Problem: I have an underbite and crossbite due to a recessed maxilla, a recessed mandible (less recessed than the maxilla), and transverse discrepancy. I have consulted with 2 surgeons, both of whom say that my problem requires double jaw surgery with 3-piece LeFort I expansion of the maxilla, counterclockwise rotation of the maxilla and mandible, and possibly genioplasty. Here is my ceph (taken recently).
https://drive.google.com/file/d/1sgBRyTMjNVQ3nlnD-qDvD6_T2dmPx7R6/view.
Situation: I have been in Invisalign treatment for the past 10 months to decompensate my teeth. Surgeon A has been rushing me to proceed with jaw surgery for months now, and I'm scheduled for jaw surgery with him in a few weeks. I don't have a plan from him yet, but he's indicated that he wants to do about 5mm of maxillary expansion. Surgeon B has said I could use 10mm of maxillary expansion, but that with my teeth where they are right now, my upper jaw could only be expanded 2-3mm. He says that in order to maximize maxillary expansion, my lower molars need to be significantly uprighted and torqued so that the roots go into the bone and the crowns of the teeth come out. And this would require braces.
Questions:
1. How do you determine how much maxillary expansion you need? Why would Surgeon A say I need 5mm of expansion, while Surgeon B says I need 10mm of expansion? Why would they disagree?
2. Are there any risks of going with Surgeon A's smaller expansion? Could it leave my crossbite unsolved? Greater relapse risk? Aesthetic risks?
3. What do the lower molars have to do with the expansion of the maxilla? Why can't the maxilla be expanded as much as needed, and then the lower molars can be uprighted after surgery?
4. What might account for why Surgeon B is saying the current state of my lower molars permits only 2-3mm of maxillary expansion, while Surgeon A is saying he can do 5mm? Is Surgeon A doing something that is risky?
