Double Jaw Surgery w/ Dr. Arnett 10/4

[znewton]

Hey Everyone,

I wasn't sure whether I wanted to make a post or even continue with my blog (I started a blog the first week or so that I got my braces and only posted two or three times). I'm realizing that I'm going to have plenty of down time to document my experience and putting it on a blog will serve as a means to hopefully help somebody else who's curious or on the fence about orthognathic surgery.

That's it for now. I'm @ Dr. Arnett's awaiting my second appointment of the day. This morning my surgical assistant took impressions, two wax bites, and another x-ray for treatment planning. Upon finishing the scan Dr. Arnett spent the next 45 minutes or so taking all sorts of measurements of my face and bite. He pointed out that I have a fair amount of asymmetry and joked that I looked like a "banana head" -- whatever that means! I'm looking forward to having a healthy bite and the facial balance/harmony that is coming my way.

I will post the link to my actual blog later and will start making regular updates there!

Zach

[Marisama]

Thanks for sharing. Good luck. I wish I were in your shoes. I'm two months behind you.

[treevernal]

Thanks for sharing. Good luck. I wish I were in your shoes. I'm two months behind you.

And im a month and a half behind you!  Good luck znewton!

[x]

Good luck playa.
 
Also, quick question. Is a 3-piece Lefort how surgeons typically handle an off-center midline?

[Marisama]

I was told by a couple surgeons that I had a "banana head"

[Kristen]

Good Luck

[znewton]

45 minutes? geez that's a long time. was he very explicit about the facial harmony/asymmetry? Did you have to go through signing all those papers yet.


damn that is specific. i was the same as you, certain procedures gunson wasn't 100% on the day before. the genio is probably common, because they run your facial scan through the VSP and it shows where your chin should be. if it goes beyond a redline then genio is it. But your genio was like .02 on the original ceph right? second one is always different though.

good luck! stash up on ginger ale lol.

He was fairly specific regarding the asymmetry. Apparently my right jaw line is "bigger" than the left side. He's going to use the HA grafts to even things out. Also, my cheekbones are more prominent on the right side of my face which he will also even out.

In regards to the genio you are correct that my original ceph showed something like .2 but I believe that was because there was no plan to do a genio. I'm not sure if the software just had to compute a value or what but it would make zero sense to do a .02 genio! I asked him about it today and as I said he just won't know until he's done with everything else. I assured him I did not want to end up looking like Jay Leno and have left the decision up to him.

I did fill out the questionnaire which addresses what I would like to see changed etc (which I've seen you discuss on your thread) but he did not go over it with me whatsoever. I really didn't put anything down though except for wanting to "Move chin forward" and "Show more teeth when smiling". All of the other options were things I really wasn't concerned about.

[znewton]

Also - the link to my blog is http://zachsjaw.wordpress.com/ 

[znewton]

i think because arnett already went over your issues (aesthetically) directly and relatively explicitly, the TMS didn't really matter as far as he was concerned. did arnett brief you on the questionnaire or did he just hand it to you?

It was just handed to me by the assistant. I was going to mention that - it wasn't an issue because we discussed everything in detail. I'm pretty sure I got the general briefing he goes over with every patient but he had no problem answering any specific questions I had for him. I do still find it funny he called me a banana head  

[Heavyweight]

Haha right? He was just commenting on the fact that I have a LOT of asymmetry and was probably trying to make me laugh. Here's the surgical plan as of now:

3-Piece Lefort I - I believe he said he would be advancing the maxilla around 2-3mm. My midline is also off and he will be moving it around 1mm to the left.

BSSO - My lower jaw will be advanced 16.3mm. By most surgeons standards this would probably be their largest advancement ever, but Dr. Arnett routinely sees this amount of movement. Lower jaw also needs to be leveled.

Genio - Right now it's up in the air. He said there is about a 50% chance that he will do the chin but he won't know until he gets everything else done.

Hydroxyapatite Grafting - He will be doing a fairly extensive amount of grafting to my cheekbones and lower jaw.

Have a pre-op appointment at the hospital tomorrow and a full physical in the afternoon. Wednesday is free and surgery is Thursday!

Are you getting a lot of counterclockwise rotation? If not, the 16.3mm movement of the lower will be linear, and that strikes me as extreme, even by A/G's standards.

[treevernal]

Arnett told me I have a "cow bite"  cause my teeth dont intercuspate and just sit on top of eachother...I chew the cud so to speak lol.  I thought it was funny.  Arnett is actually a kind, funny guy; his humor is just dry though.  Youd have to hear the way he says things to know not to take it personally.

[znewton]

Are you getting a lot of counterclockwise rotation? If not, the 16.3mm movement of the lower will be linear, and that strikes me as extreme, even by A/G's standards.

I'm really not sure about the CCW. I'm really not too concerned.

[Joy]

Good luck Znewton!!  Think positive! 

[x]

As long as he knows his audience, I think the joking is ok. It wouldn't bother me at all, might even put me more at ease since we can have a laid back, personal relationship.

[znewton]

so i read through your blog a bit, just to reiterate - Arnett devoted 45 minutes simply evaluating your face clinically - like, aesthetically did that time include other issues?

and when it came to question time, did you initiative it or was it more of an open invitation?

how explicit was arnett when he referred to asymmetry, and did he say he would address it with x, y and z? or just "everything will be good" sort of deal?

quote]

I'd say between 30-45 minutes taking various measurements and what not. That time included him taking measurements and simply expressing his thoughts and findings out loud to me as he worked.

In terms of asking questions - after he did his 3rd check of all the measurements he sat down next to me to go over all the procedures and risks. We did that verbally than went over a checklist of what we had just discussed so I was sure he had covered all his bases. I took this as an opportunity to ask questions which he politely answered without hesitation. I don't think I really had that much to ask though compared to other patients.