Orthognathic surgery: The definitive answer?

[ghiggson90]

https://us.dental-tribune.com/clinical/orthognathic-surgery-the-definitive-answer/

A damning review of the state of orthognathic surgery: unacceptable rate and breadth of complications, long-term instability, psychological distress, etc.

"The science is clear: the center of gravity in our clinical practice must shift toward earlier, more preventative interventions to at least attempt to avoid the prospect of surgery.

It also seems as if some practitioners are holding this truth at arm’s length, because if they acknowledge it, then the legal and moral imperative for sweeping reform will be inescapable."

[GJ]

They described orthognathic surgery as having “many possible complications,” with a staggering 27 percent of patients experiencing complications from nerve damage to blindness. Perhaps more concerning is the fact that this review did not involve complications related to surgical planning, which no doubt would inflate the figures further.

This is exactly right. I know so many people with bad outcomes. Their cases are documented nowhere. Many times the surgeon deems them a success, so they probably check that box if/when reporting a result.

[april]

About downward movement relapse

“Problematic” describes mandibular setback, downward movement of the maxilla and widening of the maxilla in the first post-surgical year, with mandibular setback and downward movement of the maxilla without rigid fixation showing 67 percent to have moderate relapse and 20 percent having a highly significant change.

This seems like out-of-date info because it says "without rigid fixation". Wouldn't all surgeons use rigid fixation these days?

[kavan]

The author: Dr Rohan Wijey is a DENTIST in Australia who has a vested financial interest in myofunctional therapy devices. That is found by looking into who wrote the article.

It is not too much different from an ortho having a vested interest in 'getting the bite right' where that as a LONE goal has made aesthetic problems to patients for whom if they knew any better at the time, they would have considered the maxfax surgery.

Ever read of patients on here bemoaning their face aesthetics were f**ked up BECAUSE the ortho only was the 'definitive answer' (when it really wasn't)? Goal of the ortho being surgery AVOIDANCE. They are seeking out SURGERY and to do it, they have to go through DECOMPENSATION of the prior ortho work aime at AVOIDING surgery.

Bottom line is that neither ortho braces nor 'myofunctional' devices are going to produce the results of a maxfax surgery IF the patient is indeed a candidate for the surgery. At best the type of myofunctional devices he has a VESTED financial interest in (which to me was palpable even before I looked him up because I suspected he was so vested) would do something for the types who get up here asking; 'Do I need surgery?' and the answer is 'NO'. At worst, the author seems to be of the ilk of the type of orthos telling patients who would need surgery to avoid it.

Well, dahhh...of course there are more complications with a surgery than there are with braces or other ortho devices alone and lets face it some of these orthos who have pushed backwards people's faces as to negatively impact their aesthetics and with sole goal of getting the 'bite right' don't consider a poor aesthetic outcome a 'complication'.

[Post bimax]

The author: Dr Rohan Wijey is a DENTIST in Australia who has a vested financial interest in myofunctional therapy devices. That is found by looking into who wrote the article.

It is not too much different from an ortho having a vested interest in 'getting the bite right' where that as a LONE goal has made aesthetic problems to patients for whom if they knew any better at the time, they would have considered the maxfax surgery.

Ever read of patients on here bemoaning their face aesthetics were f**ked up BECAUSE the ortho only was the 'definitive answer' (when it really wasn't)? Goal of the ortho being surgery AVOIDANCE. They are seeking out SURGERY and to do it, they have to go through DECOMPENSATION of the prior ortho work aime at AVOIDING surgery.

Bottom line is that neither ortho braces nor 'myofunctional' devices are going to produce the results of a maxfax surgery IF the patient is indeed a candidate for the surgery. At best the type of myofunctional devices he has a VESTED financial interest in (which to me was palpable even before I looked him up because I suspected he was so vested) would do something for the types who get up here asking; 'Do I need surgery?' and the answer is 'NO'. At worst, the author seems to be of the ilk of the type of orthos telling patients who would need surgery to avoid it.

Well, dahhh...of course there are more complications with a surgery than there are with braces or other ortho devices alone and lets face it some of these orthos who have pushed backwards people's faces as to negatively impact their aesthetics and with sole goal of getting the 'bite right' don't consider a poor aesthetic outcome a 'complication'.

+karma

[kavan]

+karma

 

[ghiggson90]

The author: Dr Rohan Wijey is a DENTIST in Australia who has a vested financial interest in myofunctional therapy devices. That is found by looking into who wrote the article.

It is not too much different from an ortho having a vested interest in 'getting the bite right' where that as a LONE goal has made aesthetic problems to patients for whom if they knew any better at the time, they would have considered the maxfax surgery.

Ever read of patients on here bemoaning their face aesthetics were f**ked up BECAUSE the ortho only was the 'definitive answer' (when it really wasn't)? Goal of the ortho being surgery AVOIDANCE. They are seeking out SURGERY and to do it, they have to go through DECOMPENSATION of the prior ortho work aime at AVOIDING surgery.

Bottom line is that neither ortho braces nor 'myofunctional' devices are going to produce the results of a maxfax surgery IF the patient is indeed a candidate for the surgery. At best the type of myofunctional devices he has a VESTED financial interest in (which to me was palpable even before I looked him up because I suspected he was so vested) would do something for the types who get up here asking; 'Do I need surgery?' and the answer is 'NO'. At worst, the author seems to be of the ilk of the type of orthos telling patients who would need surgery to avoid it.

Well, dahhh...of course there are more complications with a surgery than there are with braces or other ortho devices alone and lets face it some of these orthos who have pushed backwards people's faces as to negatively impact their aesthetics and with sole goal of getting the 'bite right' don't consider a poor aesthetic outcome a 'complication'.

Point taken, but:

(1) Notwithstanding his financial interests, he is nonetheless right that "muscle-centric myofunctional pre-orthodontic treatment offers patients, who may otherwise require surgery, exceptional prospects for healthy, correct facial development and may prevent the need for more extreme treatment modalities. Furthermore, even if traditional orthodontics is unavoidable, treatment may become less complex and more stable if a myofunctional orthodontic element is incorporated."

(2) Patients overwhelmingly rely on surgeons to tell them if they need surgery. Even bigger conflict there.

[kavan]

Point taken, but:

(1) Notwithstanding his financial interests, he is nonetheless right that "muscle-centric myofunctional pre-orthodontic treatment offers patients, who may otherwise require surgery, exceptional prospects for healthy, correct facial development and may prevent the need for more extreme treatment modalities. Furthermore, even if traditional orthodontics is unavoidable, treatment may become less complex and more stable if a myofunctional orthodontic element is incorporated."

(2) Patients overwhelmingly rely on surgeons to tell them if they need surgery. Even bigger conflict there.

Thing is a lot of those types of devices are best used in the EARLY GROWTH stages; children adolescents. Recessed jaws are more 'push outable' in those stages when skeletal growth can be directed by them. Watched a video of him being interviewed. The backdrop was his sitting in a play room for children.

Actually, it's common practice for a patient to first go to an ortho where the ortho could recognize a skeletal imbalance that could be corrected with surgery but fails to discuss that option. A good number of orthos just wanting to make the 'bite right' disregard the prospect of 'ortho alone' making the skeletal imbalance worse and thereby making a person with the 'bite rite' look worse aesthetically. Often the protocol (except for self pay patients who have decided themselves they would like surgery) is to get a referral from an ortho first.

[Post bimax]

Thing is a lot of those types of devices are best used in the EARLY GROWTH stages; children adolescents. Recessed jaws are more 'push outable' in those stages when skeletal growth can be directed by them. Watched a video of him being interviewed. The backdrop was his sitting in a play room for children.

Actually, it's common practice for a patient to first go to an ortho where the ortho could recognize a skeletal imbalance that could be corrected with surgery but fails to discuss that option. A good number of orthos just wanting to make the 'bite right' disregard the prospect of 'ortho alone' making the skeletal imbalance worse and thereby making a person with the 'bite rite' look worse aesthetically. Often the protocol (except for self pay patients who have decided themselves they would like surgery) is to get a referral from an ortho first.

This is essentially what happened to me, except the ortho proposed surgery and my parents declined (I was 13). I only went back to the same ortho in adulthood when my bite re-opened. I’m actually glad my parents deferred at the time because I don’t think my jaw was done growing. I also think a revision (should I opt for one) is more viable 1-2 years post op than 10-11 due to bone growth over the hardware.

[kavan]

This is essentially what happened to me, except the ortho proposed surgery and my parents declined (I was 13). I only went back to the same ortho in adulthood when my bite re-opened. I’m actually glad my parents deferred at the time because I don’t think my jaw was done growing. I also think a revision (should I opt for one) is more viable 1-2 years post op than 10-11 due to bone growth over the hardware.

Yes. 1-2 years good wait time for the revision and yes, 13 is not finished with the growth stage but not sure if it precludes a surgery.

+ to you.

[GJ]

+ to you.

Get a hotel, you two.

[kavan]

Get a hotel, you two.

+ to you. we can book for 3