Upper jaw surgery (Lefort 1) for underbite.. HELP

[molestrip]

IMO balance is the key.  A single-jaw procedure sounds too good to be true, because, well... it is.  I know, I've been through this.  OP probably needs the maxilla advanced a little and the mandible set back a little.

I agree with PloskoPlus here. Maxilla is clearly underdeveloped and I suspect mandible is overdeveloped. Once the teeth lose interdigitation it's common for both to end up off. We can't judge the occlusal plane from here and aetiologies vary. Your surgeon is right to fear sleep apnea, no one can predict what the risks are now or going forward. It's very possible to do a set back now, have things be fine, and then develop sleep apnea in 2 decades and trust me, it is not fun to discover it the hard way. The disease is far more destructive to health than commonly believed absent treatment, whose efficacy in your case can't be judged at this point.

In your position I'd opt for a mixture of both. I actually fear LeFort more than BSSO. All the nerves are cut, blood supply compromised, and stability is relatively poor. Can you get a ceph by any chance? We can draw you up a few plans here on the board and debate them if you can. Your orthodontist can provide it and if they don't have one, find a new one because no one should put you in braces without one.

I don't think maxillary advancement alone will be a disaster but you will look a litte full, some people freak out others see it as a minor inconvenience. Splitting the difference between the two, possibly with some rotation, is probably going to yield the best result and minimal risk to sleep breathing disorder going forward. I would definitely opt to fix the crossbite while you're in there. Some surgeons don't like to do it, bad idea IMO. You can't go back in 30 years and do it then and you'll be stuck with recession and root blunting. Sure there's some risks up front but the incremental risk is small in the right hands. Given what you've said, it's likely only a 2-piece anyway, no riskier than a SARPE and your nerves are gonna die anyway from the LeFort.

[Kenziie_m]

Thank you everybody for your replies! It is nice to hear different opinions on everything as well as back stories. It is funny, I always assumed it was my mandible that was the problem and never thought that my underbite had anything to do with my maxilla. However, when my surgeon brought up the fact that my maxilla was underdeveloped and explained how the surgery would help my Nasolabial folds at rest, my "droopy" nasal tip, as well as my flat cheeks it all made sense. 

They are estimating surgery in anywhere between 18-24 months (I am hoping it is sooner as my teeth were pretty straight prior to braces), but I trust their judgment and patiently wait for my surgery time to come. Since my surgery date is still a ways away, it gives me the opportunity to get as many opinions as possible. I do not take this surgery lightly (have been on the fence for years) so I want to make sure it is done with the best results as possible.

My next orthodontist appointment is June 1st and I will request a ceph at this time.

Thank you again to everyone for your responses and stories. I will talk to my surgeon about all of this and see what he has to say. I know two people who have had their jaw surgery done by him and he has nothing but good reviews so I trust him. I am pretty positive I will be fixing my slight crossbite while I am in the surgery. I am a little nervous of "chimp face" but have seen some before and after's he has done which look good so we will see. I am terrified of nerve loss however, so we will see.


As for the paper consult with Gunson, I assume that I send him my x-rays, molds, etc. and he sends me back his recommended treatment plan?

[kjohnt]

IMO balance is the key.  A single-jaw procedure sounds too good to be true, because, well... it is.  I know, I've been through this.  OP probably needs the maxilla advanced a little and the mandible set back a little.

Well it sounds like djs to fix cross bite. 

Anyway, everything I've read about your bad result could have occurred if you went with less maxillary advancement and some mandibular setback to compensate, correct?

Her mandible is not over projected.  There is no good reason to take away from it.  The best balance is to bring the maxilla out.

OP - chimp lip will be an issue until swelling fully subsides

[PloskoPlus]

Well it sounds like djs to fix cross bite. 

Anyway, everything I've read about your bad result could have occurred if you went with less maxillary advancement and some mandibular setback to compensate, correct?

Her mandible is not over projected.  There is no good reason to take away from it.  The best balance is to bring the maxilla out.

OP - chimp lip will be an issue until swelling fully subsides

I don't think you realise what a differnce a mere 2 mms can make.

[JawKid7]

Hi. I had upper jaw surgery for an underbite/crossbite. I think if you have a prominent lower jaw then a upper jaw advancement is a good option otherwise double jaw surgery should be done to prevent a chimp face.