Braces

whatatwit

something_girl,

I didn't want a brace when I was a teenager, but by the time I was 19 I decided I wanted something doing about my buck teeth.
Like your daughter, I had a removeable brace on first, this in my case was to move the teeth the large distance needed before the finishing touches were applied with the fixed one.
At the time, I was working in the Civil Service and had to answer the 'phone as well as dealing with customers directly at the Enquiry counter. Yes, it does feel strange having a plate in the roof of your mouth and you do feel as though as your are speaking funny....but it is bearable.
I was that determined to have my brace in for as short a time as possible that I even wore it to go out clubbing, I realised that as I would be having a fixed one in at a later stage, then might as well wear the removeable one at all times.

By the time she is a high school, there will be loads of older kids with braces and at least by the time her friends are going through it in a few years, her teeth will be sorted.

car25

Toothsmith wrote: »

That would probably come from a plastic surgeon!!

Just because operations are becoming more common, and maybe pain control is getting a bit better, doesn't mean that they are getting easier.

Osteotomies require breaking and repositioning one or both jaws.

Whilst the jaws reset, they need to be wired together for 3 months +.

It's like electing to have a bad car accident!

The surgery is only one part of the danger.

Can you imagine having your jaws wired together and picking up a tummy bug??

People have died because they couldn't find the wire cutters in time!

Osteotomies should not be undertaken lightly.

They are never done until patients are into their 20s though.

I had an osteotomy on my lower jaw when I was 18 which failed shortly after. I had another two osteotomies one each on both top and lower jaw when I was 25.

Toothsmith is right, it is major surgery and the effect is just like being in a major car accident, and I would NEVER EVER EVER have it done again.

My bite is still not correct and I have no feeling in my bottom lip since surgery. I have had nothing but problems with my teeth ever since.

Toothsmith

Ahhhh - now I see why you get through bite guards so quickly!

OrthognathicSurvivor

Orthognathic surgery is generally performed by Oral and Maxillofacial surgeons, not plastic surgeons. Indeed this is not something to be taken lightly, and informed consent is an absolute necessity. But chatter like this to the effect that patients are regularly dying from complications of these procedures is utterly ludicrous, and about as accurate as the statement that for planned orthognathic surgeries patients are always wired shut for 3+ months. Hint: for most planned orthognathic surgeries, most maxfac surgeons will rarely ever wire patients shut; most planned orthognathic procedures these days (at least the types used in "surgical orthodontics" i.e. to help correct underlying skeletal deformaties that are negatively impacting the bite and oral health) rely instead upon rigid internal fixation, and the use of lightweight "guiding" elastics.

In summer of 2006 I had a bilateral sagittal split osteotomy to advance my mandible, and a mandibular midline osteotomy to constrict it slightly. I wore light guiding elastics for a few weeks post-op, I was eating soft solids (pasta, flaky fish, and so forth) within a week of surgery, and I was back to work part-time after a week of recovery, and full time after two weeks. I don't pretend everyone's recovery is as easy as was mine (and I definitely acknowledge that, on average, bimax patients will have a harder recovery than those of us who have lower jaw surgery alone) but I think the posts above are unnecessarily alarmist and as such they do a disservice to anyone who might benefit from such procedures.

Toothsmith

Good points, and on re-reading my post above, the way it's set out in short sentences does make it read more alarmist than I intended - but -

I didn't say patients 'regularly' died. Death from surgical proceedures is indeed a very rare occurence.

These days, advanced surgery is taken far too lightly, and people can be in danger of looking at it as 'easy'.

Your recovery was very much in the easier end of the spectrum. I know it's MaxFax surgeons who do osteotomies, but it's cosmetic surgeons who are promoting going'under the knife' at the drop of a hat.

So - apologies if it sounded too alarmist, but I would still say that an osteotomy should be thought about very carefully, and the risks listened to, before going ahead.

Firefly

Can I just add that it's nice to read a balance of posts and it's things like the above that make people stop and think, rather than make rash and hasty decisions.

We are mostly old enough, and sensible enough to make our own decisions and way up the advice given, but a range of advice is always so helpful.

That's what I love about MSE.

OrthognathicSurvivor

That's true. But you did categorically state that these procedures involve 3+ months of being wired shut. Afaik, only IVRO requires wiring as a matter of course, and that is only used for mandibular set-back, and then not in all cases. (Yes, wiring will sometimes be needed with other procedures, but it's not a given) So the major scare you offered up relied on being wired, which is uncommon, then being unlucky enough to get a severe enough tummy bug for vomiting, then being unlucky enough to start to choke on that vomit (consider that it would consist entirely of liquids that were able to get past the wired teeth in the first place), then being unlucky enough not to get to the wire cutters in time to prevent aspiration of the vomit. It's far more likely that any of us would get killed in a road traffic accident on the way to work on Monday!

Now, I'm not saying that these are procedures that should be approached without due consideration. But the only way to make a decision of this importance is armed with the facts. So yes, patients should indeed stop to consider all of the risks (and the benefits!) but they should also weigh those risks against the chance of them actually happening. So patients should be warned that they will experience swelling and bruising, and at least some fatigue; they will probably experience numbness, which may be temporary and may be permanent (although permanent numbness is usually limited to a very small area); and they might experience pain. They should also be warned that it's possible for there to be damage to other teeth during surgery, that there may be unfavourable splits that might require wiring, even if it was not originally planned, that infections are possible, and that the plates and screws used to fix the bony segments might sometimes need to be removed in a second surgical procedure, due to infections or the hardware becoming loose, sometimes even many months post-operatively. They should be warned that some people, at least initially, can find it jarring and even distressing to have a new appearance. And they should be warned also that very occasionally it will turn out not to be possible to proceed with the surgery, or that the bones might not heal properly (I believe it is about 1% of Lefort I advancements where non-union or fibrous union occurs?). Then there are restrictions. Dietary restrictions of course vary from one surgeon to another, as do activity levels post-op. But one given is a prohibition on contact sports, or indeed any activities where there is a risk of a blow to the face, for perhaps 3 months or more post-op. But dying on the table, or dying due to aspirating vomit are considerations that are so rare that despite their seriousness, when you multiply that by their likelihood, they become very small factors in the overall equation.

Yes, my recovery was, as I stated, at the easy end of the spectrum. But it was not utterly atypical, even so. I know a bimax patient who was out and mowing her lawn at 2 weeks post-op, and any number of other lower jaw patients who were back to full time work at 2 weeks. And heck, if geriatric patients can be expected to be out of bed within a couple of days of hip replacement surgery, I think that healthy young adults should expect, on average, to experience a pretty good recovery following jaw surgery. In terms of general post-op recovery (getting back to normal life) a lot of it does boil down to your surgeon's skill (and therefore how long you spend under GA) but a lot of it is also down to attitude, and doing the right thing - hydration, nutrition, rest, and mild exercise.

Anyway, my main point here is that people are better served with being informed about what is likely, and what is possible, then being scared with stories of something that is vanishingly unlikely to happen.

Toothsmith

You're a very well informed patient! Are you a surgeon as well?

Toothsmith

OrthognathicSurvivor wrote: »

they will probably experience numbness, which may be temporary and may be permanent (although permanent numbness is usually limited to a very small area);

I believe this can be beween 1/3 and 2/3 of all patients suffer some permanent numbness, depending on proceedure.

Do you have full feeling now?

OrthognathicSurvivor

A surgeon? Heavens no. Not even a dental professional. But I am a scientist by training, and someone who wants to know. So I managed to dig out a stack of great info on the web for the BSSO I'd have in my own op (not so much about the midline procedure though - it seems to be less commonly done; Bloomquist and Joondeph have published some papers, but nothing I've found that's available without subscriptions) Then I've strived to dig out information to help other folks who participate in another online forum in which I regularly participate.

I've no idea on the rates of permanent numbness (for one thing, from what I've read, they vary greatly from one surgical team to another!) but your numbers there do seem credible. The key point though is that (as I mentioned) it is, for most people, limited to a very small area indeed. For example, one person I know has a spot perhaps the size of the very tip of your little finger on his lower lip, and another person I know has a patch about the size of a dime on her chin; both report that this does not bother them at all. However, the potential for permanent numbness, and especially if it should be more extensive than this, is perhaps even the thing that worries people the most as they contemplate BSSO. (I've not done as much reading on upper jaw procedures, but it seems that any permanent numbness resulting from Lefort I or SARPE is very rare; and one of the advantages of IVRO for mandibular setback is that it comes with a massively reduced - virtually negligible - chance of numbness)

As to me (and you'll think I am telling fibs now!) I surprised even my surgeon by being able to report that the little numbness I initially had in my lower lip and chin had entirely resolved less than 12 hours post-op. I was lucky enough to have an incredibly experienced surgeon, but I think the fates had to have been smiling on me that day.