My daughter had double jaw surgery and it has all gone wrong!

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#1 Post by **Jane** » Wed Mar 04, 2009 3:47 pm

Can someone please help / advise me. My daughter had double jaw surgery 12 weeks ago for an underbite. She had braces prior to surgery for 1 year and we thought all was well - there was a lot of swelling and I kept telling her to reserve judgement abut the outcome. BUt she kept sahing she though the bone around her upper jaw area - from nose to upper lip - was protruding. She was right! It looks all wrong. She has a protruding upper jaw line from nose down to upper lip and a gummy smile which she never had before. I am frantic with worry and she is so distressed - I feel so responsible even though she is 20 - I should have stopped her having this done. Please someone tell me this can be fixed or I don't know what I will do. Can it be reversed. It was done on NHS to correct the undrebite, but I would payANYTHING to get it sorted. Please can someone advise.

#2 Post by **marycotter5678** » Wed Mar 04, 2009 4:17 pm

Did you talk to the surgeon who did the surgery?

I would also visit a cosmetic dentist and see if gum recontouring would help her feel more confident.

#3 Post by **Jane** » Wed Mar 04, 2009 4:27 pm

Yes we are in consultation with the surgeon and waiting to hear what he is proposing. we had a problem as she was not followed up properly post op. It has been a disaster. Do you know if jaw surgery can be reversed??

#4 Post by **Jane** » Wed Mar 04, 2009 4:37 pm

It is the shape of her upper jaw line that is the main problem - it protrudes and from her nose to her top lip appears to be very long. It just looks totally wrong - she looked much better before surgery. I pray we can get this sorted out.

#5 Post by **bbsadmin** » Wed Mar 04, 2009 5:18 pm

Most likely you will be able to make it better with another surgery, but only a surgeon can tell you for sure. You need to consult one or more additional surgeons to get a new plan on how to correct the situation.

There have been people on this message board who have had more than one surgery, because the first one didn't go right, or the results just fell short of the expectations. As far as I know, many of those people were OK after the problem was corrected. But of course everyone is different. I hope you can find the right resolution for your daughter!

#6 Post by **phil** » Wed Mar 04, 2009 7:19 pm

Jane,

I just want you to know that I feel for you and your daughter at this stressful time.

It is true that although no two of our situations are the same, there have been some of us who went through experiences that didn't go as planned. I am one of those people.

I am sorry, I don't know much about navigating through the NHS, but one piece of advice I could give you is to ask questions, lots of them, and continue to ask until you have received answers to your satisfaction, especially since you feel that the postoperative care was not what it should have been. It is important that the surgeons and physicians understand that you want to understand, and you will not stop until you do.

I wish you all the best, and know that archwired is here as a resource for you, when you get more information, and need to bounce ideas off of others.

Be well, and at peace,

Phil

#7 Post by **Jane** » Thu Mar 05, 2009 1:40 am

Thank you to all who replied. I'm so grateful for the support. This is my worst nightmare coming true for my daughter. I just pray that God will help me to help her get this sorted out. I will leave no stone unturned - believe me - I will do ALL that is necessary to get this resolved for her. Can you tell me if they can reverse this surgery completely back to what it was prior to braces? Many many thanks - I'm so grateful to be able to talk to people who understand. I know that some people will say to us why did you do it in the first place and I already ask myself that so really don't need to be reminded or made to feel any worse. I'm waiting today for a call for the surgeon and I've already got in place someone for a second opinion, but I want to give the surgeon a chance to resolve it for us. It is complicated by the fact that he is retiring (now semi-retired) and passed us over to another surgeon post op - who didn't follow up until 12 weeks post op (I know it is unbelievable). We saw the orthodontist at 6 weeks and he said it all looked well - the bite is perfect - I agree but her face is not! When I spoke to the original surgeon he said it is the responsibility of the orthodontist to sort it out and we need to press for this - I really don't understand this comment. Can anyone shed any light on this? The surgeon said it sounded like she had her upper jaw moved too far forward? The orthodontist said she has a long upper lip area from the nose down and that maybe makes it look protruding - but should they not have planned with that in mind?? I'm so trying not to alarm my daughter and reassuring her I will get it sorted whatever it takes - but the ortho is trying to tell me that it is more attractive to have a protruding face (more European??!!) When I said I have NEVER seen any before and afer photos that resulted in protruding upper jaw area - he said American surgeons do a more flat face look!! This was NEVER discussed with us prior to surgery. I feel someone has done something wrong here but do not know who? Any advice welcome. Many many thanks and I apologise for long post. Please pray I will keep strong as I am so distressed at the minute.

#8 Post by **Kerry** » Thu Mar 05, 2009 2:10 am

what hospital was this with ?

im due surgery with the nhs but onl having a lower jaw advancment.

#9 Post by **Jane** » Thu Mar 05, 2009 10:22 am

The hospital was NOT in your area (I see you are from Berkshire) I don't want to do anything to jeopardise getting this sorted out, so I will not post the name of the hospital or individual surgeons/orthodontists. Had a consultation with the surgeon today and we are a bit further forward in terms of information and what we need to do next. He was extremely helpful and understanding. It is important that people realise that it is the orthodontist who ensures that the teeth are in the right place for surgery and if he gets it wrong then something like this can happen. We are still not sure if this was the intended outcome, i.e. if they got the result they were planning for (and it is just that we are not happy) or if there was a problem in the planning of the surgery. This is what we have to establish now. We are going to see the surgeon who has taken over her case and the orthodontist who planned things in a week or so to have xrays and then we will be referred for a second opinion to someone outside of our area in another part of the country (which the surgeon agreed was probably best). He also assured me today that they will work with my daughter to ensure that this is resolved as best they can - but it will likely mean a second surgery, and it will be a completely new procedure, in other words starting all over again to resolve a completely different set of problems. Please, please everyone who reads this think carefully before embarking on this surgery. I'm not saying don't do it - because the vast majority of people are very happy - I am saying please think how you will cope if you are one of the people that does not have a good outcome. For me this is a nightmare coming true and I would not wish it on anyone. I hope and trust that in the near future I can post something more positive as, believe it or not, I am an optomist and problem solver by nature.

#10 Post by **Jane** » Thu Mar 05, 2009 10:23 am

The hospital was NOT in your area (I see you are from Berkshire) I don't want to do anything to jeopardise getting this sorted out, so I will not post the name of the hospital or individual surgeons/orthodontists. Had a consultation with the surgeon today and we are a bit further forward in terms of information and what we need to do next. He was extremely helpful and understanding. It is important that people realise that it is the orthodontist who ensures that the teeth are in the right place for surgery and if he gets it wrong then something like this can happen. We are still not sure if this was the intended outcome, i.e. if they got the result they were planning for (and it is just that we are not happy) or if there was a problem in the planning of the surgery. This is what we have to establish now. We are going to see the surgeon who has taken over her case and the orthodontist who planned things in a week or so to have xrays and then we will be referred for a second opinion to someone outside of our area in another part of the country (which the surgeon agreed was probably best). He also assured me today that they will work with my daughter to ensure that this is resolved as best they can - but it will likely mean a second surgery, and it will be a completely new procedure, in other words starting all over again to resolve a completely different set of problems. Please, please everyone who reads this think carefully before embarking on this surgery. I'm not saying don't do it - because the vast majority of people are very happy - I am saying please think how you will cope if you are one of the people that does not have a good outcome. For me this is a nightmare coming true and I would not wish it on anyone. I hope and trust that in the near future I can post something more positive as, believe it or not, I am an optomist and problem solver by nature.

#11 Post by **ohmyjaw** » Thu Mar 05, 2009 1:38 pm

It does sound like she had her upper jaw moved too far forwards. Did she have here lower jaw moved much at all? When correcting an underbite, obviously, you can either move the upper jaw forwards, lower jaw back, or some combination of the two. It is up to the surgeon to determne the appropriate movements, and it sounds like your surgeon misjudged the movement, or he has an odd sense of what is aesthetically good-looking. Either way, I don't think it is the orthodontist's fault. The orthodontist and surgeon need to work together to prepare for the surgery.

I am so sorry to hear about the difficulties you have had, and I hope for the best for you and your daughter. Please don't blame yourself for what has happened - there is no way you could have predicted this outcome. And, as you said, the majority of people who have this done end up being very satisfied. I hope you can this sorted out so that your daughter can be one of them.

#12 Post by **Jane** » Thu Mar 05, 2009 1:48 pm

Phil...thank you for your words of support and comfort which I appreciate. As a mum, I am struggling to keep my daughter upbeat and positive while at the same time trying to manage my own stress. But, I know we will get through this as we are a strong family and we have come through many traumas and loss. I'm a christian, and I believe that ultimately God is in control and will work out - even the bad things - for our ultimate good. I feel that today was a turning point, and now we have to focus on the journey towards getting this sorted. The surgeon was honest enough to admit there are no quick fixes. This is something we have to accept even though we don't like to hear it when we've already had a long journey to get to this point.

#13 Post by **Jane** » Thu Mar 05, 2009 2:00 pm

ohmyjaw wrote:It does sound like she had her upper jaw moved too far forwards. Did she have here lower jaw moved much at all? When correcting an underbite, obviously, you can either move the upper jaw forwards, lower jaw back, or some combination of the two. It is up to the surgeon to determne the appropriate movements, and it sounds like your surgeon misjudged the movement, or he has an odd sense of what is aesthetically good-looking. Either way, I don't think it is the orthodontist's fault. The orthodontist and surgeon need to work together to prepare for the surgery.

I am so sorry to hear about the difficulties you have had, and I hope for the best for you and your daughter. Please don't blame yourself for what has happened - there is no way you could have predicted this outcome. And, as you said, the majority of people who have this done end up being very satisfied. I hope you can this sorted out so that your daughter can be one of them.

Thank you for responding. Yes she had both lower and upper moved - lower back and upper forward. I agree that whoever planned this misjudged something - as it is not aesthetically right. Her face does not look balanced. I look back at photos pre braces and think - why did we ever embark on this in the first place - when I see what has happened. But today when I spoke with the surgeon (who has now retired officially from the hospital) I can only believe what he is telling me - and that the surgeon we have been transferred to will work with the ortho to get things sorted out. I don't know who has misjudged things - but most of the pre surgery work is done by the orthodontist so I would assume that he plans the position of the teeth and that the surgery planning has to be made in light of that?? can anyone shed any further light??We have lots more questions that need to be answered.

#14 Post by **ohmyjaw** » Thu Mar 05, 2009 3:41 pm

I am not an expert in these things - I am only speaking from my own experience. But in my case, the ortho and surgeon did work in cooperation. They had at least two meetings concerning my case, where they looked at models and such. But it was the surgeon who ultimately decided where and what to cut - he is the one wielding the scalpel, after all. So, I just think it's a little odd that your surgeon is blaming the orthodontist.

I also donâ€™t think that the surgeon is bound to a certain course of action based on how the ortho has lined up the patientâ€™s teeth. If you think about it, the goal is to have her upper and lower teeth in proper occlusion. There may be several surgical scenarios in which this can be accomplished. As I mentioned before, the upper jaw could be moved forwards, lower can be moved back, or both jaws can be repositioned. In any of these options, she would potentially have a good occlusion, but a somewhat different shape to her face. A decision has to be made, at some point, about which option is going to be the most aesthetically pleasing. Also, there may be some constraints on what the surgeon is able/willing to do. (Larger amounts of movement may be more difficult to achieve, could require bone grafts, etc).

One last thing â€“ you mentioned she now has a gummy smile. This can happen when the upper jaw is brought forward. However, there is a way to deal with this surgically, and it is called impaction. That is when the upper jaw is shortened (in the vertical dimension) at the same time it is being moved forwards.

I hope this is helpful. This is what I have learned from going through this process myself, so if anyone else has something to add, please do. And keep us updated with how your situation progresses.

#15 Post by **Jane** » Thu Mar 05, 2009 4:27 pm

Thank you very much (previous post - sorry don't know your name) This has been really really helpful. I will certainly keep you posted about how things are proceeding. I will mention 'impaction' when we see him next. Thank you again for taking the time to respond.