Orthognathic Surgery for Starters

[VADoc]

Hello, I am new here and I have searched this forum but I couldnt find everything I was looking for in one convienent post so I am going to tell my story and ask about orthognathic surgery basics.
I am 24 year old male and have micrognathia giving me an overbite and a horrible receding chin. I only started noticing it in profile pictures when I was probably 14 or so years old. I have contemplated orthognathic surgery a few times in the past but I always dismissed it as being too extreme and self conciously driven. I have tried to read online some facts about the process but the only thing I could find were horribly dramatized before/after shots and generalized sales pitches that doctors have out on the internet. I have never consulted an orthodontist nor maxillofacial surgeon for it; I have only seen a surgeon one time and that was to remove my wisdom teeth. Here are my questions:

How long of a timeframe does it generally take? I have never had braces and I could perhaps use them since I have a small gap in my 2 upper front teeth and one of my 2 front bottom teeth is angled in front of the other. I know time is different for everyone but I would like some specifics on how long for braces, how long for surgery, recovery, etc.

How much does it cost in total? I haven't checked but I am pretty sure my insurance would not cover it since I am not having any TMJ pain, apnea or aggravating symptoms.

When is the best time for me to have the surgery done? I am a 3rd year medical student right now with one year left of school before I move on to residency for 4 or so more years so time off is very very very rare.

And also, if I get surgery I may have a rhinoplasty as well because my nose is very large for my face and also has that bump on the upper portion, maybe from a previous fracture that I didnt know I had (football??? haha)

I'm throwing these thoughts out there to gather information, I have no idea if I want the surgery or not. I just want to see some facts and decide whether to pursue it or not. Thanks so much for the help!

[Teigyr]

VADoc,

Hello and welcome!

I am only in the beginning stages of this whole thing but they estimated about 2 years total for me. I have one year in braces, surgery after a year, then braces back on for approximately 6 mos after I recover. I've researched a LOT about the recovery and have come to the conclusion there is no set timeframe.

Re insurance, I have no symptoms except my bite is way off. My bottom teeth touch/ed the roof of my mouth. I don't look funny (at least due to THAT) and nobody could tell. My teeth are straight. Insurance paid for it. My surgeon had me fill out a questionnaire about how I eat, etc., and I didn't realize that I was doing anything different than "normal" people. The surgeon was adamant that it wasn't TMJ so maybe insurance likes to decline for that.

My options were to pull top teeth and bring my teeth back to meet or have the surgery. By pulling the teeth, it would "sink" my face in a bit. All opinions (I had several) were against that.

Vanity aside, my teeth have uneven wear and while my appearance might be changed a bit, that isn't the motivation behind the surgery.

With insurance, the surgery cost would be $12,000-something. Without, it would've been $6,000-something (??? yeah, I know) My portion with insurance will be $3,000 or less. My braces are $4700 but my insurance covers $2,000 of that.

Regarding school, maybe it depends on when you have a break? My orthodontist and surgeon say they will know when I'm ready and I'll have a 6 week window, or so. It is hard to predict exactly when it'll happen. My job, while not physically demanding, requires a LOT of multi-tasking and accountable decision making. I can't take anything that'll impair my judgement. I also speak on the radio (air/ground) a lot. I believe I'll take about two weeks off, hopefully not more.

At home I have some websites, etc., that I could send you if you're interested. If I were you, I'd also consult someone because really, every case IS different!!!!

Jane
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[url=http://www.TickerFactory.com/]

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[VADoc]

Wow!! Thank you for the info! It helped out a lot.

[montesser]

VADoc,

I don't have a lot of info, but here's where I stand. Timetable that was given for me was 2 years total. 1 year of ortho, then surgery, then finish up 2nd year of ortho. My dental insurance didn't cover my braces. Cigna has stipulations, only up to age 23, so that was $6500 out of pocket. I had my consultation with my oral surgeon and they said that my health insurance should cover the surgery. I have an open bite, cross bite, and misaligned jaws. I should only be out my deductible for that costs. I don't know about recovery time, but since I'm 1 year away, I didn't ask too much about it. Can anyone else give estimate of recovery time for Orthognatic Surgery? Here are some of my pics. The only teeth that touch are my back molars.

http://i35.photobucket.com/albums/d153/montesser/Braces%20Photo%20Log/DVC00211.jpg
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MR 11-28-05
Next Cleaning 10-19-06
Extractions 1-12-06
Next Adjustment 8-19-06

[nvcarissa]

From what I understand recovery can vary, depending on the surgery you get. From what I have read here though, the first two weeks are the worst, and depending on the kind of work you do, you may need to take the entire two weeks off. Some can get away with just a week off.

I am hoping my surgery happens in May, but I don't really have a clue if I am on track to seeing that happen. I will ask my ortho at my next appointment in January.
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Braced 5/11/05, BSSO with advancement 6/21/06, Debanded: 8/1/07. Click on www for my braces story.

[lioninthelake]

[lioninthelake]

[SuzieQberg]

I am just shy of getting surgery. I actually received a phone message from an oral maxifacial surgeon yesterday to schedule me. He said it would be the end of April, which in my opinion is way too far out. Anywho....I have had braces on since June of 2004. My situation sounds exactly like yours VADoc and at this point I should be getting surgery. Good thing is, I am in the military and the military is paying for all of this. They said I will be out of work for ATLEAST 1 month. I have heard a few bad stories. I did have to military friends who have had it done and they had great success. They both said that eating is the hardest part to get used to. Recovery took maybe 6 months for each. When I initally started my oral surgeon asked about fixing my nose as well because they said it was off center. As long as I have had this nose it has never been off center in my opinion......if they will do it, I will let them. I will keep you posted on how everything goes if you would like. By the way....I will be getting upper and lower done. They will cut me on top (the four front teeth on top, just outside of that) and on the bottom behind where my wisdom teeth should be. You may be able to use your insurance if you have any ear nose or throat issues. Eating has been the hardest thing for me to do because of my bite. CAN'T WAIT TO GET THIS DONE!!!!!!!!!!!

[Meryaten]

A quick note on insurance. y surgery has been approved under my medical insurance, which is, I will grant you, pretty liberal, but I received approval because "this skeletal problem very definitely causes functional difficulties, specifically difficulty with mastication" Uh huh. Maybe that's why I am as thin as a rake... oh wait... I'm not. I think it often does come down to how the consulting surgeon words the pre-approval/treatment advisory/whatever your insurance asks for.

[nvcarissa]

[SuzieQberg]

What I was meaning.....my orthodontist told me on my last visit 1/11/06 that he is passing the time basically trying to find ANYTHING to do before my surgery. My oral surgeon did call and give me an initial appointment on 25 April. I aksed if he had anything sooner because I am being held up for schools that get me promoted.....the following day he called me back to let me know that he rescheduled me for 22 March. Now that we are moving in the right direction I am so excited and can not wait for more reasons than one to get this surgery over and done with. I guess the point I am trying to make is that I can go anyday as far as my orthodontist is concerned but the surgeon is booked out going on 4 months......not good. I have been thru 4 sets of molds and fifty million x-rays. I have a pre surgical date set for 11 March for yet more molds. I think I may have one more cleaning to get and at least 2 more visits with my ortho before surgery.

[VADoc]

Thanks for the help guys!
Another question, how do I get this process started? Do I go to my dentist and get the ortho referral, etc? I have a dentist but I see him about every +3 years. My teeth are in good shape (knock on wood), no cavities ever, brushing and flossing everyday; so the integrity of my teeth wont be a problem.

[katemm06]

Hey VA Doc,

You could go to your dentist and ask for an orthodontist referral. Or research orthos on your own to find one. Maybe ask friends or family who they have gone to. Once you have a consultation with an ortho they will refer you to an oral surgeon. My ortho works with two oral surgeons. The first one he recommended I had a bad experience with when I was younger so he gave me another referral which turned out to be such a blessing. I actually enjoy going to my oral surgeon's office on visits. He's the best doctor I've ever had Good luck!

[SJDOC]

Hello VA DOC,

I too was a student and medical resident with micrognathia/retrognathia and an overbite. Actually had symptoms of obstructive sleep apnea but didn't know it at the time. Later on, I was formally diagnosed by a pulmonologist/sleep medicine doc and then I saw an orthodontist who was really terrific. I had orthodontic work, ie tooth extractions and braces, and close coordination with a oral-maxillo facial/plastics surgeon for the planned surgery. The whole process took about two years. My surgery included a sliding osteotomy (lower jaw/mandibular advancement), maxillary/hard palate advancement, and cranial-to-maxillary bone graft to correct maxillary hypoplasia), and turbinetomy/septoplasty. The braces was a piece of cake but the recovery from surgery was a little rough. It required a night in the ICU and two nasogastric tubes for airway protection. There was intense facial edema for about two weeks(normal) and my jaw was wired closed for about a week. For a week, my food intake was strictly puree and liquids through a straw or syringe. Probably lost about ten to fifteen pounds (also normal).
It took a full month or two to fully recover. I sleep great now and the bonus is that I look better. I believe self-image and self-esteem is very important in a young person. So have the surgery if you are self-conscious. My surgery was covered by my insurance because of the sleep apnea. I think the total charges to the insurance company was over $35K.
Now here is my advice. I had friends who were in my residency class with both prognathia and retrognathia and had their surgery done at our University hospital as it had a dental/oral-maxillo-facial training program. I think their residents/fellows actually performed the surgery at little or no cost to them. My friends took about a month off from their residency program but that's no big deal.

Thanks.

[pg001999]

Hi there -

After several years of deliberation, I had a lower jaw advance and genioplasty (basically, a chin job to make it more prominent). I had an unusual case, and switched orthodontists halfway through my treatment so my treatment took a really long time.

I underwent surgery my second year in law school. I was busy and it was a bit stressful, but doable. I took one full week off from school, and just went to a few classes the following week. If you have to be in class all day you might have a hard time, but it is definitely doable.

It's been a bit over a year since my surgery and I'm completely recovered and so glad that I did it. Remember that most people who have good experiences never share their experiences, but people wh o have bad experiences are much more likely to vent...


good luck!

Pamela