are  2-3 months post surgery and side profile is a new pic, 9 months post op). Don?t have any before pics at the moment though



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[Snackan1986]

I will try to update the pics with better and bigger quality ASAP

[stupidjaws]

pics are terrible and it's tough to say!

[Snackan1986]

Hi again,

I have tried to take better pics (obviously I?m the worst photographer ever and my phone?s camera is not good enough). Anyway please see the two new attachement?s which at least is a little bit better, even tried to mark out the jaw line in one of them with small dots.

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[Kristen]

Yes I believe ccw should be done

[Marisama]

One major reason why I strongly oppose Obamacare.

[Alue]

Hmm, I'm curious to see the before photos.  I do agree that ccw may have given a better result, I think it's a case by case basis, but with your facial structure it would make sense.  It doesn't sound like your bite is aligning well either.

[Snackan1986]

I appreciate your comments...

I have looked for before photos but can?t find any that show the jaw or face in a good view. I think I will make a claim to the hospital that I want to have a copy of my journal, so hopefully the before pics are included there, however it will take a while before I will get it though, but when I do I will of course upload them. I will keep looking through my computer as well.

Seems like most of you are saying a CCW should have given a better result at least aestethically. I hope the surgeon have a good explanation why they did not do a CCW. I have requested a meeting with the surgeon however not until mid August. Anyway I wonder what makes CCW more risky, since I read on Arnett/Gunson homepage that a lot of surgeons won?t due CCW due to ?poor stability?, which Arnett/Gunson don?t agree with I think. Is CCW also to prefer to improve the bite not just aesthetically in cases where the mandible is too vertical? I am not so excited to do a really big genioplasty (with unnatural look) just to hide a poor result from double jaw surgery if it could have been much better with CCW but of course not so keen on going through double jaw surgery again. I have tried to find some x-rays on Google which shows CCW before and after but I have not found any good ones.

Alue: My bite is far from perfect, but it?s of course much better than before surgery. I hoped it would be better, but now I feel that maybe my expectations was too high, but looking on pictures from other people who had open bite their bite look much better than mine. So far I also have some other benefits from the surgery including that my jaw can relax a little bit more and I have not had much jaw pain as before surgery, to set things into perspective.

[Sharptoys]

Your case exemplifies two things:

1. The importance of the genioplasty for patients with extremely high mandibular plane angles (MPA).

In these cases, genioplasties have an effect entirely out of proportion to their cost. Using an upward and forward movement, they can be used to correct a surprising amount of anterosuperior deficiency. Depending on your current mandibular contour, you can gain up to 8mm of chin projection with a standard sliding genioplasty; this effect will be magnified further by the superiorly directed movement.

2. The aesthetic limitations of linear movement for said patients.

Obviously, a 10mm advancement is a fairly large for any surgical advancement. However, in extremely high MPA cases, a large part (if not the majority) of the advancement actually translates to vertical--rather than horizontal--movement. In the absence of a genioplasty or significant impaction, the face is actually lengthened, and the chin only marginally advanced, both of which contribute to an unsatisfactory result.

[Snackan1986]

Hi all,

Finally received my x-rays. Before braces, braces, one day after surgery (lots of swelling so does not look good and 9 months post surgery + before and after "sketch". Press on Img001.pdf below to see the before and after "sketch".

A correction of the last posts I made. I said the lower jaw was advanced 10 mm, however it was not true, much less however the surgeon gave me no number, but just said it was not much advanced, but it was advanced more on the right side than left side.

My bite right now. I can bite together with one tooth on my left side and like 3-4 on the right side. Can barely chew on left side.
Also my lip incompetence is quite bad and a lot of strain and muscle tension to make my lip meet and I have difficulties to really relaxe my facial muscles and my lips "wants to close" however since it takes so much effort my whole face get tensed. So I always try to relaxe as much as possible in lips and chin but it?s difficult.

Face: Almost seem like the braces did more to the profile than the surgery did

My options:
#Redo surgery so my bite on left side will improve,
#Genioplasty of 8-10 mm I think they said which would give me like 6-7 mm. How much could a genioplasty improve lip incompetence (muscle tensions)?
#Shave on the back teeth on my left side (I don?t think this will improve the result but could actually make it worse since it would only improve the bite so slightly so I refused this option when I visited them last week)
#Do nothing


Any comments?





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[pekay]

Snackan1986: Don't you live in Sweden?

[Snackan1986]

Snackan1986: Don't you live in Sweden?

Yes, I live in Sweden...quite far from US I know:)

[overbiter]

Hi Snackan1986. I'm sorry to have to tell you this but from the looks of the images you posted before, and these X-rays, your surgeon is not very skilled at all. To me you still look like someone who needs jaw surgery, not someone who has had jaw surgery. Your surgeon doesn't seem to have addressed your issues with having a steep jaw angle and severe recession. I can't believe he admitted to not giving you much advancement, that's just shabby. Why did he think you were getting surgery?

Aesthetics wise, and bitewise you still need another surgery. A genioplasty won't do for you either because of your steep occlusal plane. It would look strange. Are there any other surgeons in Sweden that you trust and who can see you?

[sanddunes]

Hey,

I do believe you need another jaw surgery.  I feel like there is so much that could be done in a second surgery to help you aesthetically and functionally.  You need a genioplasty also, but I would not consider one by itself without fixing your jaw and bite issues first. 

If I were you I would be firm in asking the surgeon exactly what moves were made to your jaws the first time.  How many mm's did your lower jaw move forward, upper jaw move forward, how much impaction did you have, did you have any rotation?

It doesn't fly well with me that your surgeon told you he was going to move your lower mandible 10mm but then he didn't, and you don't even know how much he ended up moving it?  You have a right to know exactly what was done in the OR.  It is just plain sloppy if the surgeon can't even tell you EXACTLY how many mm's you were advanced.  These things should be planned out 100% using cephalometric tracings before the surgery, and the plan should not change during surgery.

I sadly agree that your surgeon appears to be incompetent.  Please find the best surgeons you can and get their opinion.  Aesthetically and functionally you can still get your issues fixed in the hands of a great surgeon.

[Lazlo]

Hey,

listen dude, for you I think you NEED arnett to do your surgery, but ask for a genio as well. Reason I'm even advocating this is I recall on one of the forums, maybe it was jawsurgeryblogs or some other that there was a girl from sweden who got her surgery done with arnett/gunson and the swedish govt. paid for it since you guys have such good socialized healthcare.

DUDE, inquire, plead, force your govt to pay for your surgery. Your results are (don't feel bad, it can be fixed) the worse I've seen ever. But again, it can all be fixed, you're a handsome guy, great bone structure, you're really young, you'll look like a model once you get this s**t corrected and more imp. you might be able to have it all done for free. Now I'm not exactly sure whether the chick was from Norway or Sweden --but whatever potatoe potahtoe, contact your embassy, head of whatever govt. healthcare agency, make a MASSIVE case that your surgeon f**ked up and the only people you'll trust are in California --I think it will work and you'll end up with great results!