Probably heading for jaw surgery thought I'd intruduce msyelf and ask for some clue as to what I'm in for.

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mrunicorn
Posts: 11
Joined: Mon Feb 05, 2018 2:49 pm

Probably heading for jaw surgery thought I'd intruduce msyelf and ask for some clue as to what I'm in for.

#1 Post by mrunicorn »

I called myself Mr. Unicorn because I have a rare blood disorder I don't want to name because its so rare someone might be able to find me in real life if they knew what it was called. Apparently one of the consequences can be bone deformities, especially of the skull, because it inflames your bone marrow stretching your bones and causing them to grow in wrong. I had irritating, but not severe, pain in my jaw, difficulty closing my mouth, and severe sleep apnea. I went to a maxiofacial surgeon about a month ago and they told me my upper jaw was too big and they thought it was doubtful insurance would cover surgery to correct it but they would ask anyways. I understood going in that these surgeries are invasive, painful, and require long recovery periods.

I got a letter from my insurance company saying I WAS eligible for 4 procedures they had requested and I googled the insurance codes and found they corresponded to these:

Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any
direction, without bone graft

Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid
fixation

Osteotomy, mandible, segmental; with genioglossus advancement

Impression and custom preparation; oral surgical splint

I then got a call scheduling an appointment to do some scans review what's called a final record. Which apparently is something the Dr. goes over with you before surgery although I'm not sure what that entails.

Anyways, I just thought I'd introduce myself, ask if anyone had any advice, and if anyone can give me a better idea of what they want to do to me. It will be a few weeks before I can ask the Dr. myself and the suspense is killing me. :)

mrunicorn
Posts: 11
Joined: Mon Feb 05, 2018 2:49 pm

Re: Probably heading for jaw surgery thought I'd intruduce msyelf and ask for some clue as to what I'm in for.

#2 Post by mrunicorn »

Sorry for the horrifically misspelled title btw. I was trying to get several things done at once and didn't notice my mistake until it was too late. :oops:

snapdresser
Posts: 996
Joined: Wed Feb 18, 2015 7:31 am

Re: Probably heading for jaw surgery thought I'd intruduce msyelf and ask for some clue as to what I'm in for.

#3 Post by snapdresser »

Hi MrUnicorn, and welcome!!! :D I think you'll find yourself right at home here, where many people have gotten or are getting most of the same procedures as you. I could explain the terms they used in your insurance approval, but a picture is worth 1,000 words, so I'd just google "3-piece Lefort I Osteotomy" and "Bi-lateral Split Sagittal Osteotomy" and read up.

Your chin surgery sounds like it might be a little different than most, however. Most of us who had our chin worked on had a Sliding Genioplasty (which also pulls the tongue forward, helping with sleep apnea), but yours says "Genioglossus Advancement", which sounds like a different procedure. Unfortunately I can't help you with that one, but maybe someone else here can?

Do you have braces? If not, expect to have archbars put in during the procedure. Also, you'll be on a liquid diet for somewhere around 8 weeks. And if that's not brutal enough, you'd going to look different afterwards, and it's going to freak you out. It takes a long time to come to grip with. That aspect is frequently under-stated by surgeons.

Anyways, welcome to archwired!!! There's a ton of info on here if you poke around :D
No braces
1-piece LeFort I + BSSO + Sliding Genio on 10 JUNE 2015!
Partial hardware removal 14 SEP 2018
Image

mrunicorn
Posts: 11
Joined: Mon Feb 05, 2018 2:49 pm

Re: Probably heading for jaw surgery thought I'd intruduce msyelf and ask for some clue as to what I'm in for.

#4 Post by mrunicorn »

I researched to the best of my ability before even talking to the surgeon. I think I understand the broad strokes but would like more info. My understanding is they want to break my upper and lower jaw and allow them to heal in a better positon. I found images of the upper jaws segmented into different places but don't understand the exact purpose of the procedure as opposed to moving the jaw in one piece.

Apparently genioglossus advancement pulls the bottom of the tongue foreword and may help treat sleep apnea. My tongue also protrudes and my front teeth on both jaws angle outwards so that could be the motivation as well. I'm hoping that maybe they can do the genioplasty and genioglossus advancement as one procedure if I need a genioplasty to correct my profile but I'm not sure if that's how things are done.

I had braces as a kid and had two of my upper premolars extracted in what I guess was a misguided attempt to fix the problem, but don't currently have braces or know what the purpose of an arch wire is.

I don't like my current appearance and I'm hoping correcting the jaw malformation will improve it. When I close my mouth my chin gets stretched upwards and rounded off. I mentioned having chronic health problems and I'd really like to have less issues to deal with. If I have to go through hell now to be able to close my mouth without so much effort , not sleep in a mask, and have a more normal appearance 10 years from now it will be worth it.

snapdresser
Posts: 996
Joined: Wed Feb 18, 2015 7:31 am

Re: Probably heading for jaw surgery thought I'd intruduce msyelf and ask for some clue as to what I'm in for.

#5 Post by snapdresser »

Sounds like your expectations are fairly realistic, which is important. One piece of info to keep in mind: there’s a good chance your lips won’t just start coming together immediately after the surgery. Your muscles are acclimated to holding your lips apart, so you’ll likely have to make a concerted effort to keep them together, all day, every day, until your muscles get used to it. It should be a bit easier to close them post-op (at least after your lip mobility returns), but it’s still going to take some effort for a while.

Most people get a 1-piece Lefort. I haven’t seen your x-rays (and I’m not a surgeon anyways), but the surgeon must have decided that the movement he wants for your front section should be different from the movement he wants from the left and right sides. Perhaps you have additional maxillary enlongation in the front? I don’t know, you’d have to ask your surgeon. But a 3-piece is a bit more complex with some additional risks, so I’m sure your surgeon has a good reason for it.

I’m interested to hear how the GA goes, so keep us posted on that!
No braces
1-piece LeFort I + BSSO + Sliding Genio on 10 JUNE 2015!
Partial hardware removal 14 SEP 2018
Image

mrunicorn
Posts: 11
Joined: Mon Feb 05, 2018 2:49 pm

Re: Probably heading for jaw surgery thought I'd intruduce msyelf and ask for some clue as to what I'm in for.

#6 Post by mrunicorn »

Would that fix a high pallet? I think the Dr. may have mentioned that. Another thing I thought about would be if they wanted to open the space up and do implants to replace the teeth I had extracted although that seemed like it would be taking it to the extreme.

I'm used to keeping my mouth closed. Its just it looks awful and it feel it stretching whenever I do. I keep getting pain in my chin and lower jaw too that I thought might be related to that.

snapdresser
Posts: 996
Joined: Wed Feb 18, 2015 7:31 am

Re: Probably heading for jaw surgery thought I'd intruduce msyelf and ask for some clue as to what I'm in for.

#7 Post by snapdresser »

I don’t know what your surgeon is trying to address with the 3-piece, but doing it to address a high palate would be a new one on me. Also, I kind of doubt they’re intending to replace the teeth you had removed previously, but who knows.

That’s good news about your keeping your mouth closed already. That should hopefully make it easier post-op. It’s hard to say how the surgery will affect that pain you’re feeling, but hopefully you trust that your surgeon is making the best decisions possible for you.
No braces
1-piece LeFort I + BSSO + Sliding Genio on 10 JUNE 2015!
Partial hardware removal 14 SEP 2018
Image

mrunicorn
Posts: 11
Joined: Mon Feb 05, 2018 2:49 pm

Re: Probably heading for jaw surgery thought I'd intruduce msyelf and ask for some clue as to what I'm in for.

#8 Post by mrunicorn »

I'm hoping my surgeon is going to be pretty good. Apparently they're a professor at a fairly prestigious teaching hospital I'm going to. I've only met this person once.

snapdresser
Posts: 996
Joined: Wed Feb 18, 2015 7:31 am

Re: Probably heading for jaw surgery thought I'd intruduce msyelf and ask for some clue as to what I'm in for.

#9 Post by snapdresser »

Nice. Yeah, it’s a pretty common complaint that people only meet with their surgeon once or twice before the operation.
No braces
1-piece LeFort I + BSSO + Sliding Genio on 10 JUNE 2015!
Partial hardware removal 14 SEP 2018
Image

mrunicorn
Posts: 11
Joined: Mon Feb 05, 2018 2:49 pm

Re: Probably heading for jaw surgery thought I'd intruduce msyelf and ask for some clue as to what I'm in for.

#10 Post by mrunicorn »

Okay, I have a few updates.

They hope to do the lefort 1 in a single piece. They over-requested from insurance just in case.

They made it sound like the genioglossus advancement would include a genioplasty.

They seem to think I won't need braces beforehand due to past orthodontic work.

snapdresser
Posts: 996
Joined: Wed Feb 18, 2015 7:31 am

Re: Probably heading for jaw surgery thought I'd intruduce msyelf and ask for some clue as to what I'm in for.

#11 Post by snapdresser »

Nice! Then you get archbars! :D :D :roll: They still suck. That’s what I had. At least you only have them for about 12 weeks after surgery.
No braces
1-piece LeFort I + BSSO + Sliding Genio on 10 JUNE 2015!
Partial hardware removal 14 SEP 2018
Image

mrunicorn
Posts: 11
Joined: Mon Feb 05, 2018 2:49 pm

Re: Probably heading for jaw surgery thought I'd intruduce msyelf and ask for some clue as to what I'm in for.

#12 Post by mrunicorn »

I'm fine with archbars. Was scared orthodontics would take a year or more before I could even get my surgery.

One of the people I talked to said they would likely rotate my jaw "down" for a better airway but not sure what down means. I'm guessing counter clockwise cuz I saw that used in other cases online but not sure.

snapdresser
Posts: 996
Joined: Wed Feb 18, 2015 7:31 am

Re: Probably heading for jaw surgery thought I'd intruduce msyelf and ask for some clue as to what I'm in for.

#13 Post by snapdresser »

Was this person your surgeon? “Down” would be clockwise. I had CCW rotation and my maxilla was impacted, which it sounds like is the opposite of what you had. I don’t know of anyone who’s had clockwise rotation. If that’s really what your surgeon has planned, you might want to discuss the aesthetic implications of that with them. Tho just because I don’t know anyone who’s gotten it doesn’t mean it’s not right for you!
No braces
1-piece LeFort I + BSSO + Sliding Genio on 10 JUNE 2015!
Partial hardware removal 14 SEP 2018
Image

mrunicorn
Posts: 11
Joined: Mon Feb 05, 2018 2:49 pm

Re: Probably heading for jaw surgery thought I'd intruduce msyelf and ask for some clue as to what I'm in for.

#14 Post by mrunicorn »

I think it was a resident. They said they'd rotate the jaw (I think he meant lower jaw) down and it would help my airway.

I have vertical maxillary excess and my lips don't touch when my molars touch like normal peoples apparently do.

snapdresser
Posts: 996
Joined: Wed Feb 18, 2015 7:31 am

Re: Probably heading for jaw surgery thought I'd intruduce msyelf and ask for some clue as to what I'm in for.

#15 Post by snapdresser »

For a case of maxillary excess, I think it would be pretty unusual to have a downgraft done, so I don’t think your surgeon would do that. I’m not super familiar with rotational movements of the mandible except to match the maxilla. Rotating something “down” is a bit nebulous anyways. It could be rotating in either direction with the front, back, or both moving in the downward direction. That said, if you suffer from maxillary excess, they’re probably planning to impact your maxilla with CCW rotation. If they’re trying to lower the back of the maxilla to increase your airway during the CCW rotation, keep in mind that they have to be careful with that movement, as the plane of your teeth should be a decline, or at worst flat. Inclined planes are not ideal aesthetically. Just something to discuss with your surgeon when they present their surgical plan, if you’re so inclined (no pun intended).
No braces
1-piece LeFort I + BSSO + Sliding Genio on 10 JUNE 2015!
Partial hardware removal 14 SEP 2018
Image

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