My question thread

[x]

So rather than starting a million threads to ask each individual question, I'm just going to ask them all here as I go through the process.

To start, I have an Ortho appointment on Monday which is the first time I'll be bringing my concerns up to someone else. Should I straight up ask him to refer me to a maxillofacial surgeon or explain what I think is wrong and let him give his input? This is the same guy who treated me from ~2002-2008 so I don't know if he may take it as a personal insult that I'm unhappy with the results?

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are you european or american?

if your ortho says you're fine, you can simply schedule consults with surgeons yourself. i was fortunate to have an orthodontist that said straight up i would need surgery, and said braces would only do so much.

you shouldn't be diagnosing yourself. schedule a consult with a respectable surgeon. id ask your ortho how much experience he has with orthognathic surgery.

American

Part of the referral is selling my parents on it, my mom wasn't even receptive to the idea of my scheduling an orthodontist appointment, they sure as hell don't want to hear I need surgery, major surgery at that. Which is why it'd be better to have an Ortho tell them.

[x]

to be perfectly honest, i have yet to interact with someone who's family was "receptive" to jaw surgery. i guess you'd have to think ahead what you'd do in the event your ortho disagrees with your concerns and proposal of surgery.

That's why I'm wondering if I should actually go into detail with him or just cut straight to the chase and ask him to refer me to one, still trying to decide on that. It's no slight against him, he did the best he could with my teeth given my jaw alignment.

[x]

he's a professional.  be cordial and understanding, regardless of what he says. even if he seems against it, no shame in asking for his contacts/referrals. it's your jaw not his. this is a serious commitment financially and physically. i would listen carefully if he says you don't need surgery, because you might not need it.

I will and chances are if he says I shouldn't he's probably right, but I'm gonna consult with a surgeon irregardless of what he says.

[x]

Ok since I'm bored, I might as well kill some time with some more questions I've been wondering  

1. The left side of my face seems to be more developed than my right, with the cheek bone more prominent and stuff, will the upper face structure change over time as a result of the balancing of the jaw?

2. I have a lot of excess 'baby fat' on my face, is there any chance that bringing the maxillary and mandible forward would widen my facial bone structure, stretching the skin and making it look less fat? Does that make sense to anyone else?

3. Also, for the hell of it, what do you think the potential for aesthetic improvement is for someone without major deformities? I've seen some very great results (mostly women it seems) and some so-so, I'm guessing a lot of it is dependent on how the rest of your face looks already?


the things I type when I drink... smh

[tdawg]

If you dont have a functional concern just do plastic surgery broseph. Faster, easier, cheaper. Just make sure you go to a really good surgeon.

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I have the Orthodontist appointment later today, so hold your horses and I'll be more specific in a couple of hours 

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Welp, back.

Main points:

-The orthodontist noticed some definite changes and shifts from since I stopped treatment (early 2009), mostly probably caused by my not wearing my tooth positioner. He noticed the recessed mandible, and a lopsided bite, with one side coming down further than the other.
-He suggested I wear my tooth positioner diligently for the next 4 months, so I guess I'm maybe still in the late stages of growth.
-I brought up a maxillofacial surgeon referral to him and he seemed to recognize it as a real possibility, but I guess he wants to wait and see how the tooth positioner goes first.
-He said that tooth positioners could bring the lower jaw forward. That didn't sound right to me, but I deferred to him as the expert. Anyone wanna confirm or deny this?
-He didn't seem to think my maxillary was too long, but my mandible is.  I though quite the opposite, considering how recessed the mandible is.
-He said I should see an ENJ I think it was called, cause I'm a mouth breather. I don't know what that is, I guess I'll have to do my own research on it.

I'm probably forgetting some things, if they come to me I'll post them.

[x]

never heard of the tooth positioner bringing the lower jaw forward - at least in a meaningful way beyond orthodontic needs. not sure what an ENJ is, he probably meant an ENT (ear nose and throat). they can diagnose and treat tongue thrusts, although that tends to require speech therapy.

since your ortho considered a surgery a real possibility, i think that's enough to consider consulting with surgeons. it's not going to offend your orthodontist. hopefully you live in a decent state or large city where you'll have more choice of orthognathic surgeons. most orthos have their referrals (typically a courtesy system, thus the top doctors obviously refer to other top doctors). i would definitely bring your parents into the loop, and explain to them what your ortho said. make sure they come with you to the consults, they probably will if they're paying for them. i paid for several of my own consults.

Yeah ENT is right, I couldn't remember what it was exactly and he only mentioned it in passing.

I live in Ohio, I dunno if that's the best place to find ortho surgeons, but are you sure I should go consult with them now if he wanted to try the tooth positioner first? Wouldn't insurance be more likely to cover it if I got the ortho's approval 4 months from now?

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doubt it. the way my insurance worked at least, is they looked at the xrays and analysis done by my surgeon, and said..."well, geez - he can chew, breath without choking, yeah small airway but not severe (moderate), he is functional - rejected." my old insurance would have covered it. my current insurance excludes orthognathic surgery in virtually all cases. i did multiple sleep studies, recommendations from other doctors, waited several years, it never worked out. whether your ortho approves of surgery is irrelevant. say you get the surgery for cosmetic reasons and not functional, your ortho is going to be part of the surgical process. whether he thinks you are a surgical candidate at that point is irrelevant. he provides a service and you (or parents) are paying him/her for it.

my insurance covered a few of the consults, but not others. depended if they were in my network or how aggressive/militant their insurance rep was. dont know ANY surgeons in ohio, im sure there are plenty of strong ones. might want to consider looking at the big universities, seeing what surgeons are affiliated with those hospitals, or major or private hospitals and what surgeons are affiliated with those places.

sure someone here knows more about that.

Well that blows, I'm certainly functional so the chances of it getting covered are probably nil.

I guess consults wouldn't hurt but as far as surgery not being covered by insurance, I don't see my parents footing the bill. May as well graduate, move out to L.A. and get it done with Gunson or the other guy always mentioned.

[CK]

Well that blows, I'm certainly functional so the chances of it getting covered are probably nil.

not necessarily. the litmus test for "functional" varies from insurance to insurance. some insurance carries only require patients to prove they have sleep apnea to have their surgery covered. most people with sleep apnea won't die in their sleep, but it can have a severe affect on their quality of life - fatigue, etc. my insurance didn't care.

I guess consults wouldn't hurt but as far as surgery not being covered by insurance, I don't see my parents footing the bill. May as well graduate, move out to L.A. and get it done with Gunson or the other guy always mentioned.

well, getting consults now - which are likely less expensive than in california - is important because you can figure out what is really wrong (or if anything is wrong) and what they say. w/o insurance gunson will cost 40-50k. that's a BMW.

[x]

Is there a way to know if I have sleep apnea? I'm a mouth breather and when I was younger they tried to get me to wear this neck brace at night, I don't remember what they were trying to treat then though.

I guess I'll go ahead and ask about consults now and just phrase it as if the orthodontist suggested it

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What about the neck brace? Something similar to this:

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ok, will do

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I meant in Euphoria's case. His lower face isnt that retruded from what I recall.

I mean it's not as extreme as not being able to discern between my chin and my mandible or something (which I've seen in some cases), but it was retruded enough for my orthodontist to notice it as an issue.

This is about what it looks like: