Jaw surgery: is it worth it without the esthetic component?

[biterelapse]

my dentist and my orthodontist both reccomended i get jaw surgery and at the beggining of the whole ordeal I was dead set on getting it because i saw it as the best solution to fix my "functional issues". They both "convinced me " or sold me on the idea of getting it based on airway based improvements. (i have a narrow airway)

However the more i do research and the more i find out about what this surgery really is about, ive been thinking lately, its all a big misnomer and without aesthetics being the driving force for getting the surgery, there really is no reason to get it.

simply put, if "how you look"  isnt a concern (not saying it shouldn't be) there are better ways (safer)  airway issues, at least the way i see it.   

for example, if someone has sleep apnea issues, or breathing issues - this can be improved by simply losing weight, eating better and having better sleep hygiene

if one has bite issues, these can be corrected using a combination of orthodontics, implants, occlusal balancing, etc

I think the big issue is that this maxilofacial surgery is always "sold" to the patient as being required for functional problems, but in reality the only thing that is exclusively and predictably solved by surgery itself are esthetics and how a person looks. 

id appreciate if anyone has experience with this surgery and cares to provide opinion

[kavan]

For issues like sleep apnea and a maxfax surgery that OPTIMIZES aesthetics and FUNCTION, a very good analysis for that is the 'Arnett' analysis. This type of analysis is incorporated into some software coming out of SPAIN (think it's called 'Nemo') and referred to as 'FAB' which stands for something like; 'Face Airway and Bite'.

A lot of building in aesthetics with function such that there is optimal balance of both is often contingent on CCW (counterclockwise rotation) where sometimes this might call for a CCW posterior downgraft, something where there are more doctors who don't do them then those who do them. Although not everyone will be needing that type of downgraft, just be informed, the reason the technique came into existence was with the objective to optimize aesthetics WITH function.

Disclosure:  My post to this regard is not an invitation to teach all about CCW posterior downgrafting or entertain IF you need one.  Rather just something you may, on your own, research further.

[biterelapse]

For issues like sleep apnea and a maxfax surgery that OPTIMIZES aesthetics and FUNCTION, a very good analysis for that is the 'Arnett' analysis. This type of analysis is incorporated into some software coming out of SPAIN (think it's called 'Nemo') and referred to as 'FAB' which stands for something like; 'Face Airway and Bite'.

A lot of building in aesthetics with function such that there is optimal balance of both is often contingent on CCW (counterclockwise rotation) where sometimes this might call for a CCW posterior downgraft, something where there are more doctors who don't do them then those who do them. Although not everyone will be needing that type of downgraft, just be informed, the reason the technique came into existence was with the objective to optimize aesthetics WITH function.

Disclosure:  My post to this regard is not an invitation to teach all about CCW posterior downgrafting or entertain IF you need one.  Rather just something you may, on your own, research further.

yeah thats exactly what they suggest.   what constitutes the arnett analysis ?  by that i mean, what separates arnett's technique from other types of analysis ?

[kavan]

yeah thats exactly what they suggest.   what constitutes the arnett analysis ?  by that i mean, what separates arnett's technique from other types of analysis ?

Here's a link: https://www.semortho.com/article/S1073-8746(19)30046-5/fulltext

See my disclosure in my prior post: 'Disclosure:  My post to this regard is not an invitation to teach all about CCW posterior downgrafting or entertain IF you need one.  Rather just something you may, on your own, research further.'

So, no invitation either implied for me to describe Arnett analysis with reference to all other types.

[biterelapse]

thanks kind sir

[InvisalignOnly]

for example, if someone has sleep apnea issues, or breathing issues - this can be improved by simply losing weight, eating better and having better sleep hygiene

if one has bite issues, these can be corrected using a combination of orthodontics, implants, occlusal balancing, etc

I think the big issue is that this maxilofacial surgery is always "sold" to the patient as being required for functional problems, but in reality the only thing that is exclusively and predictably solved by surgery itself are esthetics and how a person looks. 
id appreciate if anyone has experience with this surgery and cares to provide opinion

While there's some truth to what you're suggesting, I think you're making some quite strange assumptions here. Re: breathing issues, I have no idea what you mean by 'better sleep hygiene' - in my case, I am a slim, fit woman with a very healthy diet and I have breathing issues probably related to my recessive jaw, nothing to do with weight or other factors. Also, a lot of bite issues cannot be fixed by orthodontics alone.

You say that aesthetic problems can be 'predictably' solved by jaw surgery - in fact it's anything but predictable, if it was, there wouldn't be hundreds of people on this forum trying to figure out what they might end up looking like after surgery. The fact is, the surgery changes the way the face looks, for the better or for the worse. So if you are fine with the way you look now, it might be a good idea not to have this surgery even if you have functional issues, in case you have complications from the surgery that might be worse than the functional issue, and / or you end up looking worse or just in a way that you don't like. This does not mean, however, that the surgery itself is useless for correcting functional problems for those who have them.

[biterelapse]

While there's some truth to what you're suggesting, I think you're making some quite strange assumptions here. Re: breathing issues, I have no idea what you mean by 'better sleep hygiene' - in my case, I am a slim, fit woman with a very healthy diet and I have breathing issues probably related to my recessive jaw, nothing to do with weight or other factors. Also, a lot of bite issues cannot be fixed by orthodontics alone.

You say that aesthetic problems can be 'predictably' solved by jaw surgery - in fact it's anything but predictable, if it was, there wouldn't be hundreds of people on this forum trying to figure out what they might end up looking like after surgery. The fact is, the surgery changes the way the face looks, for the better or for the worse. So if you are fine with the way you look now, it might be a good idea not to have this surgery even if you have functional issues, in case you have complications from the surgery that might be worse than the functional issue, and / or you end up looking worse or just in a way that you don't like. This does not mean, however, that the surgery itself is useless for correcting functional problems for those who have them.

by sleep hygiene i meant turning off the phone/computer/screens at least 2 hours before going to bed, eating smaller meals before bed, not consuming drugs/substances that alert the nervous system too much, turning off all of the lights, etc...its marginal, but can lead to better sleep. 

what kind of breathing issues do yu have ?    are you short for air/oxygen during the daytime , and/or do you have sleep apnea?  and if so how much apnea do you have mild, moderate, severe?   

i see your point, the surgery fixing the aesthetics is not "predictable"  necessarily, however my point is that the aesthetics are the only "issue" that CAN ONLY be corrected by surgery.  there is no other way to alter the facial structure other than cutting/repositioning bone....meanwhile for other issues like breathing/bite/facial pain....there is a way to circumvent the need for surgery and assuage those issues without it - 

howver i am generalizing here and there are some people whose jaws are so far back and/or assymetric that they literally NEED airway expansion and/or surgeical bite correction ....my argument would be wrong when referring to that group of people

[InvisalignOnly]

You are clearly confusing breathing issues with insomnia / sleep disorders, plus the things you mention have nothing to do with any kind of 'hygiene'. There are quite a few people with bite problems that cannot be solved by orthodontics and in fact, so called camouflage orthodontics can make their functional issues worse.

Obviously jaw surgery is very invasive with a lot of potential risks and downsides, so there are plenty of valid reasons to refuse it, but it's a bit of an exaggaration to say that the functional problems it's designed to solve can easily be solved in other ways. Some of them cannot be, but for many people it's an acceptable option just to live with the functional problems rather than have the surgery. If I was entirely happy with the way I look, I'd not get the surgery and just try to live with the breathing and bite problems I have - that's me, everyone can decide for themselves what's important to them and what risks they're willing to take.

[biterelapse]

You are clearly confusing breathing issues with insomnia / sleep disorders, plus the things you mention have nothing to do with any kind of 'hygiene'. There are quite a few people with bite problems that cannot be solved by orthodontics and in fact, so called camouflage orthodontics can make their functional issues worse.

Obviously jaw surgery is very invasive with a lot of potential risks and downsides, so there are plenty of valid reasons to refuse it, but it's a bit of an exaggaration to say that the functional problems it's designed to solve can easily be solved in other ways. Some of them cannot be, but for many people it's an acceptable option just to live with the functional problems rather than have the surgery. If I was entirely happy with the way I look, I'd not get the surgery and just try to live with the breathing and bite problems I have - that's me, everyone can decide for themselves what's important to them and what risks they're willing to take.

got it, i agree with that. 
I personally love the idea of this surgery and the benefits it can bring to me, but i just dont think we have enough data to support the stability of it.  rigid fixation is pretty barbaric in my opinion (and yeah i realize theres no other alternative) maybe stem cell harvesting ?    in addition, if youre a fully developed adult and your muscles, tendons, nerves have already adapted to your current facial structure, there is a chance of relapse even if jaw bones are moved into the "right" place, simply because those same "muscles, tendons, nerves" will "push back" against the new bone position and over time (maybe years) theyre prone to relapse. 

have you ever had a sleep study and if so were you diagnosed with sleep apnea ?     I ask because many times people with recessive jaws sleep poorly, but that doesnt necesarilly mean that the airway volume is "inadequate".  many max-fax surgeons will "convince" patients that having recessive jaws necesarily leads to an "inadequate airway volume" which is not always the case. in fact i know plenty of people with recessive jaws that sleep normally.  I ask because even when a sleep test's result indicate "moderate sleep apnea" that doesnt necesarilly mean you have a breathing disorder and your airway may have been compromised for a variety of reasons THAT ONE TIME YOU TOOK THE TEST.   --what you ate, how much caffeine or weed you consumed that day, how your stress levels are that day, your sleep position, etc etc.     by the way i dont mean to be intrusive or rude, just sharing my thoughts

[InvisalignOnly]

Sure, you're making some good points especially regarding the risk of relapse. I'm planning to get jaw surgery primarily for aesthetic reasons, which is probably the case with lots of people, as you point out. I was too lazy to do the sleep study suggested by my ENT doctor so haven't officially been diagnosed with anything yet. I sleep fine but feel excessively tired in the morning and run out of breath really quickly when running or doing exercise, and often find I have to grasp for air even when not exercising and keep blowing my nose for no real reason, like I feel there's something 'stuck' inside. I get sinus infections often.

I also have a deviated septum which is not helping things. I know I could get a septoplasty for that, but my nose looks OK externally and after weighing up the risks vs benefits plus the cost, I decided against it. By the way, apparently quite a few people who had a septoplasty only got temporay relief and then their septum got displaced again, so it's the same potential issue as with jaw surgery (risk of relapse).

[biterelapse]

Sure, you're making some good points especially regarding the risk of relapse. I'm planning to get jaw surgery primarily for aesthetic reasons, which is probably the case with lots of people, as you point out. I was too lazy to do the sleep study suggested by my ENT doctor so haven't officially been diagnosed with anything yet. I sleep fine but feel excessively tired in the morning and run out of breath really quickly when running or doing exercise, and often find I have to grasp for air even when not exercising and keep blowing my nose for no real reason, like I feel there's something 'stuck' inside. I get sinus infections often.

I also have a deviated septum which is not helping things. I know I could get a septoplasty for that, but my nose looks OK externally and after weighing up the risks vs benefits plus the cost, I decided against it. By the way, apparently quite a few people who had a septoplasty only got temporay relief and then their septum got displaced again, so it's the same potential issue as with jaw surgery (risk of relapse).

A septoplasty does not alter your nose's external look or structures at all. nose surgery that alters your nose's esthetics and outward structure and appearacne is called rhinoplasty. 

a septoplasty, which sound like you need has almost no risk when carried out by a good doctor, its one of the more common procedures and easy to perform by someone who has the necessary expertise.  furthermore, a septoplasty is covered by insurance since it has no esthetic implications whatsoever, and even if you have no insurance and have to pay out of pocket, its around $3000 dollars on average which isnt too much money considering youre fixing your most important breathing structure.    Finally, i would suggest getting a CT scan of your sinuses (if you havent already ) and having your ENT check if you have turbinate hypertrophy and conchae bullosa (2 VERY common side effects of a deviated septum) .   

i can relate to your breathing issues, I sometimes find myself gasping for air when im just moving around or walking, but i have no way of knowing if this is pathologically realted to the position of my jaws.

honestly, there is no reason for you NOT to get a sleep study and i would strongly reccomend you get one. again, its covered by insurance and even if they dont cover, it its only about $2000 dollars which is not an outrageous amount of money relative to the important findings a test like this one can bring to light .    AT THE VERY LEAST get a pulse oxymetry test which is used to measure oxygen levels of the blood.  this can give you more information on to how your breathing is affecting you at night...if you oxygen levels are fine (above 95% AFAIK) then maybe you dony even need a sleep study.

[april]

I was too lazy to do the sleep study suggested by my ENT doctor so haven't officially been diagnosed with anything yet. I sleep fine but feel excessively tired in the morning and run out of breath really quickly when running or doing exercise, and often find I have to grasp for air even when not exercising and keep blowing my nose for no real reason, like I feel there's something 'stuck' inside. I get sinus infections often.

Have you tried the breathe right nasal strips from the pharmacy? You can't really wear them during the day in front of people w/o looking weird, but they've been helpful during the night for me. They open your nose and the air that comes in feels so refreshing.

They also kinda give you an idea of what you'd look like with wider nostrils after a jaw surgery.

[kavan]

While there's some truth to what you're suggesting, I think you're making some quite strange assumptions here. Re: breathing issues, I have no idea what you mean by 'better sleep hygiene' - in my case, I am a slim, fit woman with a very healthy diet and I have breathing issues probably related to my recessive jaw, nothing to do with weight or other factors. Also, a lot of bite issues cannot be fixed by orthodontics alone.

You say that aesthetic problems can be 'predictably' solved by jaw surgery - in fact it's anything but predictable, if it was, there wouldn't be hundreds of people on this forum trying to figure out what they might end up looking like after surgery. The fact is, the surgery changes the way the face looks, for the better or for the worse. So if you are fine with the way you look now, it might be a good idea not to have this surgery even if you have functional issues, in case you have complications from the surgery that might be worse than the functional issue, and / or you end up looking worse or just in a way that you don't like. This does not mean, however, that the surgery itself is useless for correcting functional problems for those who have them.

Ruling out untoward events (getting one of the risks/complications) and whether or not the patient likes the result, with GOOD PLANNING and software (by the surgeon), aesthetic improvement IS predictable as are some deviations from it in situations where there are to be some trade-offs. With the high tech planning software, it will also list the deviations from norm IF any are to be 'trade-offs' of the design. Just because the PATIENT can't figure out what they will look like with all the planned displacements does NOT preclude predictability on the part of the surgeon designing the plan.

However, the people who do get the most out of bimax surgery are usually those who are 'bothered' by  (as in not 'attached' to them or would not miss them when gone) the SAME aesthetic deviations that the surgery can 'fix' or otherwise improve on.

[InvisalignOnly]

A septoplasty does not alter your nose's external look or structures at all. nose surgery that alters your nose's esthetics and outward structure and appearacne is called rhinoplasty.

Yes I know. However, many people get something called a septorhinoplasty - once they cut up your nose anyway, they take the opportunity to also change the way it looks. If I wanted to get a nose job anyway, I'd combine it with the septoplasty, but decided against it, because it is a serious and uncomfortable procedure with possible complications and for me it's not worth it. The ENT doctor I saw also said it wasn't worth it, based on my CT scan. I'm not going to go into any more details about this, I feel like we are wasting each other's time going on and on about this on a jaw surgery forum.

[InvisalignOnly]

Have you tried the breathe right nasal strips from the pharmacy? They also kinda give you an idea of what you'd look like with wider nostrils after a jaw surgery.

Thanks for the tip, will see if they're available where I live.