Saw two surgeons, both quacks; no idea where to go from here

[Neverloved]

Since my last post on here I've had consultations with two maxillofacial surgeons, who unfortunately turned out to be quacks who found every excuse they could not to take my case. The first said I was a "slight/minor case" that was "within statistical limits", and the second flat-out refused to have me as a patient because of my diagnosis of cyclothymic disorder since it's "a form of depression".

I'm at a loss as to what to do at this point. I don't have a clue how to find a good surgeon who can solve my problem, since that typically goes by word of mouth and I don't know anyone else near me who's going through this surgery. Do I just have to keep getting consultations with random surgeons and hoping that I get lucky and find a good one? Or does anyone on here know of a good surgeon in the UK or France who isn't going to rely on arbitrary statistics to decide whether or not a deformity is worth treating or not?
Was the objection based on my cyclothymic disorder diagnosis just (as I hope) an example of a not very good surgeon trying to find an excuse not to treat me, or is it something that's going to follow me around? Is there a way medical records be expunged, like criminal records?

I've thought about trying to get a consultation with Arnett & Gunson, but that would mean getting a hefty loan to pay the medical fees since I don't live in the US, and I'd really like to avoid having to be paying off this surgery for the rest of my life. Not that I won't take this option if I have to, but I'm hoping to avoid it.

I have a 1mm negative overbite, 4mm gummy smile, lip incompetence and maxillary hypoplasia. So, I need a Lefort I advancement and impaction, possibly lower jaw work, followed by cheek and jaw angle implants. Obviously the implants are out of the question until the jaw surgery is done. Can anybody here help me find a good surgeon?

[hduggan]

I'm not in the UK, so I don't know how things work over there. Over here, when we wanted to get a good reading on what course to take with my son, we went to the local teaching hospital. For us, that's a big university with a large dental/orthodontic school, with the best name in our state.

Although we ended up getting the work done elsewhere (because my son goes to school out-of-state, and the teaching hospital required that the orthodontic work and oral surgery both be done here), it gave us the chance of having a few very experienced surgeons/professors looking at him and reaching the same conclusion as our oral surgeon eventually reached. And it let us know that the *other* orthodontist we saw (who wanted to do TAPs on my son's extremely deformed jaw) was, as one of the doctors/professors suggested, maybe engaging in magical thinking

I would remain open to the possibility, though, that they're shying off from the surgery because they don't feel that it's functionally or maybe even esthetically necessary. I'm in no way saying that that's the case. But if you're facing a self-esteem issue, rather then a functional or even cosmetic issue, surgery is unlikely to help.

[Neverloved]

Doesn't matter if they think it's necessary. The deformity is there, *I* it's necessary to treat it, and last I checked, I was the one offering to pay them for that treatment.

[crazybeautiful]

As a general guide to UK treatment, the NHS follows a 'severity of case' guidline:

http://www.bos.org.uk/orthodonticsandyo ... whatisiotn

I think this gives a general perspective of what is severe and what is minor. Of course if you were to come here for surgery, it would be private treatment so wouldn't be dependent on this.

The general procedure here would be to seek referal from either a dentist or orthodontist. I imagine orthodontists still work in tandem with surgeons outside of the NHS too. However as my treatment was from the NHS, I don't really know much about private

As for what treatment you actually need [if it came to having treatment], that's down to the professionals to decide, not you.

[Neverloved]

I'll probably have it done privately. Everything I've read about the NHS makes me doubtful about trusting it, especially for surgery like this.

That page is confusing. It says that "reversals of the normal relationship of upper and lower teeth" of more than 2mm are grade 4, yet open bites of less than 4mm are grade 3. But last I checked, an open bite is the same as a negative overbite, which is a reversal of the normal overbite relationship; so what would a 3mm negative overbite be, grade 3 or grade 4?

Besides, I'd argue I fall into the last category anyway because maxillary hypoplasia and vertical excess are craniofacial anomalies.

[hduggan]

Doesn't matter if they think it's necessary. The deformity is there, *I* it's necessary to treat it, and last I checked, I was the one offering to pay them for that treatment.

No, it does matter. You can offer to pay, but they still get to decide what kinds of cases they want to treat. If they don't think the treatment is necessary, then treating you would mean violating their code to "first do no harm."

[amandapanda]

Do you have any pictures of your bite/teeth? That might help us in trying to understand your situation a bit better.

[crazybeautiful]

I'm not actually sure what the policy is for NHS treatment for non-British residents. I assume you would have to go private anyway. Though in terms of the NHS in general, 'don't knock it until you have tried it'. Whatever may be of issue with the NHS, it is not the level of standard or care or quality of work of the surgeons, etc, in question. To condemn NHS treatment in this way is unwarranted, especially if you have never received any! (can you tell I'm a strong advocate of the NHS? )

Not sure I agree that an open bite 'is the same as' an overjet. And I think 'craniofacial abnormalities' are really what characterises everything: it just depends on how severe it is. Grade 5 is of something such as cleft palate, as it says.

As well as an advocate of the NHS I'm also an advocate of acknowledging issues such as depression/low self-esteem are a real concern here. However, we have to differenciate between them being a by-product of a valid jaw problem that needs treating, over them actually being the root of the problem. This surgery is not cosmetic, so you may not need the surgery, despite wanting it. If your jaw problem is minor, then the thing to address may be the other issues. For example you could well get the surgery but end up questioning what change it actually made.

You may indeed qualify for surgery afterall, however. But the only people to make a judgement on that are the professionals. I would say get some more consultations by all means, but take on board what they say instead of searching until they tell you what you want to hear. If the common consensus is that you don't really need the surgery, then I would address the cyclothymic disorder. Perhaps talk to someone about it.

Good luck

[Neverloved]

I think legally my parents are British citizens now, since they've been living and working here for over 15 years, but I admit I know little to nothing about the NHS. I know only that not having a permanent address in the States anymore prevents me from getting insurance there.

Do you have any pictures of your bite/teeth? That might help us in trying to understand your situation a bit better.

Horrible, narrow, and crooked (please excuse the poor quality, it's an iPhone pic). And yes I am biting down even though the open bite makes it look like I'm not.

[crazybeautiful]

Your bite looks pretty decent to me, in all honesty.

If you think that open bite it bad...
http://crazybeautifulsurgery.blogspot.c ... yikes.html

Perspective is a good thing!

[Marisama]

Your bite looks pretty decent to me, in all honesty.

If you think that open bite it bad...
http://crazybeautifulsurgery.blogspot.c ... yikes.html

Perspective is a good thing!

Pretty ignorant post if you ask me. My bite is not recognizably bad, but causes great pain and discomfort because of minor discrepancies. I think you should rethink posting things like this.

[crazybeautiful]

I'm trying to make them feel better about their situation, not worse. And from what I take from this thread, the issue is inherently less about functional concerns than it is other things. If I were addressing you, we would be talking about different issues (ie the pain and discomfort you feel). I try to be tactful in everything that I write, because we all know on here exactly what it is like to go through this stuff.

I'm simply commenting on an image, as a layman. However, their consultations with two surgeons have suggested the problem is minor/does not require treatment. And if you read my previous posts you should see that I'm taking a considered approach to whatever advice I can possibly offer to help the OP out. So indeed, perhaps perspective is a good thing

But, thank you for branding me ignorant. I will try to work on my deficiencies

[Neverloved]

I'm simply commenting on an image, as a layman. However, their consultations with two surgeons have suggested the problem is minor/does not require treatment.

Thanks, but if they're both quacks I doubt it matters how bad my bite really is. What I need is a way to find a decent surgeon.

I don't see how that bite is "decent" anyway, there's horrible crowding and glaring gaps between upper and lower arches. Perhaps compared to the very worst cases on here, it's okay-ish, but certainly not normal.

[suzanna]

I'm simply commenting on an image, as a layman. However, their consultations with two surgeons have suggested the problem is minor/does not require treatment.

Thanks, but if they're both quacks I doubt it matters how bad my bite really is. What I need is a way to find a decent surgeon.

I don't see how that bite is "decent" anyway, there's horrible crowding and glaring gaps between upper and lower arches. Perhaps compared to the very worst cases on here, it's okay-ish, but certainly not normal.

Have you seen any orthodontists yet? If so, what did they say about having surgery? If they are for it, they should be able to help you find a surgeon who will work with you. Maybe the oral surgeons are advising against doing surgery because your case could be fixed with orthodontics only?

And I'm no professional or anything, but I personally wouldn't consider that "horrible crowding". I've seen a lot of cases of crowding much worse than yours that were fixed with braces alone.

[Neverloved]

I imagine the crowding can be fixed with braces, but what about the gummy smile, maxillary hypoplasia and vertical excess?