Le Forte one 3 piece fails to expand

[Ben]

As per the title 7 months ago I had upper jaw surgery. I very quickly realised after my surgery that I hadn't gotten anything like the 8mm of expansion planned . I questioned the surgeon about it. He answered that there was a complication in the surgery, that the molar band tubing had occluded in the surgery which meant that he couldn't get the expansion required. I then asked well how much expansion did we get? He said 4mm and that we had planned for 5mm so it wasn't too bad. I was taken aback by this because he was lying or had forgotten the surgical models showing the planned 8mm.  I could feel with my tongue that nothing like 4mm expansion had taken place. in fact my pre and post surgical models clearly show that no expansion was achieved.

I also think he didn't advance my jaw enough as my incisors are pretty much edge to edge in a relaxed lower jaw state, and it is only when I draw my lower jaw all the way back and clamp down hard, causing my front teeth to move under the pressure, that any of my molars contact. My lower incisors are already inclined backwards so I don't think any space can be gained here.

My thoughts are that something like this just shouldn't happen, does anyone have anything to add?
I'm gutted with how I've been left after this surgery and I'm currently pursuing compensation from both my Orthodontist and Maxillofacial surgeon. This has complication too, I ended my treatment early 3 months post op and I didn't accept the palatal expander that was offered to correct the lack expansion.
I have many reasons for not accepting the expander and for finishing my treatment, and I feel I'm well justified in my actions hopefully those involved in investigating my case will agree.

[overbiter]

You should have opted for SARPE before jaw surgery. That way you would have gotten a stable and decent amount of expansion. What country are you in? I doubt whether you will get much joy going down the legal route. Unless something was clearly amiss during the surgery then there is no point. It will take a long time to be resolved, will be expensive etc. Your best bet is to go for another surgery with a different surgeon.

[Lazlo]

yup, i just talked to another surgeon and ortho today --basically multi-segment expansions during surgery don't really work, aren't worth it. sarpe is the only way to go and then you have to do a two phase treatment.

[Ben]

Thanks for the replies it hurt to read some of them but it clears up why my orthodontist went into a rant after I'd had my surgery about how they don't normally do leforte one because it is the old way (gzzz thanks for telling me could you not of told me earlier?) I'm gutted by this. Their whole treatment of me has been incompetent and well the result speaks for itself. This is serious and it dam well shouldn't have happened if they had done there jobs with the minimum of care.  My life chances have been destroyed by their Cavalier attitude.

My lower jaw is nicely developed I needed 8mm of expansion to put the upper teeth into a nice bite relationship with the lower ones.

I thought I would be getting sarpe done but I guess I didn't really know what was going on until it was all to late. I just thought trust the professionals obviously now I know how wrong I was to do so.



I'm in New Zealand, I paid for all this myself. Seeing another surgeon is out of the question I haven't the money to do so. However I've made a complaint against he surgeon and orthodontist to dental council here, they pay for it all and hopefully I can get my money back for all the fees incurred in treatment.
Their whole treatment of me has been incompetent and well the result speaks for itself. This is serious and it dam well shouldn't have happened if they had done there jobs with the minimum of care.  My life chances have been destroyed by their Cavalier attitude.

After I had the surgery, my surgeon said to me, wel..you know what Ben, I've got cross bites too. Yeah but you haven't just had 2 years of braces (pre surgery) and spent 40 grand to get it fixed.

The 2 years of braces before surgery as far as I can was totally unnecessary, I hate to think what damage that has done. When they do the leforte one they have to flare the teeth between the k9's and front teeth out to make way for the segments so those teeth are screwed, they are now very loose. I've lost feeling in my gum and over half the teeth in my upper jaw, my maxilla has lost vertical height causing, I think, my nasal breathing to be blocked up a lot of the time especially in cold weather. These is really hard for me to live with, having a blocked which can't be breathed through at least for me isn't something I can live with indefinitely. My maxilla was meant to be dropped down I'd hoped that combined with widening via sarpe would help my nose be really clear. My upper arch now has bad symmetry. The left side of my maxilla is leaning over,  the teeth have quite an angle to them but it isn't the teeth it is the jaw bone underneath that is leaning. The whole thing is horrible really

I was too busy studying at university and so in my naivety I just put my faith in those that were treating me, so sad the whole system sucks.

[Lazlo]

Thanks for the replies it hurt to read some of them but it clears up why my orthodontist went into a rant after I'd had my surgery about how they don't normally do leforte one because it is the old way (gzzz thanks for telling me could you not of told me earlier?) I'm gutted by this. Their whole treatment of me has been incompetent and well the result speaks for itself. This is serious and it dam well shouldn't have happened if they had done there jobs with the minimum of care.  My life chances have been destroyed by their Cavalier attitude.

My lower jaw is nicely developed I needed 8mm of expansion to put the upper teeth into a nice bite relationship with the lower ones.

I thought I would be getting sarpe done but I guess I didn't really know what was going on until it was all to late. I just thought trust the professionals obviously now I know how wrong I was to do so.

dude, if you needed 8 mm of expansion then SARPE IS an option for you and you should have it done. AND the surgeon who screwed up your multi-segment should pay for it. Get a good lawyer. This is an open-shut case of negligence, poor planning and incompetence.



I'm in New Zealand, I paid for all this myself. Seeing another surgeon is out of the question I haven't the money to do so. However I've made a complaint against he surgeon and orthodontist to dental council here, they pay for it all and hopefully I can get my money back for all the fees incurred in treatment.
Their whole treatment of me has been incompetent and well the result speaks for itself. This is serious and it dam well shouldn't have happened if they had done there jobs with the minimum of care.  My life chances have been destroyed by their Cavalier attitude.

After I had the surgery, my surgeon said to me, wel..you know what Ben, I've got cross bites too. Yeah but you haven't just had 2 years of braces (pre surgery) and spent 40 grand to get it fixed.

The 2 years of braces before surgery as far as I can was totally unnecessary, I hate to think what damage that has done. When they do the leforte one they have to flare the teeth between the k9's and front teeth out to make way for the segments so those teeth are screwed, they are now very loose. I've lost feeling in my gum and over half the teeth in my upper jaw, my maxilla has lost vertical height causing, I think, my nasal breathing to be blocked up a lot of the time especially in cold weather. These is really hard for me to live with, having a blocked which can't be breathed through at least for me isn't something I can live with indefinitely. My maxilla was meant to be dropped down I'd hoped that combined with widening via sarpe would help my nose be really clear. My upper arch now has bad symmetry. The left side of my maxilla is leaning over,  the teeth have quite an angle to them but it isn't the teeth it is the jaw bone underneath that is leaning. The whole thing is horrible really

I was too busy studying at university and so in my naivety I just put my faith in those that were treating me, so sad the whole system sucks.

[Ben]

dude, if you needed 8 mm of expansion then SARPE IS an option for you and you should have it done. AND the surgeon who screwed up your multi-segment should pay for it. Get a good lawyer. This is an open-shut case of negligence, poor planning and incompetence.

This kind of reply is easier for me to read...but
I have no chance at getting a lawyer, even a lousy one, no money at all. New Zealand is a small country with a tight knit community of medical professionals taking them on, no matter the case, I'm told normally (Statistically I believe I read 98% of the time) results in a loss for the patient. Since my case is complex involving a Surgeon and Orthodontist who have no problem blatantly lying and whose 'professional' opinion can move heaven and earth I'm not confident of a win. I've been informed that my best chance is through the dental council where I may be able to get the treatment fees I paid reimbursed.
It seems no one here understands how serious this all is for me . This was my big effort to get normal function, of my breathing (to be fair it hasn't been great since my orthodontic extractions in my teens but worse since this surgery), bite relationship and appearance, and it has been botched for no good reason, and it is like oh well just get on with it now..

To give you some Idea what I'm dealing with I had a chat with my Orthodontist about my having a constantly blocked nose after surgery it ended up with her passionately arguing her opinion that mouth breathing isn't a serious health problem and has no ill effects on the sufferer. when I asked her why she became an orthodontist she said because she was afraid that the intended use by the New Zealand government to use fluoride in the drinking water would mean a shortage of jobs for dentists. Ok to some people this might be fair enough but it isn't what I wanted to hear and Interestingly she doesn't state this as her reason for becoming an Orthodontist on her website.

[Ben]

Sorry I'm not the best writer.
What she said is the opposite, she was under the impression that the use of fluoride would improve the nations dental health to the point where there would be a reduced need for dentists and so she decided it best to become an orthodontist.
She knows nothing at all though, she wouldn't get involved in anything unorthodox. This women isn't capable of any sort of thinking on her own.

[overbiter]

Mate, from what you've been writing it sounds like you've been done like a kipper. I can't believe you've shelled out forty grand for a worse outcome than you had pre surgery. Anyway, I would have imagined that NZ would have it's own NHS, or at least a really good insurance system. Paying that kind of money out of pocket makes no sense to me. I'm in London, and I'm in the stages of getting treatment for free. Hopefully everything goes smoothly for me, but your experience just goes to show that paying for this kind of surgery doesn't always work.

I think I have some of the same issues as you. I have a short maxilla, so I can definitely understand where you are coming from with the blocked nose. I think aesthetically speaking that short maxillas look terrible as well. If you have had yours shortened has it affected your looks? I want to get both my lower and upper jaws expanded. I really feel this would be good for me. I will need to bring this up with the surgeon.

As for your ortho, we've all had bad experiences with them but yours sounds pretty terrible. She's a perfect example of someone who is both clueless and in complete denial. It is a shame that so many people in important positions are hopeless at what they do. That's why anyone who gets orthodontics/jaw surgery and has a great result is incredibly lucky.

[Ben]

Hey man yeah I'm gutted. New Zealand isn't a good country to have our sort of health problems, privately funded was the only way for me to receive treatment.
My looks haven't been effected too much I've only lost a tiny bit of vertical length at the front and with my teeth coming forward about 2mm so I look a bit better than before surgery. I've lost the height at the back of my jaw, from what I can tell about 2mm which with my palate already so high is gutting. Yeah the short maxilla looks like s**t and I reckon impinges on my sinus space, well I suppose it has too really. Funny though the specialists that I've seen don't seem to have a clue about the relationship between the high palate and the lack of sinus space they are so focused on treating their specific areas. They want to remove turbinate material even though it is all healthy and functioning correctly but simply doesn't have enough room to do its job. I want more room to be created by expanding and dropping down of my maxilla this makes more sense to me.
 I only show a little of my upper teeth when I smile and my mouth is really dished in. I think my bicuspid extractions as a teen has something to do with this dished in look too. I look like an old toothless women when I smile. I was never that fussed about straight teeth going into this treatment I really just wanted my jaws put into a good position.
I find the blocked nose is very hard to live with. People don't get how much it effects me, I hate mouth breathing and all of its pitfalls sadly all the doctors I've seen have no clue about it.
Thanks for the reply mate and I hope your surgery goes well I would say just get things in writing and make dam sure the surgeon knows what you want. Make sure you discuss what the relaxed position of your lower jaw is in relation to the upper and how closing another potentially few mm when you bite down will effect it. I think the teeth need to be able to rest together with full contact and a small over bite and most importantly put no strain on the temporomandibular joint when you are doing so. Also think about the angle of the upper and lower incisors, I think the lower need to be angled forward a little bit, but I would say that before surgery everything dentally should be in the middle of its acceptable range of movement so that it can go either way somewhat to compensate for surgical problems. This is all just my opinion of course I probably don't know what I'm talking about it just in my experience would have made a difference to my outcome.
The leforte 1 3 piece segmented osteotomy IMO gains the kind of expansion that will not improve our limited sinus space. I think SARPE would be the way to go for us, doing the surgery in 2 stages for the best outcome.
I think it takes bone crafting to lengthen the maxilla more than a few mm doesn't it? I reckon we would need to do this, do it once do it properly. I feel there is a lot to be gained from taking the effort to do this right and so much to be lost to rush it and get it wrong.

[Ben]

Hey I do have all the records but really unless someone was to look in person it is hard to see the details. Here are some of the photo records,  initial and final records. Note the presence of wisdom teeth and a better symmetry of upper jaw in the initial records.
The final records show the advancement which was only about 2mm should have been 3-4mm so that is biting down and having my front teeth occlude long before the molars touch, this has improved a bit since then and now there is some molar contact on one side, but still requires a hard bite and movement from the front teeth to achieve . Both of the photos is with my mandible drawn all the way back, the initial shows edge to edge but in a relaxed state there is a few mm of under bite present, the final shows a slight over bite but to achieve it is uncomfortable and probably damaging the tmj's it also causes movement of the front teeth.
I want to get all the moulds together, these clearly show that expansion was not achieved and how the symmetry of my jaw was negatively effected.

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[Ben]

Despite all the evidence I have in front of me and what I see and feel in my mouth,  when I say I'm so gutted and why to those involved and other medical professionals I've seen, they say things that piss me off such as- I'm sorry you FEEL that way-
Is feel the right word? I don't think so because it isn't really a feeling it is the reality of the situation anyone would be pissed off wouldn't they?

[Lazlo]

Hey I do have all the records but really unless someone was to look in person it is hard to see the details. Here are some of the photo records,  initial and final records. Note the presence of wisdom teeth and a better symmetry of upper jaw in the initial records.
The final records show the advancement which was only about 2mm should have been 3-4mm so that is biting down and having my front teeth occlude long before the molars touch, this has improved a bit since then and now there is some molar contact on one side, but still requires a hard bite and movement from the front teeth to achieve . Both of the photos is with my mandible drawn all the way back, the initial shows edge to edge but in a relaxed state there is a few mm of under bite present, the final shows a slight over bite but to achieve it is uncomfortable and probably damaging the tmj's it also causes movement of the front teeth.
I want to get all the moulds together, these clearly show that expansion was not achieved and how the symmetry of my jaw was negatively effected.

if your parents are supportive you need to get them involved. you need to sue for the entire sum of the money you paid and then you need to get your surgery done by a reputable surgeon elsewhere. start acting on that now.

[Ben]

Thanks mate I appreciate your reply.  I'll describe the situation here in NZ- it is almost impossible to privately sue medical professionals in New Zealand since there is a zero fault system operating here, although small amounts can be settled in the small claims court (no lawyers) only pay outs less than 18 grand though, but could be a last resort option for me. The agencies for compensation (refund of fees) is the dental association (could be hard conflict of interest they all know each other and tend to stick together) I've taking my case to them, they are a free service. Then there is ACC, accident compensation corporation, a government department which has just had 3.6 billion dollar surplus, probably at the expense of those it is suppose to serve. Not much of a surprise then that I've been told by numerous sources that it would be unlikely I could get anything from them.

I'm pretty much on my own in this. I think my dad gets it but it has taken me 7 months of constantly describing the situation.  I think I've just brain washed him into getting it even so, his attention span will only last about 30 seconds on the subject. People in general doctors, family and friends are really dumb when it comes to my problems they seem to think it is all in my head (psychological).

[Lazlo]

Thanks mate I appreciate your reply.  I'll describe the situation here in NZ- it is almost impossible to privately sue medical professionals in New Zealand since there is a zero fault system operating here, although small amounts can be settled in the small claims court (no lawyers) only pay outs less than 18 grand though, but could be a last resort option for me. The agencies for compensation (refund of fees) is the dental association (could be hard conflict of interest they all know each other and tend to stick together) I've taking my case to them, they are a free service. Then there is ACC, accident compensation corporation, a government department which has just had 3.6 billion dollar surplus, probably at the expense of those it is suppose to serve. Not much of a surprise then that I've been told by numerous sources that it would be unlikely I could get anything from them.

I'm pretty much on my own in this. I think my dad gets it but it has taken me 7 months of constantly describing the situation.  I think I've just brain washed him into getting it even so, his attention span will only last about 30 seconds on the subject. People in general doctors, family and friends are really dumb when it comes to my problems they seem to think it is all in my head (psychological).

if you're in queentstown or on the south island give me a pm i know a lawyer there, he does real estate law, but he might be able to recommend someone....give you some advice...

[Ben]

Hey thanks man, I'm way up the other end of the north island so probably no good to see him. It would be interesting to see what he says though.
What did you think of the photos? Can you see the loss of that nice u shape of the jaw?