Revision of double jaw surgery after 3 years - Veteran here!

[Sarah96]

Hello. I joined this forum 3 years ago when I had my first double jaw surgery. I even made a post here about revision surgery but then a lot happened and I forgot to update here.

So... I had a class 2 open bite with a cant on my upper jaw. My lower jaw and chin was also extremely recessed.

I was 18 years old when I had my double jaw surgery and I knew something was off even right after. My midline was off, my cant was still there, my nose was crooked completely to the left side, my bite was off etc etc. I still had recessed jaw and my upper jaw was over impacted.

I waited for a long time for things to become better. My doctors didn't accept their fault and accused me of being paranoid. After waiting for a whole year I decided to talk with other surgeons. Then finally started my new journey.

I started all over again with a new orthodontist and surgeon. 1.5 years ago I had my plates and screws removed. Then I started to wear braces again.

Now I'm 17 days op. My procedure this time is:
Upper jaw impaction on front and down fraction on back. Upper jaw was brought forward 2 mm.
Cant fixed
BSSO with genioplasty
Septoplasty
CCW rotation

I will make a comparison of healing process between the first surgery and the second here:

First surgery took 4 hours. Revision surgery took 6 hours because revision is more complicated and risky.
Right after first surgery I threw up for hours. It was really uncomfortable and I had so much pain. My face was so swollen as well. But right after my revision surgery I didn't throw up or feel nauseous at all. There was discomfort but pain was bearable. My face was not that swollen.
After my first surgery I wasn't banded shut or anything. After my revision, I was banded shut 5 days post op. It's when it became difficult and painful.
After my first surgery I didn't have a full liquid diet. I started soft foods after 10 days. But right now I'm on full liquid diet for 17 days. I can't open my jaws even slightly. So my only option is to drink milk, really liquid soups and juices.

Tomorrow I will see my orthodontist and hopefully he will let me use changeable bands. I want to be able to move my jaw again.

Is it worth it?
Well... It's better than first surgery. At least I can say that my bite is corrected. But I still have a lot of lip incompetence. My upper lip is so short so that's one of the reasons. But I also show lower teeth at rest. I guess there is nothing my surgeon could possibly do about it. I don't blame him because if he impacted my upper jaw more, it would be so recessed and I wouldn't show teeth.
I see some asymmetries but they don't bother me that much. They are minimal.
My only concern is that I have mentalis strain... I don't know if it's because my muscles can't used to the new position yet. But even when I don't force my lips to close I have that chin dimpling and it's making me so sad... I will discuss this issue with my ortho tomorrow but it's bothering me after 2 jaw surgeries I still can't be like those normal people with my lips closed.
If you ever had that kind of issue please tell me.

If you have any revision thoughts or questions I can share what I know with you.

Also I will add photos later for you to see and judge for me.

[kplatt2010]

Hi Sarah,
Before my surgery, I had to strain to close my mouth. My mouth hung open at rest. Following surgery, my mouth still hung open at rest. It was not until the ortho had done some major work following surgery that I was able to close my mouth naturally at rest.

I also showed more of the bottom teeth than I liked immediately after surgery. However; part of that issue I would discover later was that the bottom teeth had tipped in-ward. It has been a major battle with my teeth to try and get them to roll out. My ortho has faith that he can do it. I'm trying to keep faith in him that he can get the job done. I do think as the bottom teeth have shifted, I can see less of the bottom teeth.

Stay strong.

[Sarah96]

Thanks for your answer! I am glad to hear you can close your mouth at rest now. And I hope your treatment still goes smoothly and your ortho can fix the problems! I guess in your case there was still issues with bite which will be improved by orthodontics? You had hard times but it's nice if you can see the reward!

Today I saw my ortho and he told me that my bite is so great and there is almost no work to do. He just needs to keep that bite. But he gave me some exercises to make since I was banded shut for 2 weeks and my mouth movement is minimal now. I asked about mentalis strain and they told me to do muscle exercises but it's not guaranteed that it will reduce. They told me they change bone structure with surgery but they have no way to change soft tissue and muscle tone.
They told me that if they moved my jaw more forward than this then it would be so masculine for my face. And I already have an upturned nose and more movement means more upturned nose so they didn't want that. I agree with everything they said. It's just sad to know there is no cure for this persistent mentalis strain
I hope exercises can help at least to cover my bottom teeth without strain.

[kplatt2010]

Hey Sarah-
I had to google what mentalis strain was. The google pull mentions botox as a good treatment. Has the surgeon mentioned this as a viable option? Take a look at this https://www.realself.com/question/europ ... rse-effect

I'm off to see my oral surgeon tomorrow. I think it will all go well. We've been keeping an eye on hardware on my right side that may or may not have been a little lose. It's been all good with my jaw PT exercises (tongue depressor exercises/ jaw stretching).

Let me know what they say about botox. Ortho is not the one who would do it.

[Sarah96]

Hey Sarah-
I had to google what mentalis strain was. The google pull mentions botox as a good treatment. Has the surgeon mentioned this as a viable option? Take a look at this https://www.realself.com/question/europ ... rse-effect

I'm off to see my oral surgeon tomorrow. I think it will all go well. We've been keeping an eye on hardware on my right side that may or may not have been a little lose. It's been all good with my jaw PT exercises (tongue depressor exercises/ jaw stretching).

Let me know what they say about botox. Ortho is not the one who would do it.

How did your appointment go? I hope it's going well for you.

Also thank you for your recommendation. I will ask about it to my surgeon at my next appointment. I hope it is an option for me to do.

[Onetruereddot]

Hey, you said your midlines were off after your first surgery. How much were they off by? I think I'm in a similar situation myself.

[kplatt2010]

Hi Sarah,
Appointment went well. I still have one screw that may be coming lose. However; it's not at the point that it needs to be removed at this point. The surgeon shared that when it's really lose, the gum will get bubbly and mushy around hardware. Recommendation is to get a yearly panoramic for 5 or 6 years...

The surgeon said the jaw surgery had nothing to do with the braces challenge to get bottom teeth to roll back out. He said it should actually be easier to get them to shift because he broke the jaw.

I take everything he says with a grain of salt.

[Run10KToday]

Hi Sarah,

Thanks for sharing your story and hope everything goes well with you. I have a similar situation like you -- I had Double Jaw Surgery 3 years ago and I end up with a cant and asymmetrical upper/lower jaws. I'm seeking for revision as well. Do you mind to share with us some pics before & after? I'm not sure how much cant (degree) did you have before the revision... Do you recommend your surgeon? Thanks.

[Sarah96]

Hey, you said your midlines were off after your first surgery. How much were they off by? I think I'm in a similar situation myself.

I don't know the exact measurements but I'll add pictures and you can see there. I think it was off about 3/4 mm. I think it was noticeable. Actually my midline is still off but not as much as before and it's not that noticeable.

Hi Sarah,
Appointment went well. I still have one screw that may be coming lose. However; it's not at the point that it needs to be removed at this point. The surgeon shared that when it's really lose, the gum will get bubbly and mushy around hardware. Recommendation is to get a yearly panoramic for 5 or 6 years...

The surgeon said the jaw surgery had nothing to do with the braces challenge to get bottom teeth to roll back out. He said it should actually be easier to get them to shift because he broke the jaw.

I take everything he says with a grain of salt.

Nice to hear your appointment went well. I hope you don't have to have a surgery for this and I hope it won't bother you. But even if you need a surgery to remove screws, it is easy and healing process is quick. But of course I hope there will be no need for that.

Oh, maybe they broke the jaws and now jaws are still healing, it is easier to make changes on teeth? It's like it is easier to make changes on children's teeth. But I don't really know. They should be able to plan everything about orthodontics before surgery.

[Sarah96]

Hi Sarah,

Thanks for sharing your story and hope everything goes well with you. I have a similar situation like you -- I had Double Jaw Surgery 3 years ago and I end up with a cant and asymmetrical upper/lower jaws. I'm seeking for revision as well. Do you mind to share with us some pics before & after? I'm not sure how much cant (degree) did you have before the revision... Do you recommend your surgeon? Thanks.

Sorry to hear that you are also dealing with asymmetrical jaws after your surgery. I tried to find some photos which can show you the asymmetry I had but it is not really visible on photos. It's obvious on my X-rays that my jaws are slanted.

I found a picture of my smile after my first surgery and you can compare it with the revision one.

first surgery smile.JPG

This is after my first surgery. My midline is off and I show more gums on one side.

huge smile after.jpg

This is after my revision. My smile is not slanted. My midline is closer to center. 3 weeks post op.

beforeafter.jpg

Left pic is my profile after first surgery. Right is after revision.


Actually this revision surgery corrected my slanted jaws, my bite and my profile but I feel like I look worse on front view now. It was easier to close my mouth before revision.

[kplatt2010]

Hey Sarah,
How did you get the pictures to load? I tried using the attachment feature and it say's the pics are too big. The insert image does not seem to actually insert the pic.
Karla

[Sarah96]

Karla, I had the same problem at first but I used paint to make pics smaller and to decrease quality of the pics. So I could add them.

[kplatt2010]

Thanks for the tip Sarah!
Karla