I'm having surgery next week and I'm worried

[metallaces]

I got braces just to have jaw surgery to improve my profile. I have a recessed maxilla, mandible and chin, as well as an overbite. I met with my surgeon for the first time today and I'm worried that he didn't take my aesthetic concerns seriously. He told me that his plan was to rotate my upper jaw to fix my "open bite" (it's an overjet caused by gaps that my ortho put in for the surgery???) and advance my lower jaw. I explained that I want to bring both jaws forward because my maxilla is recessed as well and he said "well... I can't bring it too far forward, I have to stay within an aesthetic range". Ok? Then he explained to me that he wont know the final plan until he looks at my pictures on a computer program. Apparently this computer program will tell him the "optimal movements".

I won't be seeing him again until the day of my surgery, so basically I won't be finding out what's happening to my jaws until I get to the OR. My recessed maxilla is my least favourite part of my face and I don't want to go through ALL THIS just to not have him address that concern.

I can't switch surgeons because this is literally the only time I can get surgery and it's a public healthcare system so I don't get much say...

What should I do? 

[Dogmatix]

You say your maxilla is recessed, your surgeon say it's not. If what you want is an objective opinion, you need to provide pictures.

Are you sure you're qualified to know that the maxilla is recessed? These relations are not always easy to understand, e.g an underbite is sometimes treated with an advancement of both the mandible and maxilla, even though a layman would think it's the mandible that should be moved back.

Your surgeon is right that he can't give you the final plan until everything is setup for surgery, but he should know approximately. He is also right that there are guidelines like cephalometric meassurements, soft tissue plane and true vertical line that guides the displacements, and it would be unethical to deviate from these too much.

If you want anyone to say anything of value to you, you need to provide pictures and x-rays if you have.

[metallaces]

You say your maxilla is recessed, your surgeon say it's not. If what you want is an objective opinion, you need to provide pictures.

Are you sure you're qualified to know that the maxilla is recessed? These relations are not always easy to understand, e.g an underbite is sometimes treated with an advancement of both the mandible and maxilla, even though a layman would think it's the mandible that should be moved back.

Your surgeon is right that he can't give you the final plan until everything is setup for surgery, but he should know approximately. He is also right that there are guidelines like cephalometric meassurements, soft tissue plane and true vertical line that guides the displacements, and it would be unethical to deviate from these too much.

If you want anyone to say anything of value to you, you need to provide pictures and x-rays if you have.

Thank you for your response, I don't have a copy of my xrays but here is a picture of my profile

[Dogmatix]

Thank you for your response, I don't have a copy of my xrays but here is a picture of my profile

I'm not qualified to give surgical suggestions.
But what I can say is. Your surgeon tells you he will rotate your maxilla, is that a counterclockwise rotation? If so, that is a kind of advancement. My plan does not contain any noticeable advancement of the maxilla base, but a counterclockwise rotation, bringing the incisor tip forward 7mm. If you quote your surgeon correct, he also told you "I can't bring it too far forward", which sounds like there is an advancement, but of course not too much.

[metallaces]

I'm not qualified to give surgical suggestions.
But what I can say is. Your surgeon tells you he will rotate your maxilla, is that a counterclockwise rotation? If so, that is a kind of advancement. My plan does not contain any noticeable advancement of the maxilla base, but a counterclockwise rotation, bringing the incisor tip forward 7mm. If you quote your surgeon correct, he also told you "I can't bring it too far forward", which sounds like there is an advancement, but of course not too much.

No what he showed me was a clockwise rotation to fix an "open bite"

[metallaces]

I'm not qualified to give surgical suggestions.
But what I can say is. Your surgeon tells you he will rotate your maxilla, is that a counterclockwise rotation? If so, that is a kind of advancement. My plan does not contain any noticeable advancement of the maxilla base, but a counterclockwise rotation, bringing the incisor tip forward 7mm. If you quote your surgeon correct, he also told you "I can't bring it too far forward", which sounds like there is an advancement, but of course not too much.

What happens in this video at 1:55 is what he showed me

https://youtu.be/OH_mOS_WeS4

[Dogmatix]

No what he showed me was a clockwise rotation to fix an "open bite"

I can only say what I think. An advancement of the maxilla, that isn't ccw seems hard. It seems like the upper lip is somewhat in line subnasal and bringing the ANS forward seems like it would bring the base of the nose forward and flatten it. If you have an open bite, it needs to be closed some how, I can only speculate if it could be handled by rotating or moving in other ways.

Is it possible to postpone the surgery and consult with a private surgeon if you have the money and want a second opinion? Private surgeons can sometimes do more advanced movements than a public and can give other options. Normally you can get a first video consultation pretty fast just to get a first opinion and hear if you're out of line with your thoughts or not.

[metallaces]

I can only say what I think. An advancement of the maxilla, that isn't ccw seems hard. It seems like the upper lip is somewhat in line subnasal and bringing the ANS forward seems like it would bring the base of the nose forward and flatten it. If you have an open bite, it needs to be closed some how, I can only speculate if it could be handled by rotating or moving in other ways.

Is it possible to postpone the surgery and consult with a private surgeon if you have the money and want a second opinion? Private surgeons can sometimes do more advanced movements than a public and can give other options. Normally you can get a first video consultation pretty fast just to get a first opinion and hear if you're out of line with your thoughts or not.

What is the ANS?
There are no private OMF surgeons in my province

[Dogmatix]

What is the ANS?
There are no private OMF surgeons in my province

ANS is the point where the Maxilla is detatched in a normal lefort 1 surgery of the maxilla.
https://www.researchgate.net/figure/Lateral-cephalometric-landmarks-used-in-this-study-S-Sella-N-nasion-ANS-anterior_fig1_262815811

ANS is short for Anterior Nasal Spine, and as you see it goes as high up as the base of the nose. Meaning if you pursue a maxillary linear advancement, this point will move horizontally forward, which I'm not sure you want.

The fact that you're not aware of the basic anatomy of the surgery, may mean that the surgeon see things that you don't see. However it never hurts to get a second opinion, and as said, sometimes public surgeons are limited to not perform the most advanced procedures.

There are some international surgeons you maybe can consult, some are named in the surgeons review section of the forum.

[kavan]

Sounds legit to me that he can't bring your maxilla 'too far' forward and has to keep things within an optimal range that balance aesthetics with balancing/correcting a bite. Measures of displacement are based on the numbers and angles kicked up AFTER they juggle a bunch of things around--MULTI VARIABLE SITUATION--and the specific displacements DO come AFTER they use a computer program --VIRTUAL SURGERY PLANNING--to get an optimized balance.  The exception to getting a specific plan in hand is when you're paying about $500 for a consult where they draft a plan as part of it.  Not to mention that, most people don't understand what all the terms mean in maxfax, like the points, angles and planes yet alone the PLANS even if they get one.

[kavan]

What happens in this video at 1:55 is what he showed me

https://youtu.be/OH_mOS_WeS4

Now, this harks back to the point i made in this string where most patients don't understand the points, angles and planes yet alone the plans. This and not knowing what the ANS is. OK, no foul that you don't know what those things are. But don't expect for the doc to give you a whole plan and expect to understand everything that's on there and most certainly don't cancel 'because' he did not give you a plan.

As to the video at the time you cited, the video shows clockwise rotation of POSTERIOR IMPACTION. It's what they need to to to close an open bite when it's the DOWN GROWTH--too much of it--of the posterior maxilla that is the culprit of the open bite.

[kavan]

You say your maxilla is recessed, your surgeon say it's not. If what you want is an objective opinion, you need to provide pictures.

Are you sure you're qualified to know that the maxilla is recessed? These relations are not always easy to understand, e.g an underbite is sometimes treated with an advancement of both the mandible and maxilla, even though a layman would think it's the mandible that should be moved back.

Your surgeon is right that he can't give you the final plan until everything is setup for surgery, but he should know approximately. He is also right that there are guidelines like cephalometric meassurements, soft tissue plane and true vertical line that guides the displacements, and it would be unethical to deviate from these too much.

If you want anyone to say anything of value to you, you need to provide pictures and x-rays if you have.

Very good general answer. I upvoted for it.

[kavan]

Thank you for your response, I don't have a copy of my xrays but here is a picture of my profile

Your photo does not show a recessed maxilla. It shows a problem with the lower '1/3rd' of the face a LOT of imbalance to the lower 1/3rd. The video you showed at the time where you said described the type of surgery to the maxilla you are getting correlates with the problem to the lower 1/3rd being an open bite that is addressed via posterior impaction which is needed to fix your open bite and also to advance the lower jaw forward. However, your maxilla might be brought forward to get the 'balance' needed to correct your IMBALANCE. But the imbalance is NOT a recessive maxilla.

[metallaces]

Thank you so much Dogmatrix and kavan! You're both right, I definitely don't know enough about this surgery to be judging what my surgeon is doing. Thank you for calming my nerves, I'll have to trust the professional

[Dogmatix]

Thank you so much Dogmatrix and kavan! You're both right, I definitely don't know enough about this surgery to be judging what my surgeon is doing. Thank you for calming my nerves, I'll have to trust the professional

When is your surgery? Let us know how it goes.