Re: orthognathic surgery for 13-year-old

[Guest guest]

Hi. First, ask whoever told you that when the surgery would be

appropriate for your daughter. 13 is, I think, mighty young. I would

expect that she still has some growing to do, and that one of those

growth spurts might even make her lower jaw larger.

I am not a professional, but I did have lower jaw advancement, 5 mm,

and a bit of sideways movement. Conventional wisdom, I think, is that

she's too young now. And that tests should be done to assure that her

growth is complete before the surgery takes place.

Of course, she will spend some time in braces pre-op to get her mouth

ready, and you want to ask for an estimate of that, too. But bear in

mind that it is only an estimate.

To do my surgery, I spent 16 months in braces. Then I checked into

the hospital (at 12:01 a.m. on a Tuesday! That's unusual, I think,

but my doc tries to save his patients' having to pay for an extra day

in the hospital. I actually checked into a pediatric ward, where the

nurses have been readying my guy's jaw surgery patients for years,

and they were wonderful. They gave me an IV (probably containing

antibiotics and steroids) and told me to take a bath and wash my

hair. They asked the standard questions, and told me to go to sleep,

but that the next morning I'd be up early for another shower and hair-

washing.

I went to the waiting area for the OR about 6, answered the

anesthetist's questions (yes, general anesthesia and intubation are

necessary) and things started going away. I do remember being

trundled into the OR, and sliding onto the surgical bed, and next

thing I knew, I was waking up gradually. With a cathether and an IV

still, as well as a morphine " clicker. " I stayed that night in a post

anesthesia care unit, where there was always a nurse at my side,

although I did not need him. I don't remember any pain, but I do

remember some pretty vivid hallucinations, thanks to the morphine. I

was fine, though. Next morning, I got rid of the catheter and the

morphine pump, went for x-rays, then went to my room, and had a clear

liquid lunch, salty as the devil. Doc came to see me, and I went home

about 1 on Wednesday.

In the interim, he'd made interior incisions to get at each side of

my jawbone, and made a cut on each side, through the bone. He had a

partner there as his assistant, but he does all his own cuts. (He had

also done about 1700 orthognathic surgery procedures before me, so he

does it frequently and well. That's something you wanna look for in a

surgeon.) After making those cuts, he (or they) very carefully split

my lower jawbone, to the point where they could slide it forward 5 mm

(about a quarter of an inch). He also did the necessary " carpentry "

(his word) to move it forward. I did not need upper jaw surgery,

thank goodness, as I believe the recovery there is more difficult,

but I would have done it if he'd told me to.

Then they made two tiny incisions through my cheeks, so they could

get the right angles to insert the screws. they drilled three little

holes on each side of the jaw, and inserted three little screws made

of titanium in each jaw. At some point they wired a thin plastic

wafer, or splint (but it didn't feel thin) into my upper brace. They

did the stitches, mostly inside, but three on each cheek, too, and

sent me to the recovery place.

I was a lot bruised, a bit swollen and not in any pain.

I stayed out of work for a month -- but I was 56. My main complaint

was weariness. For about eight weeks I ate either liquid or very soft

foods. At week seven he removed the splint. At about week eight, post

op, he sent me back to the ortho, where we got the fine tuning done.

That was the end of August. Early in October, I was out of braces.

Post op, I was neither wired nor banded.

My bite is better, my teeth are straighter, and my TMJ is better (but

don't count on this last happening; it may and it may not.

This may be TMI at this early point. I would do it again if needed. I

would be very careful in picking my ortho and surgeon.

Insurance: I hope your surgeon will also be knowledgeable about

insurance, or have someone in his employ who is. They can help you.

One key, for me, was to file under major medical, rather than dental.

He explained to my insurance company, with a letter, pictures, molds,

x-rays, etc., that the procedure was a medical necessity, was not

dental or cosmetic, and was for repair of a skeletal anomaly.

Good wishes for you and your daughter. If there are things I haven't

answered, ask away. I think there has also been recent discussion on

this board of another mother's son who has been told about the same

thing at age 13. You might want to check the archives.

I have good function, no residual numbnes, and am well pleased. My

insurance did cover the surgery, but not most of the orthodontics.

Cammie

> My 13 year may need orthognathic surgery, because her lower jaw is

> too far back and I really need a description and/or any information

> I can find. Can someone help me? My insurance says it is not

> covered, and the surgeon says it is medically neccessary, what do I

> do?

[Guest guest]

Hi. First, ask whoever told you that when the surgery would be

appropriate for your daughter. 13 is, I think, mighty young. I would

expect that she still has some growing to do, and that one of those

growth spurts might even make her lower jaw larger.

I am not a professional, but I did have lower jaw advancement, 5 mm,

and a bit of sideways movement. Conventional wisdom, I think, is that

she's too young now. And that tests should be done to assure that her

growth is complete before the surgery takes place.

Of course, she will spend some time in braces pre-op to get her mouth

ready, and you want to ask for an estimate of that, too. But bear in

mind that it is only an estimate.

To do my surgery, I spent 16 months in braces. Then I checked into

the hospital (at 12:01 a.m. on a Tuesday! That's unusual, I think,

but my doc tries to save his patients' having to pay for an extra day

in the hospital. I actually checked into a pediatric ward, where the

nurses have been readying my guy's jaw surgery patients for years,

and they were wonderful. They gave me an IV (probably containing

antibiotics and steroids) and told me to take a bath and wash my

hair. They asked the standard questions, and told me to go to sleep,

but that the next morning I'd be up early for another shower and hair-

washing.

I went to the waiting area for the OR about 6, answered the

anesthetist's questions (yes, general anesthesia and intubation are

necessary) and things started going away. I do remember being

trundled into the OR, and sliding onto the surgical bed, and next

thing I knew, I was waking up gradually. With a cathether and an IV

still, as well as a morphine " clicker. " I stayed that night in a post

anesthesia care unit, where there was always a nurse at my side,

although I did not need him. I don't remember any pain, but I do

remember some pretty vivid hallucinations, thanks to the morphine. I

was fine, though. Next morning, I got rid of the catheter and the

morphine pump, went for x-rays, then went to my room, and had a clear

liquid lunch, salty as the devil. Doc came to see me, and I went home

about 1 on Wednesday.

In the interim, he'd made interior incisions to get at each side of

my jawbone, and made a cut on each side, through the bone. He had a

partner there as his assistant, but he does all his own cuts. (He had

also done about 1700 orthognathic surgery procedures before me, so he

does it frequently and well. That's something you wanna look for in a

surgeon.) After making those cuts, he (or they) very carefully split

my lower jawbone, to the point where they could slide it forward 5 mm

(about a quarter of an inch). He also did the necessary " carpentry "

(his word) to move it forward. I did not need upper jaw surgery,

thank goodness, as I believe the recovery there is more difficult,

but I would have done it if he'd told me to.

Then they made two tiny incisions through my cheeks, so they could

get the right angles to insert the screws. they drilled three little

holes on each side of the jaw, and inserted three little screws made

of titanium in each jaw. At some point they wired a thin plastic

wafer, or splint (but it didn't feel thin) into my upper brace. They

did the stitches, mostly inside, but three on each cheek, too, and

sent me to the recovery place.

I was a lot bruised, a bit swollen and not in any pain.

I stayed out of work for a month -- but I was 56. My main complaint

was weariness. For about eight weeks I ate either liquid or very soft

foods. At week seven he removed the splint. At about week eight, post

op, he sent me back to the ortho, where we got the fine tuning done.

That was the end of August. Early in October, I was out of braces.

Post op, I was neither wired nor banded.

My bite is better, my teeth are straighter, and my TMJ is better (but

don't count on this last happening; it may and it may not.

This may be TMI at this early point. I would do it again if needed. I

would be very careful in picking my ortho and surgeon.

Insurance: I hope your surgeon will also be knowledgeable about

insurance, or have someone in his employ who is. They can help you.

One key, for me, was to file under major medical, rather than dental.

He explained to my insurance company, with a letter, pictures, molds,

x-rays, etc., that the procedure was a medical necessity, was not

dental or cosmetic, and was for repair of a skeletal anomaly.

Good wishes for you and your daughter. If there are things I haven't

answered, ask away. I think there has also been recent discussion on

this board of another mother's son who has been told about the same

thing at age 13. You might want to check the archives.

I have good function, no residual numbnes, and am well pleased. My

insurance did cover the surgery, but not most of the orthodontics.

Cammie

> My 13 year may need orthognathic surgery, because her lower jaw is

> too far back and I really need a description and/or any information

> I can find. Can someone help me? My insurance says it is not

> covered, and the surgeon says it is medically neccessary, what do I

> do?

[Guest guest]

Hi

My daughter had surgery on her jaw last year she was 12, her jaw was

growing more on one side than the other. we live in the UK, her

surgeon told us that it should be done then even though they are

still growing. If left it would affect the whole of the jaw and make

things worse. It was done last March she was in hospital for 2 days,

she had the incision made just in front of her ear and it cant be

seen at all. i suppose your daugters surgery will be done in side her

mouth, so it wont be so bad. My daughter is now wearing braces and

may need another op later to put her jaw back to its correct

position. I am glad it was done then. And I trusted her doctors

opinion and nobody elses, Please dont worry.