orthognathic surgery Questions and Answers Archive

Nov
2001

Q&A: Can I avoid braces if I have oral surgery to correct a severe overbite?

Question:

I've been told I have a pretty severe over bite and should have oral surgery to correct it because it causes serious pain in my jaw and popping when I chew. The way the procedure was described to me is that there would be incisions made on either side of my lower jaw, then they would lengthen it and put screws in my jaw. Is there any way that this surgery can be done with out having to get braces as well?

- Athena

Answer:

 David A. King, DDS - LocateADoc.com

The standard of care leans towards orthognathic surgery (ie: corrective jaw surgery) involving atleast an oral & maxillofacial surgeon and an orthodontist. Proper tooth alignment can be critical for a stable and acceptable outcome.

-- David A. King, DDS
Wilmington, Delaware



May
2001

Q&A: Do I have any options if my insurance company will not cover the repair of my under bite resulting in eating problems?

Question:

I have a bad underbite. I had a surgery consult, and had been planning on having the surgery at the end of June. They planned on moving my upper jaw forward and possibly moving the lower one back also. They were also going to shorten my upper jaw. Then I found out my insurance doensn't cover the surgery and it is likely to cost 30-35,000 dollars. I can't afford that! I'm really insecure about my smile, and I have a lot of problems eating. Is there any way to get my insurance company to cover it? Do you know of any companies that do cover that kind of surgery?

- Kelly

Answer:

Kelly, Unfortunate for many, insurance companies often apply the cosmetic surgery rules to orthognathic surgery. They feel the establishment of a functional bite is nothing more than cosmetic surgery, and most companies will not cover cosmetic surgery. It may take a number of appeal and review letters to get the company to assist you. You may need to make a number of calls to the company, and have both your doctor's office and your employee benefits rep make calls, too. If it can be a benefit to any medical problems you have, e.g.TMJ, gastric problems, air way problems you might get a favorable responce. Check also that your benefit handbook excludes or does not exclude corrective jaw surgery. It may mean changing docs, but if they do cover it it may mean you have to see a new provider. Good luck

--Charles R. McNamara, DMD
Winter Park, Florida



May
2001

Q&A: Can I have revised the orthognathic surgery done to correct my under bite?

Question:

I am 25 years of age, Chinese male living in Hong Kong and recently had surgery to correct an under bite. Actually, my problem wasn't severe, but I had always been self-conscious about it ever since I was a kid and had wanted to fix it. Last year, I was referred to an orthognathic surgeon who was the best in Hong Kong, supposedly. At first, I thought by moving my lower jaw back would fix my problem, as I didn't notice anything wrong with everything above that. But my doctor insisted that my upper jaw be moved forward as well because I had a flat face, as he put it. I had doubts about this at first because I anticipated that by moving my upper jaw forward would also affect the shape of my nose as well. But the doctor reassured me that this was not going to happen because the cut was going to be done right under my nose. My occupation relies heavily on my voice and the way I talk so I also had to make sure that this operation would not affect my voice and speech in any way. Again, he reassured that I had nothing to worry about. Since he was the expert, I took his words for it. It's been five weeks after my surgery now, and the recovery went fairly quickly as most of the swelling is gone. But now I am facing two major problems. As I anticipated, the base of my nose has come forward and up slightly since my upper jaw was moved forward by 5mm. My nose now looks wider and the nostrils are more visible and flared. An even bigger problem for me is that some how my uvula and soft palate have been moved forward along with the jaw, and it's constantly rubbing on my tongue. This is impairing the functions in my mouth severely, because it's making me gag all the time. I sound like I have something stuck in my mouth when I talk and I can't even speak properly now. My surgeon says that I am overreacting about the nose and asked me to relax. But he can't explain the problem with the uvula, and neither could the throat specialist he referred me to see. I am extremely upset with side effects because the surgeon guaranteed that they would not happen. I am so unhappy about the result that I am actually considering to get my upper moved back to where it was. Can you tell me if this is possible? I have heard that orthognathic surgery revisions are rare and quite difficult to perform. If it is possible, do I have to do it within a certain period of time before the bone heals? Has anyone had problems like mine? Please advise as this driving me insane.

Answer:

David A. King, DDS - LocateADoc.com

Advancing the maxilla can have affects on the nose as you have described. Swelling still may be why you have the sensation of your uvula resting on your tongue. The maxillary advancement would have to be pretty significant to usually have this problem. Without examining you pre & post-op, it is tough to comment on that. Revisions can be done at anytime but since you are only 5 weeks post-op, I would recommend that you have alittle more patience before making that type of decision because soft tissue and bone healing after surgery can take considerably longer (6-9 months). If you still are not satisfied, get another opinion.

--David A. King, DDS
Wilmington, Delaware



Jun
1999

Q&A: Is my 3 year old daughter too young to have surgery for open bite and how do I find info on Lefort I Osteotomy?

Question:

Dear Dr., My 3 year old daughter has an open bite. We have been reffered to an oral surgeon and told that surgery would be required. Are these procedures usually preformed on children of this age and if so, how does this affect future bone growth and development? Also, could you help me find more information about Le Fort I osteotomy on the web to help us better understand this procedure?

- Anna

Answer:

The correction of an open bite is often done with a Lefort I osteotomy. The majority of the patients that undergo this procedure are older than 15 years old enless they have been diagnosed with a facial syndrome that requires a staged surgical correction. In these patients the final effects on overal growth and developement is unclear because of their underlying condition. For this reason I would be perfectly clear about your childs long term treatment plans as well as the primary diagnosis. Once you know this information you will be able to make a much better decision. For additional information about Lefort I osteotomies I would reccommend researching these key words on the web and at your local public library. Orthognathic surgery Craniofacial surgery Jaw corrective surgery good luck

--Priveer Sharma, D.M.D.
Winter Park, Florida



Apr
1999

Q&A: Why do so many teeth have to be extracted if my son has Mandibular Hypoplasia and how much will this take?

Question:

my son is 12yrs of age and possibly needs mandibular advancement also 2supernumerary teeth behind#8/9removed 4premolars to be determined+4 3rdmolars.why would they remove so many teeth? and what is mandibular advancement? How long would it be for all this to be over? please help

- patty

Answer:

In general it appears that your son has been diagnosised with Mandibular Hypoplasia. The correction of this condition is performed with a procedure know as Orthognathic Surgery. If you are interested in the sequencing of this treatment you can look at the AOMS Home page or speak to a Board certified Oral & Maxillofacial Surgeon. As far as when his treatment will be over is difficult to say specifically, however in general the whole process can take up to two years and surgery is timed after your son has completed his facial growth. Good Luck

--Priveer Sharma, D.M.D.
Winter Park, Florida