jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Lurker25 on April 28, 2017, 02:38:49 AM
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As per the title, I'll be having double jaw surgery to correct my Class 3 malocclusion in ~2 weeks.
I had my final visit with the surgeon a couple of days ago and he gave me the treatment plan, based upon my initial recommendations, along with the numbers. What I need are some suggestions because I feel that the values might be a little low.
- LeFort 1, 3 pieces (CPT code 21147): He will widen the maxilla along with moving the maxilla down a bit as he noticed a discrepancy with how the upper teeth meet with the lower teeth (the orthodontist cannot correct this), along with my lower third being a little short. He also mentioned performing a high LeFort 1 and moving my maxilla forward by 4 mm along with a CCW rotation (this involves the BSSO below).
- BSSO (CPT code 21196): He said he will only perform this procedure to correct an alignment issue; my midline is off a few mm. If my midline was not off (due to a previous childhood accident), he said he wouldn't need to do this.
- Genioplasty (CPT code 21120): He wants to perform a sliding genioplasty. He mentioned either 4 mm or 6 mm. He mentioned that the tools that he has vary in 2 mm increments, hence the jump from 4 mm to 6 mm. This will be paid for out of pocket.
My concerns are below:
- Moving the maxilla only 4 mm forward. Based upon my lateral ceph., how much would you (the experts) recommend? Also,
what is my current occlusal plane angle and what do I need to shoot for? 5-6 degrees? - BSSO only for alignment. If the maxilla gets moved more than 4 mm, I would imagine that the mandible would need to be lengthened as well. Also, my insurance covers CPT 21127 ("Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft," when medically necessary). Would this be something to look into due to my large gonial angle?
- Genioplasty. I understand that there is tissue ontop of the bone which provides projection, but is 6 mm sufficient? Would 8 mm be a better choice? Especially since this is coming out of pocket. Also, I would like him to widen (insert bone/graft) the chin as well.
This surgery date is not set in stone and I can call it off or postpone it. It is already in jeopardy since I'm coming off from a pretty bad cold.
Also, if anyone can recommend a qualified surgeon that I can pass my x-rays on to, that I can pay for an opinion/suggestions, that would be greatly appreciated.
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Wouldn't CCW of your maxilla make your teeth more protruded?
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Wouldn't CCW of your maxilla make your teeth more protruded?
That would make sense. But wouldn't advancing the maxilla forward (hopefully more than 4 mm), along with a 3 piece LeFort 1 bring them more down?
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Some good information here.
Anyone have any suggests based upon the baselines provided by the surgeon? I am still under the impression that a 4 mm advancement of the maxilla will be insufficient. What about the genioplasty?
FYI: The orthodontist pushed my front teeth outward in order to make space between my lateral incisors and canines so that the surgeon would have space to cut the maxilla for the 3-piece LeFort 1.
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high occlusal plane, high mandibular plane angle, need ccw.
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high occlusal plane, high mandibular plane angle, need ccw.
Thank you for the response.
What about the suggested maxilla (4 mm) and chin advancement (4 - 6 mm)?
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Seems you don't have much choice with the maxilla amount given that you're not also advancing the jaw.
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Seems you don't have much choice with the maxilla amount given that you're not also advancing the jaw.
I'd agree with you on that.
I guess I would just have to speak to the surgeon about advancing the mandible as well to match the maxilla advancement.
I'm going to consult a few other well-known surgeons that many have posted on this board.
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Attached is the initial lateral ceph. from November 2014 upon initial consultation prior to braces along with some pictures of the bite.
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