Is it not unlikely that im a candidate for functional jaw surgery?

[Dennis_]

Hi all,

First things first some (photographed) xray images:

https://imgur.com/a/yOyOQnN#gHqlBgE

Age 21, Germany.
From early childhood until about 19 years of age I mainly breathed trough the mouth and didn't swallow properly.
In retrospect I showed some sleep apnea symptoms like snoring, breathing stops or waking up with a dry mouth.
I was diagnosed with ADHD not too long ago.
Now, even after stopping breathing trough the mouth when I'm conscious, i have trouble breathing trough the nose.
My sleep quality is still bad and I usually wake up with a dry mouth and I'm tired troughout the day. However I think the snoring and the breathing stops improved after I started sleeping on the side and tried to stop breathing trough the mouth when sleeping (as good as I can help it). Sometimes I wake up with a headache and out of breath.
I still get dizzy and exhausted easily when I do sports, despite being in good shape on paper. I regularly yawn or take big breaths troughout the day.
My posture improved a little bit, but I still feel like I'm compensating with a forward head posture or tilting my head upwards.
I notice that its hard to breath and swallow correctly when I'm sitting down at a table and look downwards with a tucked chin. For example when I'm studying.

I consulted a orthodontist and the following assessment is directly translated from his notes:

• no problems with TMJ
• Upper: Narrow jaw, especially in the anterior area. Buccaly tilted teeth on the side. Proclination of the front teeth.
• Lower: Dental arch transversally narrow. Teeth on the side are lingually tilted and wilson curve is strongly pronounced. Slight proclination of front teeth, moderate crowding of front teeth.
• Bite: Skeletal class 3, dental class 1 on both sides. Open bite with non-occlusion of 15-25. Overjet 3mm, overbite ~ 3mm.

The orthodontist offered me to do MSE with about 7mm of expansion and invisalign afterwards. He can give me a definite number once I've done a 3d ct.
I don't have a deviated septum.

However I'm not sure how much MSE would help and insurance doesn't cover the procedure.
That's why I'm also considering some sort of jaw surgery IF insurance would cover it and there is a medical need for it.

Therefore I'm interested whether you think:

• I'm a good candidate for functional surgery (e.g. MMA or whatever is done in a case like mine) or not
• Insurance would cover the surgery or not
• My case is challenging and difficult to fix or rather straightforward

I'm not too deep into the surgery rabbit hole yet so Id appreciate the input from more experienced members.

Not 100% sure how I will proceed yet, but I'm asking my GP for a referral to get a sleep study done and Ill probably consult a surgeon.

Let me know if there is anything unclear.

[Sergio-OMS]

Hi all,

First things first some (photographed) xray images:

https://imgur.com/a/yOyOQnN#gHqlBgE

Age 21, Germany.
From early childhood until about 19 years of age I mainly breathed trough the mouth and didn't swallow properly.
In retrospect I showed some sleep apnea symptoms like snoring, breathing stops or waking up with a dry mouth.
I was diagnosed with ADHD not too long ago.
Now, even after stopping breathing trough the mouth when I'm conscious, i have trouble breathing trough the nose.
My sleep quality is still bad and I usually wake up with a dry mouth and I'm tired troughout the day. However I think the snoring and the breathing stops improved after I started sleeping on the side and tried to stop breathing trough the mouth when sleeping (as good as I can help it). Sometimes I wake up with a headache and out of breath.
I still get dizzy and exhausted easily when I do sports, despite being in good shape on paper. I regularly yawn or take big breaths troughout the day.
My posture improved a little bit, but I still feel like I'm compensating with a forward head posture or tilting my head upwards.
I notice that its hard to breath and swallow correctly when I'm sitting down at a table and look downwards with a tucked chin. For example when I'm studying.

I consulted a orthodontist and the following assessment is directly translated from his notes:

• no problems with TMJ
• Upper: Narrow jaw, especially in the anterior area. Buccaly tilted teeth on the side. Proclination of the front teeth.
• Lower: Dental arch transversally narrow. Teeth on the side are lingually tilted and wilson curve is strongly pronounced. Slight proclination of front teeth, moderate crowding of front teeth.
• Bite: Skeletal class 3, dental class 1 on both sides. Open bite with non-occlusion of 15-25. Overjet 3mm, overbite ~ 3mm.

The orthodontist offered me to do MSE with about 7mm of expansion and invisalign afterwards. He can give me a definite number once I've done a 3d ct.
I don't have a deviated septum.

However I'm not sure how much MSE would help and insurance doesn't cover the procedure.
That's why I'm also considering some sort of jaw surgery IF insurance would cover it and there is a medical need for it.

Therefore I'm interested whether you think:

• I'm a good candidate for functional surgery (e.g. MMA or whatever is done in a case like mine) or not
• Insurance would cover the surgery or not
• My case is challenging and difficult to fix or rather straightforward

I'm not too deep into the surgery rabbit hole yet so Id appreciate the input from more experienced members.

Not 100% sure how I will proceed yet, but I'm asking my GP for a referral to get a sleep study done and Ill probably consult a surgeon.

Let me know if there is anything unclear.

I am afraid you must consult in person with a surgeon in your country.

[Dennis_]

I am afraid you must consult in person with a surgeon in your country.

For sure, thats inevitable. Im not so much looking for definite answers, but more for a first informal estimation If that makes sense.
I thought this would be possible with the xray side profile I provided.

[GJ]

Yes, what is unclear is how you were diagnosed as "Skeletal class 3" - you look class 2 to me.

Your airway looks small, but an x-ray is not the best method to look at an airway. Airway and the symptoms you're describing could be justification for surgery. I'm not sure expanding the maxilla is possible at your age. It would only expand the upper airway, if at all, so you'd have to figure out what the limiting factor is in your airway. Seems your airway is your main concern, so you should go get a proper scan and see how small it is, and then go from there. That will probably give a lot of insight into whether you should go any further. Since aesthetics don't seem to be your priority, I won't even comment on that, other than the one above that you look more class 2 than class 3, to me.

Oh, and I don't think we can know if your insurance will cover this. Most of us are in the US and have no concept of German health insurance. On a consult, they're probably be able to easily answer that for you. Sounds like you need a consult.

[Dennis_]

Yes, what is unclear is how you were diagnosed as "Skeletal class 3" - you look class 2 to me.

Your airway looks small, but an x-ray is not the best method to look at an airway. Airway and the symptoms you're describing could be justification for surgery. I'm not sure expanding the maxilla is possible at your age. It would only expand the upper airway, if at all, so you'd have to figure out what the limiting factor is in your airway. Seems your airway is your main concern, so you should go get a proper scan and see how small it is, and then go from there. That will probably give a lot of insight into whether you should go any further. Since aesthetics don't seem to be your priority, I won't even comment on that, other than the one above that you look more class 2 than class 3, to me.

Oh, and I don't think we can know if your insurance will cover this. Most of us are in the US and have no concept of German health insurance. On a consult, they're probably be able to easily answer that for you. Sounds like you need a consult.

Thanks, yes i'll get a consult for sure now.
While I wouldnt go trough with surgery purely for aesthetics and no medical indication, I do care about it still.
And If I ever decide to do it, I want a aesthetically pleasing result to be honest.
Feel free to comment on the aesthetics If you want, im aware that its not very optimal.

[kavan]

Insurance coverage in Germany is not something I know about. But since your salient complaint could resolve to sleep apnea, the protocol for insurance paying for a maxfax surgery to address it is a sleep study that confirms the apnea.

Whether or not MSE would help is not really predictable from here on the board. If you are considering possibility of surgery, you should wait until you find out if it gets approved or not before you start altering via expansion BECAUSE what needs to be done for a surgery needs to be planned out by the surgeon doing the surgery along with the ortho. Hence, independent ortho procedures should be avoided in the interim of finding out whether or not you will be approved for surgery.

[kavan]

Insurance coverage in Germany is not something I know about. But since your salient complaint could resolve to sleep apnea, the protocol for insurance paying for a maxfax surgery to address it is a sleep study that confirms the apnea.

Whether or not MSE would help is not really predictable from here on the board. If you are considering possibility of surgery, you should wait until you find out if it gets approved or not before you start altering via expansion BECAUSE what needs to be done for a surgery needs to be planned out by the surgeon doing the surgery along with the ortho. Hence, independent ortho procedures should be avoided in the interim of finding out whether or not you will be approved for surgery.

ETA: Aesthetically, I think you would benefit by having the mandible advanced MORE than the maxilla (as opposed to both advanced by the same amount) and also a surgery that would decrease the mandibular plane angle.

[kavan]

Yes, what is unclear is how you were diagnosed as "Skeletal class 3" - you look class 2 to me.

Your airway looks small, but an x-ray is not the best method to look at an airway. Airway and the symptoms you're describing could be justification for surgery. I'm not sure expanding the maxilla is possible at your age. It would only expand the upper airway, if at all, so you'd have to figure out what the limiting factor is in your airway. Seems your airway is your main concern, so you should go get a proper scan and see how small it is, and then go from there. That will probably give a lot of insight into whether you should go any further. Since aesthetics don't seem to be your priority, I won't even comment on that, other than the one above that you look more class 2 than class 3, to me.

Oh, and I don't think we can know if your insurance will cover this. Most of us are in the US and have no concept of German health insurance. On a consult, they're probably be able to easily answer that for you. Sounds like you need a consult.

On his ceph, I'm seeing that a line dropped from the 'N' point passes through his 'A' and 'B' points as in SNA=SNB. ANB= SNA=SNB=0. So, that's probably why he got the class 3 classification.

[Gadwins]

In germany if a surgeon says you need this surgery for health reason, the public insurance will always cover the costs (without any request to your insurance).

That is independently from your orthodontic treatment. There has to be a request to your insurance from your orthodontic. Normally if the orthodontic says yes, then the insurance will also say yes. There are well known criteria for a insurance-covered-treatment, which you can easily find through google.

So it could be that the surgeon says that you need a jawsurgery, because it will improve your airway and the insurance will pay for that. But your bite is "too good", so you won't get covered the orthodontic treamtent from your insurance.

There are still some extra costs from your surgeon and orthodontic, if you don't undergo the treatment in a university hospital.

[Dennis_]

ETA: Aesthetically, I think you would benefit by having the mandible advanced MORE than the maxilla (as opposed to both advanced by the same amount) and also a surgery that would decrease the mandibular plane angle.

Having this post of yours in mind:

You should first establish whether or not your case is one where you would need one of the big name maxfax docs or if it's one that a local doc can do. Because there's no reason to pay for/travel to a big name doctor if you've got something that could be fixed up by a local one. For example the big name doctors do the significant posterior downgrafting CCW cases which sets them apart from many to most other doctors. But the only way to get feed back on here as to whether or not you are that type of case, would be to put up a copy of your CEPH.X-ray.

Do you reckon that im a more complicated case and it requires a more skilled surgeon to perform the movements that you said would benefit me aesthetically?

[kavan]

Having this post of yours in mind:

Do you reckon that im a more complicated case and it requires a more skilled surgeon to perform the movements that you said would benefit me aesthetically?

I gave you a response that adapted to YOUR initial post, it's CONTEXT and CONCERNS. So, if you have a question, I ask that it be RELATIVE to what ever I said to YOU and not request that I adapt, to you, a response I gave to another relative to their specific concerns.

[Dennis_]

I gave you a response that adapted to YOUR initial post, it's CONTEXT and CONCERNS. So, if you have a question, I ask that it be RELATIVE to what ever I said to YOU and not request that I adapt, to you, a response I gave to another relative to their specific concerns.

I think my question still stands under these standards.
I just wanted to give some context to why I was asking the question.

What you was saying:
ETA: Aesthetically, I think you would benefit by having the mandible advanced MORE than the maxilla (as opposed to both advanced by the same amount) and also a surgery that would decrease the mandibular plane angle.

What I was/am asking:
Do you reckon the movements you said would benefit me aesthetically in my case can be performed by local surgeons and are not particulary hard to perform or do they require so much skill that most surgeons wouldnt be able to pull it off?
Also If you want you can expand on the answer and say what makes me a difficult/easy case.

[kavan]

If you want to know how my response to an OTHER person relates to you, then you will have to wait until that other person posts their cephs and he gets a response of whether or not his case is a clear cut one for CCW posterior downgraft or not and then take it upon yourself to compare your ceph to his. But I do not answer questions that ask me to apply something I said to an entirely different person to another which was the basis of your question.

Your presentation did NOT prioritize aesthetics. It was one of FUNCTION and also one of INSURANCE. I think the responses you got here were all on target with your presentation.

As to my saying I think you would look better with the mandible advanced more than the maxilla, that could relate to possible CCW posterior downgrafting. So, you can look into that possibility if you like. But I'm not going to speak for who knows what or which surgeons in your local area can or can't do that.  You will first have to consult with one and see/hear what they suggest for you.

[kavan]

ETA: There is nothing in my post (nor anyone else's) to you that precludes you from consulting with a surgeon in your area. As to my aesthetic suggestion, it's something you could bring forth in a consultation with a local surgeon. Nothing about my aesthetic suggestion to you precludes you from doing such.

Consulting with a local surgeon is most certainly something you can do. It is not needed for me to posit whether or not your local surgeon can or can't improve both your form and function or has or has not the skill to do both BEFORE you even go on a consult with one. My not doing so doesn't preclude you from doing so either.

If you want to know how my response to an OTHER person relates to you, then you will have to wait until that other person posts their cephs and he gets a response of whether or not his case is a clear cut one for CCW posterior downgraft or not and then take it upon yourself to compare your ceph to his. But I do not answer questions that ask me to apply something I said to an entirely different person to another which was the basis of your question.

Your presentation did NOT prioritize aesthetics. It was one of FUNCTION and also one of INSURANCE. I think the responses you got here were all on target with your presentation.

As to my saying I think you would look better with the mandible advanced more than the maxilla, that could relate to possible CCW posterior downgrafting. So, you can look into that possibility if you like. But I'm not going to speak for who knows what or which surgeons in your local area can or can't do that.  You will first have to consult with one and see/hear what they suggest for you.