jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: ItalianTourist13 on July 24, 2025, 08:34:32 PM
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Hi,
I visited a local OMS surgeon regarding my post surgical relapse of my anterior open bite after a revision lower jaw surgery. I was interested in a 3rd surgery but he said he would not recommend it. I showed him my 5 month CT scan (attached here) and he was quite shocked as to how far back my overseas surgeon made the BSSO cut. He said this reduced the region of bone-to-bone contact, causing my lower jaw to rotate downward after the months. If he did my original surgery he would have made the cut far forward near the molars to increase the region of bone-to-bone contact. He said I was a 'very lucky man' given that my mandible bones healed despite the unideal cut.
He did note that my ramus was rotated quite far forward as it should be more vertical, probably due to condyles rotating to compensate for the lower jaw relapse. This has apparently been the reason for my TMJ instability. However, he said that 7 months post OP is still early for the TMJs and he would wait 1-2 years post OP for the TMJs to get used to their new position. He seemed quite informed about the TMJ and actually routinely performs TMJ surgeries as well as 4 jaw surgeries a week.
Despite the issues he noted, he said given my lower bone loss (as shown by the notch in the scan), he would not do revision lower jaw surgery as the chances of a non-union are too high, which might require hip bone grafting and is "asking for trouble".
He told me to speak with the ortho who works in the same clinic. As a back-up plan, if the ortho can't fix my open-bite with TADs and Invisalign, then he will perform a revision UPPER JAW surgery and bring it down to meet the lower jaw, since the upper jaw has healed perfectly fine. The ortho said she can fix my bite with molar intrusion, which will rotate the lower jaw. I am worried this will rotate my condyles even more but according my the OMS and ortho, they will adjust over time.
Do you guys think I should go ahead with the Invisalign and forget about revision surgery? The OMS is competent and well-regarded, so I don't think he was dismissing lower jaw revision because it would be too hard for him. He even warned me to not go shopping around for other surgeons since I will definitely find one money-hungry surgeon who will cut me up for money. I appreciated his honesty and was quite surprised by it.
Still, I have some issues that I am not sure molar intrusion with Invisalign can fix. I have slight lip incompetence and find it challenging to close my lips during sleep when my jaw is relaxed. I have to use mouth tape to keep lips together. During the day time, I can keep lips together with not much issue though.
Do you think that invisalign molar intrusion can help with lip incompetence?
Your thoughts will be greatly appreciated.
PS. I was jutting my lower jaw out in the CT scan. My actual anterior open bite looks worse than shown.
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Here are the scans:
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I'm not sure what I'm looking at. Can you upload before and after scans, and scans that show you not jutting your jaw forward?