Help, advice lots to consider

[Wellconfused]

Hi Everyone,

It has taken me years to get to this stage alone and am now faced with some decisions on the options given. I will try and give an in depth overview covering everything. I am based in the UK inacse of any phrases or differences.

I am 35yo male and have, since late teens been aware of a weak chin. I had braces as a teenager top and bottom and had 4 teeth taken out. Since having braces, a few years had passed and I became aware of having an overbite (can assume it was there at completion of braces, certainly not before) and obviously reeceding lower jaw. I have put up with it since, not thinking there was anything that could havebeen done.

In recent years, my side profile has really began to grate on me, maybe the odd comments from colleagues etc has taken its toll.
I then raised the issue with my local dentist who said the issue was skeletal and as my teeth had moved a little since the braces they referred me to my local hospital orthadontist. Here I saw a team of dentists who agreed I had a weak chin due to my lower jaw and also noted down some crowding on the teeth, They recommended double jaw surgery after approx 18months of braces which would address the teeth and side profile.
I had some xrays done also. Whilst thinking over this and waiting for the xray results I had a consultation with a plastic surgeon regarding chin implants and the pro's/cons (obviously aware it will only improve the side profile not teeth)
I then went back to the orthodontists for a review with the x-ray's and this is when they told me normal jaw surgery would not suit my jaw make up as the lower jaw had atrophy and reffered me onto more of a specialist in this area.

Here I met with a doctor I am currently still under who diagnosed me with condylar atrophy, anterior open bite, retrognathic mandible and infomed me the lower jaw would not be strong enough?  to support normal jaw surgery due to the atrophy and has given me the following  treatment options. Prior to this I said my main concern is my profile more than the teeth. (I do not have any tmj problems or any issues with eating etc)

A management plan he gave was this;-

Bimaxillary osteotomywith counter clockwise advancement and bilateral joint replacements or genioplasty.

Whilst this has been going on I pushed for a sleep study to be done as im aware I am a bad snorer. The results of this are that I have mild sleep apnea, so something else to add to the list. I went to see a specialist regarding this who didnt offer much help as he said its mild and due to not being overweight or having any other factors other than my skeletal make up has left it with me going down the route with the orthodontist. (to note I have a very low epworth score)

I have seen the specilaist once since finding out about the sleep apnea, he said there is something he can do with the genioplasty to help with the sleep apnea but stated his other option would better treat the issue.

So as it stands I am left with making a choice if I want to go down any of those routes and which one. Being honest its clear that the first option although long winded and much more invasive will tick all the issues rather than just the genioplasty that will only improve the side profile and possibly the sleep apnea. I am basically stuck on what to do, one part of me says to just go with it but then I worry about any issues espcially surrounding jaw joints as there doesnt seem to be much on the net about it / long term issues etc.
I would say not looking at the sleep apnea I was 70/30 for my profile over teeth as being a problem. Prior to the sleep apnea I had pretty much decided on the genioplasty and if the teeth still bothered me, maybe sort orthadontists out inthe future.

Any help, advice anyone on here can give would be gratefully recieved.
Thanks

[kavan]

Hi Everyone,

It has taken me years to get to this stage alone and am now faced with some decisions on the options given. I will try and give an in depth overview covering everything. I am based in the UK inacse of any phrases or differences.

I am 35yo male and have, since late teens been aware of a weak chin. I had braces as a teenager top and bottom and had 4 teeth taken out. Since having braces, a few years had passed and I became aware of having an overbite (can assume it was there at completion of braces, certainly not before) and obviously reeceding lower jaw. I have put up with it since, not thinking there was anything that could havebeen done.

In recent years, my side profile has really began to grate on me, maybe the odd comments from colleagues etc has taken its toll.
I then raised the issue with my local dentist who said the issue was skeletal and as my teeth had moved a little since the braces they referred me to my local hospital orthadontist. Here I saw a team of dentists who agreed I had a weak chin due to my lower jaw and also noted down some crowding on the teeth, They recommended double jaw surgery after approx 18months of braces which would address the teeth and side profile.
I had some xrays done also. Whilst thinking over this and waiting for the xray results I had a consultation with a plastic surgeon regarding chin implants and the pro's/cons (obviously aware it will only improve the side profile not teeth)
I then went back to the orthodontists for a review with the x-ray's and this is when they told me normal jaw surgery would not suit my jaw make up as the lower jaw had atrophy and reffered me onto more of a specialist in this area.

Here I met with a doctor I am currently still under who diagnosed me with condylar atrophy, anterior open bite, retrognathic mandible and infomed me the lower jaw would not be strong enough?  to support normal jaw surgery due to the atrophy and has given me the following  treatment options. Prior to this I said my main concern is my profile more than the teeth. (I do not have any tmj problems or any issues with eating etc)

A management plan he gave was this;-

Bimaxillary osteotomywith counter clockwise advancement and bilateral joint replacements or genioplasty.

Whilst this has been going on I pushed for a sleep study to be done as im aware I am a bad snorer. The results of this are that I have mild sleep apnea, so something else to add to the list. I went to see a specialist regarding this who didnt offer much help as he said its mild and due to not being overweight or having any other factors other than my skeletal make up has left it with me going down the route with the orthodontist. (to note I have a very low epworth score)

I have seen the specilaist once since finding out about the sleep apnea, he said there is something he can do with the genioplasty to help with the sleep apnea but stated his other option would better treat the issue.

So as it stands I am left with making a choice if I want to go down any of those routes and which one. Being honest its clear that the first option although long winded and much more invasive will tick all the issues rather than just the genioplasty that will only improve the side profile and possibly the sleep apnea. I am basically stuck on what to do, one part of me says to just go with it but then I worry about any issues espcially surrounding jaw joints as there doesnt seem to be much on the net about it / long term issues etc.
I would say not looking at the sleep apnea I was 70/30 for my profile over teeth as being a problem. Prior to the sleep apnea I had pretty much decided on the genioplasty and if the teeth still bothered me, maybe sort orthadontists out inthe future.

Any help, advice anyone on here can give would be gratefully recieved.
Thanks

Most likely the bi max with counter clockwise rotation of maxilla and BSSO of lower jaw WITH chin genio altogether. But you need to consult around as to get a 2nd opinion on the joint replacements with it.

[april]

It sounds like you have condylar resorption as a result of orthodontics, and they're saying that surgery won't be stable without the joint replacements.


Even though it's true - you are at high risk of relapse if you do lower jaw surgery - I still would absolutely get a 2nd, 3rd, 4th opinion before cutting out your joints, especially given that you don't experience any TMJ dysfunction. It will be a life long commitment to surgery (they won't last as long as they claim), and infection will require them to be taken out. I know in the UK they are pretty gung-ho with joint replacements though, so you probably won't have many options there. If it were me, I would do the genio, or  I would contact Gunson's office and ask for any surgeon recommendations in the UK. His approach is different, and he works on many with condylar resorption. Or go see him for a consult if you're willing to travel (and wait...).

[Wellconfused]

Thanks Kavan and April for your replies. Yes my main concern with the joint replacements is that its will not last forever and could as you say bring about new issues, are there any alternatives than the joint replacements that you have heard of ? I think the Consultant mentioned distraction osteogenesis at some point but again was concerned regarding relapse / stability of my jaw as is?
And on that am I like to have issues seeing as my condyles have resorbed ? Ie tmj / biting/ anythjg reLly. I dont at the minute but weird to think i dont have those top bits which attach to the upper jaw yet no isues?

Sliding genioplasty will definitely help profile but I read mixed reciews on the sleep apnea side.
Thanks again.

[kavan]

Thanks Kavan and April for your replies. Yes my main concern with the joint replacements is that its will not last forever and could as you say bring about new issues, are there any alternatives than the joint replacements that you have heard of ? I think the Consultant mentioned distraction osteogenesis at some point but again was concerned regarding relapse / stability of my jaw as is?
And on that am I like to have issues seeing as my condyles have resorbed ? Ie tmj / biting/ anythjg reLly. I dont at the minute but weird to think i dont have those top bits which attach to the upper jaw yet no isues?

Sliding genioplasty will definitely help profile but I read mixed reciews on the sleep apnea side.
Thanks again.

Well, you would have to weigh the prospect of the joint replacements not lasting for ever VS. the prospect of the maxfax surgery NOT holding up WITHOUT joint replacements. It seems like the doc is telling you that the RISK of the surgery FAILING is HIGH without the replacements.

This might be true. But if it's a matter of joint replacements, there is a higher bar of capacity, experience associated with that and in turn, precipitates a search for docs who are most conversant in joint replacements.

The 'big name' associated with joint replacements is Wolford (who is not in the UK). So, maybe read up on him and try to look for docs in the UK who might have studied with him or at least are well versed in the techniques he teaches and has contributed to the venue of joint replacement surgery.

[CCW]

are there any alternatives than the joint replacements that you have heard of ?

Yeah, first meds to stabilize the condition followed by surgery. Gunson never does TJR and has good results with his approach.

https://www.arnettgunson.com/condylar-resorption/

[Fowler]

Wellconfused - Have you made any progress at all?  I echo the points kavan made about possible relapse without tmj replacements. Due to a bony spur in my left tmj, I had to have a condoylectomy which has left me unable to have bimax unless I have replacement tmj's fitted.

Not sure how many people have had new joints fitted as well as bimax so would be good to hear if you have made progress.