Re: Age & Results.......Cammie? Mike?

[Guest guest]

virginia...all i can say is i am 42 years old...had surgery october

2004...upper and lower and it appears that i am still numb on upper palate,,,,

have

nerve damage on lower lip.... and have very stiff mouth.... went to " top md " in

new york city..... think really hard about this...especiallyif you need upper

and lower... my vote....not to do it.... especially withupper and lower..i hear

lower is easier.... this is a big deal..... my breathing is better and

profile and bite slightly better than with braces alone...

you best really need this to go thru with it....just my advice..

[Guest guest]

> Hello,

>

> I am fairly new to this site. I've read alot of postings,

especially

> those by Cammie and Mike. Definite opposing views on whether to

have

> surgery or not.

>

> Mike, in your experience are you finding more people than not are

> experiencing permanent nerve damage? And does it appear age is

> playing a significant role in recovery?

>

> I have a significant overbite. I have an arthritic left joint with

> TMJ. I am 43 years old. I've been in upper braces for 4 months.

> Next month I get lower braces. The surgery for lower jaw

advancement

> of about 3-5 mm has been approved by medical coverage.

>

> Yesterday, I had an appointment with my ortho and I said I didn't

> want surgery (after researching this site). He assured me that the

> surgery was safe and the " majority " of his patients have had very

> good results. He said he would not recommend the surgery if most

of

> his patients experienced nerve damage. Yesterday I was positive

that

> surgery was not for me, now I am confused. He (as well as my

> surgeon) did say that age would play a role in recovery and they

> couldn't absolutely guarantee no permanent nerve damage, but said

it

> was unlikely.

>

> On one had, I would like to help my TMJ symptoms (but just the

braces

> alone have alleviated the problems substantially).

>

> Cammie, what procedure did you have. Was your surgery done for

> medical reasons? I believe you had lower jaw advancement, but did

> you have your jaw wired shut? Would you recommend having the jaw

> wired versus titanium plates? I've read that the slide advancement

> with plates of the lower jaw may be more risky because the nerve

can

> be damaged more easily.

>

> Thanks so much for your replies.

>

> Virginia

[Guest guest]

> Hello,

>

> I am fairly new to this site. I've read alot of postings,

especially

> those by Cammie and Mike. Definite opposing views on whether to

have

> surgery or not.

>

> Mike, in your experience are you finding more people than not are

> experiencing permanent nerve damage? And does it appear age is

> playing a significant role in recovery?

>

> I have a significant overbite. I have an arthritic left joint with

> TMJ. I am 43 years old. I've been in upper braces for 4 months.

> Next month I get lower braces. The surgery for lower jaw

advancement

> of about 3-5 mm has been approved by medical coverage.

>

> Yesterday, I had an appointment with my ortho and I said I didn't

> want surgery (after researching this site). He assured me that the

> surgery was safe and the " majority " of his patients have had very

> good results. He said he would not recommend the surgery if most

of

> his patients experienced nerve damage. Yesterday I was positive

that

> surgery was not for me, now I am confused. He (as well as my

> surgeon) did say that age would play a role in recovery and they

> couldn't absolutely guarantee no permanent nerve damage, but said

it

> was unlikely.

>

> On one had, I would like to help my TMJ symptoms (but just the

braces

> alone have alleviated the problems substantially).

>

> Cammie, what procedure did you have. Was your surgery done for

> medical reasons? I believe you had lower jaw advancement, but did

> you have your jaw wired shut? Would you recommend having the jaw

> wired versus titanium plates? I've read that the slide advancement

> with plates of the lower jaw may be more risky because the nerve

can

> be damaged more easily.

>

> Thanks so much for your replies.

>

> Virginia

Dear Virgina

I tried sending u a message and I pressed post instead of send so I

will retype as much as I can remember.

In reguard to permanent nerve damage. I am three wks post-op from

lower jaw advancement and I researched doing this surgery big time

before going ahead. No exaggeration I went to at least 10 oral

surgeons and looked up statistics on the internet for days. Most Drs

told me there is a chance of anywhere from a 5 to 15% chance of

permanent numbness from lower jaw surgery. Statistics I saw showed

about 5 to 10% that ended up with permanent numbness. The Dr. that

did my surgery told me that in over 20 years of doing the surgery he

is yet to have a patient that had permanent numbness. Although he

said I cd have be the first. Which I think shows that that the skill

of the Dr does play a huge role.

As far as oral fixation vs being wired. My Dr believe that is much

more benefical to be wired as opposed to titanium screws for the

following reason. When ur fixated the joints are forced to remain in

certain position which may cause TMJ problems, because it is not

exact science the joints may not be in comfortable position. When ur

wired there is more leway for the joint to position themselves in a

position they are comfortable in. He written published studies on

this and believe whole heartly it is much better to be wired

especially if TMJ is an issue. I know there are great Drs. who think

oral fixation is the way to go, I am just giving you my Dr's opinion.

My Dr did an excellent job on me.

I also had an overbite like you. It wd certainly be much more

advantageous if they cd correct ur bite with just lower as opposed to

upper and lower. My Doctor told lower jaw surgery tends to have less

complications and quicker healing than upper.

As far as age is concerned certainly an 18yr old tends to heal

quicker than a 40 yr old but overall health plays a huge role. I am

40 an athlete and health enthuiast when it comes to diet. My Dr cd

not believe how little swelling I had after 2wks and quickly I seem

to be healing. What you digest in ur body will play be a major

component as well. I have been drinking a lot of water and taking

alot of protein drinks and healthy high protein foods blended up.

From the research I have done the vast majority of patients are happy

they did the surgery. It was something in the high 90's

Three wks post-op despite the misery of being wired. I am thrilled I

did the surgery. I was not unhappy with the way I looked before

surgery. I didnt have trouble attracting men. But I am now estatic

with the cosmetic improvement already. As far as TMJ I am still wired

so it really is to soon to tell. The braces also greatly alleviated

many of my TMJ problems but if I felt the side of my face it was

still sore especially if I did alot of talking. Which no suprises is

something I tend to do. I had to manuever my jaw to eat. I alway had

popping and clicking when I ate. I have to see how things change when

I get these wires out in three wks. I am looking foward to my new

coreectly functioning bite.

I know it is a very personal decision but let it be ur decision. Dont

let all those people who gasp when u tell them ur considering surgery

let u talk u out of it. They are not oral surgeons and orthodontist.

They dont understand what ur going through. My oral surgeon even said

that the way my bite was I cd probably go through the rest of my life

perfectly ok living with my bite . Me personally I as very happy I

did it because I finally have a bite and profile and smile I am very

proud of and so is boyfriend with no permanent numbness so far no

pain.

Whatever u decide I am sure it will be the right decision for you.

Best of Luck

[Guest guest]

Hi Virginia,

I'll weigh in as a surgery vet here, if you don't mind. I've been a

member of these sites since about Feb 2001 - check out site 2 and

also the geocities info website at

http://www.health.groups.yahoo.com/group/orthognathicsurgerysite2 and

http://www.geocities.com/orthognathicinfo/

I had upper/lower/genio surgery in August of 2002. I was 46 going on

47 when I had my surgery. I had a really easy recovery. I would do it

again if I had to, provided I had the same surgeon and ortho.

While I don't want to discount Mike's experience, which is

unfortunate, it is not the norm and I personally wouldn't base my

decision on it. Any surgeon will tell you that there is a small

percentage chance of permanent numbness - you weigh that risk in

making your decision (what is permanent numbness, by the way? it

could range from slightly altered sensation to full loss of feeling).

There are also no guarantees that the surgery will make TMJ problems

better or worse. All things to consider when making your decision,

but they are not the only considerations, likely.

In the end, you're the one who has to make the decision. You do that,

in my view, by gaining as much information as you can, which you're

doing, bravo! (check out the other links I've provided). In the end,

if you decide to go ahead, it is a trust issue with your ortho and

surgeon. That means you trust them to make the best decisions

regarding wiring/plates & screws, splints, etc. They are the ones

with all the training and experience. Ask questions about it, yes,

but trust them in the end.

Also, ask them for patient references, good & bad. Mine both offered,

but I didn't followup, I'd met many people online here, and was

comfortable with my decision. It also helped that I'd met one of my

surgeon's upcoming patients before she had this surgery.

I had TMJ problems that were helped during the process by a bite

splint, but I knew it would not be a permanent solution, that the

long term solution was surgery, which both ortho & surgeon

recommended.

Everyone goes through a pretty nervous stage when making this

decision, and even closer to the surgery if you decide to go ahead,

all of that is normal.

Good luck,

> Hello,

>

> I am fairly new to this site. I've read alot of postings,

especially

> those by Cammie and Mike. Definite opposing views on whether to

have

> surgery or not.

>

> Mike, in your experience are you finding more people than not are

> experiencing permanent nerve damage? And does it appear age is

> playing a significant role in recovery?

>

> I have a significant overbite. I have an arthritic left joint with

> TMJ. I am 43 years old. I've been in upper braces for 4 months.

> Next month I get lower braces. The surgery for lower jaw

advancement

> of about 3-5 mm has been approved by medical coverage.

>

> Yesterday, I had an appointment with my ortho and I said I didn't

> want surgery (after researching this site). He assured me that the

> surgery was safe and the " majority " of his patients have had very

> good results. He said he would not recommend the surgery if most

of

> his patients experienced nerve damage. Yesterday I was positive

that

> surgery was not for me, now I am confused. He (as well as my

> surgeon) did say that age would play a role in recovery and they

> couldn't absolutely guarantee no permanent nerve damage, but said

it

> was unlikely.

>

> On one had, I would like to help my TMJ symptoms (but just the

braces

> alone have alleviated the problems substantially).

>

> Cammie, what procedure did you have. Was your surgery done for

> medical reasons? I believe you had lower jaw advancement, but did

> you have your jaw wired shut? Would you recommend having the jaw

> wired versus titanium plates? I've read that the slide advancement

> with plates of the lower jaw may be more risky because the nerve

can

> be damaged more easily.

>

> Thanks so much for your replies.

>

> Virginia

[Guest guest]

Virginia,

During the last few months, spending almost every day meeting with various

oral surgeons, oral medicine specialists, orthopaedic surgeons, and many

other health professionals here in Vancouver trying to determine the

specific cause of my pain, mostly longstanding nerve damage does seem to be

quite rare. Several surgeons quoted recent North American studies that

indicated a 1-2% risk. I have been using a lot of my brother's connections

from people that he went throgh med school with, or his contacts that he now

has in the medical community. One oral surgeon that was excellent to talk

to was Krakowiak(he has done 100+ orthognathic surgeries in

California). He told me over the phone that he has had some people develop

tmj, and other, problems post-op and that various forms of treatment have

eventually worked(mostly conservative treatment), but that for some it is

unfortunately a longstanding chronic pain problem. He quoted me a 2-3% risk

of problems after the surgery and that the older you are, generally the

harder it is to recover. He advised not to try nerve blocks, botox

injections, and especially any surgery to the tmj joint(this particular tmj

joint replacement surgery has been very unsuccessful-mostly performed in the

US in the Chicago area now).

I have been trying to find an independent post-op record/database here in

Canada with no luck yet. I think that it would be a great idea to have a

publicly accessible database for patients that have had this surgery(the

many forms of it), so that they can list what has happened to them, good or

bad, That way people could look for themselves for any trends and

percentages. There would of course be some potential problems to the

validity of the database, but it would at least be of some help. Does anyone

know of anthing like this in the U.S. or elsewhere?

Mike

>

>Reply-To: orthognathicsurgerysupport

>To: orthognathicsurgerysupport

>Subject: [Orthognathic Surgery Support ] Re: Age & Results.......Cammie?

> Mike?

>Date: Wed, 18 Feb 2004 17:37:25 -0000

>

>

> > Hello,

> >

> > I am fairly new to this site. I've read alot of postings,

>especially

> > those by Cammie and Mike. Definite opposing views on whether to

>have

> > surgery or not.

> >

> > Mike, in your experience are you finding more people than not are

> > experiencing permanent nerve damage? And does it appear age is

> > playing a significant role in recovery?

> >

> > I have a significant overbite. I have an arthritic left joint with

> > TMJ. I am 43 years old. I've been in upper braces for 4 months.

> > Next month I get lower braces. The surgery for lower jaw

>advancement

> > of about 3-5 mm has been approved by medical coverage.

> >

> > Yesterday, I had an appointment with my ortho and I said I didn't

> > want surgery (after researching this site). He assured me that the

> > surgery was safe and the " majority " of his patients have had very

> > good results. He said he would not recommend the surgery if most

>of

> > his patients experienced nerve damage. Yesterday I was positive

>that

> > surgery was not for me, now I am confused. He (as well as my

> > surgeon) did say that age would play a role in recovery and they

> > couldn't absolutely guarantee no permanent nerve damage, but said

>it

> > was unlikely.

> >

> > On one had, I would like to help my TMJ symptoms (but just the

>braces

> > alone have alleviated the problems substantially).

> >

> > Cammie, what procedure did you have. Was your surgery done for

> > medical reasons? I believe you had lower jaw advancement, but did

> > you have your jaw wired shut? Would you recommend having the jaw

> > wired versus titanium plates? I've read that the slide advancement

> > with plates of the lower jaw may be more risky because the nerve

>can

> > be damaged more easily.

> >

> > Thanks so much for your replies.

> >

> > Virginia

>Dear Virgina

>I tried sending u a message and I pressed post instead of send so I

>will retype as much as I can remember.

>In reguard to permanent nerve damage. I am three wks post-op from

>lower jaw advancement and I researched doing this surgery big time

>before going ahead. No exaggeration I went to at least 10 oral

>surgeons and looked up statistics on the internet for days. Most Drs

>told me there is a chance of anywhere from a 5 to 15% chance of

>permanent numbness from lower jaw surgery. Statistics I saw showed

>about 5 to 10% that ended up with permanent numbness. The Dr. that

>did my surgery told me that in over 20 years of doing the surgery he

>is yet to have a patient that had permanent numbness. Although he

>said I cd have be the first. Which I think shows that that the skill

>of the Dr does play a huge role.

>As far as oral fixation vs being wired. My Dr believe that is much

>more benefical to be wired as opposed to titanium screws for the

>following reason. When ur fixated the joints are forced to remain in

>certain position which may cause TMJ problems, because it is not

>exact science the joints may not be in comfortable position. When ur

>wired there is more leway for the joint to position themselves in a

>position they are comfortable in. He written published studies on

>this and believe whole heartly it is much better to be wired

>especially if TMJ is an issue. I know there are great Drs. who think

>oral fixation is the way to go, I am just giving you my Dr's opinion.

>My Dr did an excellent job on me.

>I also had an overbite like you. It wd certainly be much more

>advantageous if they cd correct ur bite with just lower as opposed to

>upper and lower. My Doctor told lower jaw surgery tends to have less

>complications and quicker healing than upper.

>As far as age is concerned certainly an 18yr old tends to heal

>quicker than a 40 yr old but overall health plays a huge role. I am

>40 an athlete and health enthuiast when it comes to diet. My Dr cd

>not believe how little swelling I had after 2wks and quickly I seem

>to be healing. What you digest in ur body will play be a major

>component as well. I have been drinking a lot of water and taking

>alot of protein drinks and healthy high protein foods blended up.

>From the research I have done the vast majority of patients are happy

>they did the surgery. It was something in the high 90's

>Three wks post-op despite the misery of being wired. I am thrilled I

>did the surgery. I was not unhappy with the way I looked before

>surgery. I didnt have trouble attracting men. But I am now estatic

>with the cosmetic improvement already. As far as TMJ I am still wired

>so it really is to soon to tell. The braces also greatly alleviated

>many of my TMJ problems but if I felt the side of my face it was

>still sore especially if I did alot of talking. Which no suprises is

>something I tend to do. I had to manuever my jaw to eat. I alway had

>popping and clicking when I ate. I have to see how things change when

>I get these wires out in three wks. I am looking foward to my new

>coreectly functioning bite.

>I know it is a very personal decision but let it be ur decision. Dont

>let all those people who gasp when u tell them ur considering surgery

>let u talk u out of it. They are not oral surgeons and orthodontist.

>They dont understand what ur going through. My oral surgeon even said

>that the way my bite was I cd probably go through the rest of my life

>perfectly ok living with my bite . Me personally I as very happy I

>did it because I finally have a bite and profile and smile I am very

>proud of and so is boyfriend with no permanent numbness so far no

>pain.

>Whatever u decide I am sure it will be the right decision for you.

>Best of Luck

>

>

_________________________________________________________________

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[Guest guest]

Virginia,

During the last few months, spending almost every day meeting with various

oral surgeons, oral medicine specialists, orthopaedic surgeons, and many

other health professionals here in Vancouver trying to determine the

specific cause of my pain, mostly longstanding nerve damage does seem to be

quite rare. Several surgeons quoted recent North American studies that

indicated a 1-2% risk. I have been using a lot of my brother's connections

from people that he went throgh med school with, or his contacts that he now

has in the medical community. One oral surgeon that was excellent to talk

to was Krakowiak(he has done 100+ orthognathic surgeries in

California). He told me over the phone that he has had some people develop

tmj, and other, problems post-op and that various forms of treatment have

eventually worked(mostly conservative treatment), but that for some it is

unfortunately a longstanding chronic pain problem. He quoted me a 2-3% risk

of problems after the surgery and that the older you are, generally the

harder it is to recover. He advised not to try nerve blocks, botox

injections, and especially any surgery to the tmj joint(this particular tmj

joint replacement surgery has been very unsuccessful-mostly performed in the

US in the Chicago area now).

I have been trying to find an independent post-op record/database here in

Canada with no luck yet. I think that it would be a great idea to have a

publicly accessible database for patients that have had this surgery(the

many forms of it), so that they can list what has happened to them, good or

bad, That way people could look for themselves for any trends and

percentages. There would of course be some potential problems to the

validity of the database, but it would at least be of some help. Does anyone

know of anthing like this in the U.S. or elsewhere?

Mike

>

>Reply-To: orthognathicsurgerysupport

>To: orthognathicsurgerysupport

>Subject: [Orthognathic Surgery Support ] Re: Age & Results.......Cammie?

> Mike?

>Date: Wed, 18 Feb 2004 17:37:25 -0000

>

>

> > Hello,

> >

> > I am fairly new to this site. I've read alot of postings,

>especially

> > those by Cammie and Mike. Definite opposing views on whether to

>have

> > surgery or not.

> >

> > Mike, in your experience are you finding more people than not are

> > experiencing permanent nerve damage? And does it appear age is

> > playing a significant role in recovery?

> >

> > I have a significant overbite. I have an arthritic left joint with

> > TMJ. I am 43 years old. I've been in upper braces for 4 months.

> > Next month I get lower braces. The surgery for lower jaw

>advancement

> > of about 3-5 mm has been approved by medical coverage.

> >

> > Yesterday, I had an appointment with my ortho and I said I didn't

> > want surgery (after researching this site). He assured me that the

> > surgery was safe and the " majority " of his patients have had very

> > good results. He said he would not recommend the surgery if most

>of

> > his patients experienced nerve damage. Yesterday I was positive

>that

> > surgery was not for me, now I am confused. He (as well as my

> > surgeon) did say that age would play a role in recovery and they

> > couldn't absolutely guarantee no permanent nerve damage, but said

>it

> > was unlikely.

> >

> > On one had, I would like to help my TMJ symptoms (but just the

>braces

> > alone have alleviated the problems substantially).

> >

> > Cammie, what procedure did you have. Was your surgery done for

> > medical reasons? I believe you had lower jaw advancement, but did

> > you have your jaw wired shut? Would you recommend having the jaw

> > wired versus titanium plates? I've read that the slide advancement

> > with plates of the lower jaw may be more risky because the nerve

>can

> > be damaged more easily.

> >

> > Thanks so much for your replies.

> >

> > Virginia

>Dear Virgina

>I tried sending u a message and I pressed post instead of send so I

>will retype as much as I can remember.

>In reguard to permanent nerve damage. I am three wks post-op from

>lower jaw advancement and I researched doing this surgery big time

>before going ahead. No exaggeration I went to at least 10 oral

>surgeons and looked up statistics on the internet for days. Most Drs

>told me there is a chance of anywhere from a 5 to 15% chance of

>permanent numbness from lower jaw surgery. Statistics I saw showed

>about 5 to 10% that ended up with permanent numbness. The Dr. that

>did my surgery told me that in over 20 years of doing the surgery he

>is yet to have a patient that had permanent numbness. Although he

>said I cd have be the first. Which I think shows that that the skill

>of the Dr does play a huge role.

>As far as oral fixation vs being wired. My Dr believe that is much

>more benefical to be wired as opposed to titanium screws for the

>following reason. When ur fixated the joints are forced to remain in

>certain position which may cause TMJ problems, because it is not

>exact science the joints may not be in comfortable position. When ur

>wired there is more leway for the joint to position themselves in a

>position they are comfortable in. He written published studies on

>this and believe whole heartly it is much better to be wired

>especially if TMJ is an issue. I know there are great Drs. who think

>oral fixation is the way to go, I am just giving you my Dr's opinion.

>My Dr did an excellent job on me.

>I also had an overbite like you. It wd certainly be much more

>advantageous if they cd correct ur bite with just lower as opposed to

>upper and lower. My Doctor told lower jaw surgery tends to have less

>complications and quicker healing than upper.

>As far as age is concerned certainly an 18yr old tends to heal

>quicker than a 40 yr old but overall health plays a huge role. I am

>40 an athlete and health enthuiast when it comes to diet. My Dr cd

>not believe how little swelling I had after 2wks and quickly I seem

>to be healing. What you digest in ur body will play be a major

>component as well. I have been drinking a lot of water and taking

>alot of protein drinks and healthy high protein foods blended up.

>From the research I have done the vast majority of patients are happy

>they did the surgery. It was something in the high 90's

>Three wks post-op despite the misery of being wired. I am thrilled I

>did the surgery. I was not unhappy with the way I looked before

>surgery. I didnt have trouble attracting men. But I am now estatic

>with the cosmetic improvement already. As far as TMJ I am still wired

>so it really is to soon to tell. The braces also greatly alleviated

>many of my TMJ problems but if I felt the side of my face it was

>still sore especially if I did alot of talking. Which no suprises is

>something I tend to do. I had to manuever my jaw to eat. I alway had

>popping and clicking when I ate. I have to see how things change when

>I get these wires out in three wks. I am looking foward to my new

>coreectly functioning bite.

>I know it is a very personal decision but let it be ur decision. Dont

>let all those people who gasp when u tell them ur considering surgery

>let u talk u out of it. They are not oral surgeons and orthodontist.

>They dont understand what ur going through. My oral surgeon even said

>that the way my bite was I cd probably go through the rest of my life

>perfectly ok living with my bite . Me personally I as very happy I

>did it because I finally have a bite and profile and smile I am very

>proud of and so is boyfriend with no permanent numbness so far no

>pain.

>Whatever u decide I am sure it will be the right decision for you.

>Best of Luck

>

>

_________________________________________________________________

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[Guest guest]

,

You were both my informal referral and patient example

Shiloh

[Guest guest]

,

You were both my informal referral and patient example

Shiloh

[Guest guest]

,

You were both my informal referral and patient example

Shiloh

[Guest guest]

Sorry to have ignored you, Virginia. I have been preoccupied with

some other things for the last few days.

I had bilateral saggital split osteotomy to advance my lower jaw 5

mm, and move it to the right 3 mm. With this surgery, my surgeon

prefers to use the rigid internal fixation -- I was neither wired nor

banded, and have three little titanium screws on each side.

I too have read that there is less likelihood of nerve damage with

something called a " vertical cut, " which I dunno exactly what is, and

that it requires having the jaw wired.

I never had any numbness -- that was the first question my surgeon

asked me in recovery, whether I had any numbness -- at all. (Yes, my

guy is very, very good and very, very experienced. Does lots of 'em.)

He told me that he really prefers not to wire his patients shut, as

once they are released those great big jaw muscles can sna back

powerfully and cause a relapse.

All that said, I would want my surgeon to use whatever techniques HE

believed most appropriate. If my doc had said I needed upper, too, I

would have done it. If he had said I had to be wired, I would have

done that. And I told him that. He was very definite that any

benefits I would get from upper jaw surgery were so tiny by

comparison to the risks that he would not do it. (Not as in, if I

were you I wouldn't. But as in, " Someone would have to beat me up and

tie me down and force me to do the upper on you. " )

My periodontist had told me that by undergoing the orthodontics I

could save my teeth. My orthodontist told me that he thought I should

have the surgery, in the interests of long-term retention of the

changes he made. My surgeon told me what he could and could not do,

explained the risks and benefits, and told me to decide. He did tell

me that if I decided the surgery was not for me, that was a

legitimate choice, too, and I could prepare to wear the retainers

forever (which I will, anyhow) and tell my ortho to do the best he

could. But he too said that the chance of relapse from the ortho was

much greater with the susrgery, as the surgery would allow my ortho

to " finish my case, " matching up the jaws and the teeth. " I suspect

that the reason you relapsed the first time is that we didn't know

back then the importance of matching up the jaws, " he said.

You are more than a decade younger than I was when I had surgery. My

surgeon's oldest patient (at least when he saw me) had been 62, and

did just fine. I did just fine. It just took me longer to get back to

my full energies, I think, that it does a healthy youngster. I was in

pretty good shape, going in. Unfortunately, the surgery (and some

other subsequent matters not having to do with the surgery) got me

off the exercise trail. I wish I were in as good shape now!

You are anticipating a pretty small change -- 5 mm is about a quarter

of an inch. I can't tell any difference, really, in my face, although

close friends say they can. I can tell that my teeth are straight,

and they and my mouth are healthy now, where they were profoundly not

so before all this.

Bear in mind, too, that many folks who have the surgery AFTER their

joints have deteriorated find that repairs are more difficult. I'm

not saying that will happen to you -- I can't predict the future,

either! But I know people who wish they had had the surgery younger,

before the jaws went.

And if you have problems with perio disease, you should also weigh

into the account the fact that perio disease has been linked to heart

troubles. I saw a cardiologist lately for a routine check, and he was

pleased to know that my perio disease is no longer a real issue.

I can tell you that my surgeon made a great point of telling me that

he is very careful to find that big nerve that runs through the lower

jaw, and to protect it. And although he has a partner assist him, he

insists on making all his own cuts, he told me.

Honestly, for me, the surgery was nowhere near as fearsome as I had

thought it would be. I was terrified. I left the ortho's office in

tears that first day. I thought I would swell up, have trouble

breathing, etc. I had none of that, I suspect because I had work on

the lower only, which I believe to be much the easier of the

operations. I lost almost no blood.

It's up to you, though. Nobody else can evaluate the risks and

benefits for you. Get as many facts and stats as you can, think on

the whole thing, ask any questions you have, and then you decide.

Best of wishes to you.

Cammie

> Hello,

>

> I am fairly new to this site. I've read alot of postings,

especially

> those by Cammie and Mike. Definite opposing views on whether to

have

> surgery or not.

>

> Mike, in your experience are you finding more people than not are

> experiencing permanent nerve damage? And does it appear age is

> playing a significant role in recovery?

>

> I have a significant overbite. I have an arthritic left joint with

> TMJ. I am 43 years old. I've been in upper braces for 4 months.

> Next month I get lower braces. The surgery for lower jaw

advancement

> of about 3-5 mm has been approved by medical coverage.

>

> Yesterday, I had an appointment with my ortho and I said I didn't

> want surgery (after researching this site). He assured me that the

> surgery was safe and the " majority " of his patients have had very

> good results. He said he would not recommend the surgery if most

of

> his patients experienced nerve damage. Yesterday I was positive

that

> surgery was not for me, now I am confused. He (as well as my

> surgeon) did say that age would play a role in recovery and they

> couldn't absolutely guarantee no permanent nerve damage, but said

it

> was unlikely.

>

> On one had, I would like to help my TMJ symptoms (but just the

braces

> alone have alleviated the problems substantially).

>

> Cammie, what procedure did you have. Was your surgery done for

> medical reasons? I believe you had lower jaw advancement, but did

> you have your jaw wired shut? Would you recommend having the jaw

> wired versus titanium plates? I've read that the slide advancement

> with plates of the lower jaw may be more risky because the nerve

can

> be damaged more easily.

>

> Thanks so much for your replies.

>

> Virginia

[Guest guest]

Sorry to have ignored you, Virginia. I have been preoccupied with

some other things for the last few days.

I had bilateral saggital split osteotomy to advance my lower jaw 5

mm, and move it to the right 3 mm. With this surgery, my surgeon

prefers to use the rigid internal fixation -- I was neither wired nor

banded, and have three little titanium screws on each side.

I too have read that there is less likelihood of nerve damage with

something called a " vertical cut, " which I dunno exactly what is, and

that it requires having the jaw wired.

I never had any numbness -- that was the first question my surgeon

asked me in recovery, whether I had any numbness -- at all. (Yes, my

guy is very, very good and very, very experienced. Does lots of 'em.)

He told me that he really prefers not to wire his patients shut, as

once they are released those great big jaw muscles can sna back

powerfully and cause a relapse.

All that said, I would want my surgeon to use whatever techniques HE

believed most appropriate. If my doc had said I needed upper, too, I

would have done it. If he had said I had to be wired, I would have

done that. And I told him that. He was very definite that any

benefits I would get from upper jaw surgery were so tiny by

comparison to the risks that he would not do it. (Not as in, if I

were you I wouldn't. But as in, " Someone would have to beat me up and

tie me down and force me to do the upper on you. " )

My periodontist had told me that by undergoing the orthodontics I

could save my teeth. My orthodontist told me that he thought I should

have the surgery, in the interests of long-term retention of the

changes he made. My surgeon told me what he could and could not do,

explained the risks and benefits, and told me to decide. He did tell

me that if I decided the surgery was not for me, that was a

legitimate choice, too, and I could prepare to wear the retainers

forever (which I will, anyhow) and tell my ortho to do the best he

could. But he too said that the chance of relapse from the ortho was

much greater with the susrgery, as the surgery would allow my ortho

to " finish my case, " matching up the jaws and the teeth. " I suspect

that the reason you relapsed the first time is that we didn't know

back then the importance of matching up the jaws, " he said.

You are more than a decade younger than I was when I had surgery. My

surgeon's oldest patient (at least when he saw me) had been 62, and

did just fine. I did just fine. It just took me longer to get back to

my full energies, I think, that it does a healthy youngster. I was in

pretty good shape, going in. Unfortunately, the surgery (and some

other subsequent matters not having to do with the surgery) got me

off the exercise trail. I wish I were in as good shape now!

You are anticipating a pretty small change -- 5 mm is about a quarter

of an inch. I can't tell any difference, really, in my face, although

close friends say they can. I can tell that my teeth are straight,

and they and my mouth are healthy now, where they were profoundly not

so before all this.

Bear in mind, too, that many folks who have the surgery AFTER their

joints have deteriorated find that repairs are more difficult. I'm

not saying that will happen to you -- I can't predict the future,

either! But I know people who wish they had had the surgery younger,

before the jaws went.

And if you have problems with perio disease, you should also weigh

into the account the fact that perio disease has been linked to heart

troubles. I saw a cardiologist lately for a routine check, and he was

pleased to know that my perio disease is no longer a real issue.

I can tell you that my surgeon made a great point of telling me that

he is very careful to find that big nerve that runs through the lower

jaw, and to protect it. And although he has a partner assist him, he

insists on making all his own cuts, he told me.

Honestly, for me, the surgery was nowhere near as fearsome as I had

thought it would be. I was terrified. I left the ortho's office in

tears that first day. I thought I would swell up, have trouble

breathing, etc. I had none of that, I suspect because I had work on

the lower only, which I believe to be much the easier of the

operations. I lost almost no blood.

It's up to you, though. Nobody else can evaluate the risks and

benefits for you. Get as many facts and stats as you can, think on

the whole thing, ask any questions you have, and then you decide.

Best of wishes to you.

Cammie

> Hello,

>

> I am fairly new to this site. I've read alot of postings,

especially

> those by Cammie and Mike. Definite opposing views on whether to

have

> surgery or not.

>

> Mike, in your experience are you finding more people than not are

> experiencing permanent nerve damage? And does it appear age is

> playing a significant role in recovery?

>

> I have a significant overbite. I have an arthritic left joint with

> TMJ. I am 43 years old. I've been in upper braces for 4 months.

> Next month I get lower braces. The surgery for lower jaw

advancement

> of about 3-5 mm has been approved by medical coverage.

>

> Yesterday, I had an appointment with my ortho and I said I didn't

> want surgery (after researching this site). He assured me that the

> surgery was safe and the " majority " of his patients have had very

> good results. He said he would not recommend the surgery if most

of

> his patients experienced nerve damage. Yesterday I was positive

that

> surgery was not for me, now I am confused. He (as well as my

> surgeon) did say that age would play a role in recovery and they

> couldn't absolutely guarantee no permanent nerve damage, but said

it

> was unlikely.

>

> On one had, I would like to help my TMJ symptoms (but just the

braces

> alone have alleviated the problems substantially).

>

> Cammie, what procedure did you have. Was your surgery done for

> medical reasons? I believe you had lower jaw advancement, but did

> you have your jaw wired shut? Would you recommend having the jaw

> wired versus titanium plates? I've read that the slide advancement

> with plates of the lower jaw may be more risky because the nerve

can

> be damaged more easily.

>

> Thanks so much for your replies.

>

> Virginia

[Guest guest]

Sorry to have ignored you, Virginia. I have been preoccupied with

some other things for the last few days.

I had bilateral saggital split osteotomy to advance my lower jaw 5

mm, and move it to the right 3 mm. With this surgery, my surgeon

prefers to use the rigid internal fixation -- I was neither wired nor

banded, and have three little titanium screws on each side.

I too have read that there is less likelihood of nerve damage with

something called a " vertical cut, " which I dunno exactly what is, and

that it requires having the jaw wired.

I never had any numbness -- that was the first question my surgeon

asked me in recovery, whether I had any numbness -- at all. (Yes, my

guy is very, very good and very, very experienced. Does lots of 'em.)

He told me that he really prefers not to wire his patients shut, as

once they are released those great big jaw muscles can sna back

powerfully and cause a relapse.

All that said, I would want my surgeon to use whatever techniques HE

believed most appropriate. If my doc had said I needed upper, too, I

would have done it. If he had said I had to be wired, I would have

done that. And I told him that. He was very definite that any

benefits I would get from upper jaw surgery were so tiny by

comparison to the risks that he would not do it. (Not as in, if I

were you I wouldn't. But as in, " Someone would have to beat me up and

tie me down and force me to do the upper on you. " )

My periodontist had told me that by undergoing the orthodontics I

could save my teeth. My orthodontist told me that he thought I should

have the surgery, in the interests of long-term retention of the

changes he made. My surgeon told me what he could and could not do,

explained the risks and benefits, and told me to decide. He did tell

me that if I decided the surgery was not for me, that was a

legitimate choice, too, and I could prepare to wear the retainers

forever (which I will, anyhow) and tell my ortho to do the best he

could. But he too said that the chance of relapse from the ortho was

much greater with the susrgery, as the surgery would allow my ortho

to " finish my case, " matching up the jaws and the teeth. " I suspect

that the reason you relapsed the first time is that we didn't know

back then the importance of matching up the jaws, " he said.

You are more than a decade younger than I was when I had surgery. My

surgeon's oldest patient (at least when he saw me) had been 62, and

did just fine. I did just fine. It just took me longer to get back to

my full energies, I think, that it does a healthy youngster. I was in

pretty good shape, going in. Unfortunately, the surgery (and some

other subsequent matters not having to do with the surgery) got me

off the exercise trail. I wish I were in as good shape now!

You are anticipating a pretty small change -- 5 mm is about a quarter

of an inch. I can't tell any difference, really, in my face, although

close friends say they can. I can tell that my teeth are straight,

and they and my mouth are healthy now, where they were profoundly not

so before all this.

Bear in mind, too, that many folks who have the surgery AFTER their

joints have deteriorated find that repairs are more difficult. I'm

not saying that will happen to you -- I can't predict the future,

either! But I know people who wish they had had the surgery younger,

before the jaws went.

And if you have problems with perio disease, you should also weigh

into the account the fact that perio disease has been linked to heart

troubles. I saw a cardiologist lately for a routine check, and he was

pleased to know that my perio disease is no longer a real issue.

I can tell you that my surgeon made a great point of telling me that

he is very careful to find that big nerve that runs through the lower

jaw, and to protect it. And although he has a partner assist him, he

insists on making all his own cuts, he told me.

Honestly, for me, the surgery was nowhere near as fearsome as I had

thought it would be. I was terrified. I left the ortho's office in

tears that first day. I thought I would swell up, have trouble

breathing, etc. I had none of that, I suspect because I had work on

the lower only, which I believe to be much the easier of the

operations. I lost almost no blood.

It's up to you, though. Nobody else can evaluate the risks and

benefits for you. Get as many facts and stats as you can, think on

the whole thing, ask any questions you have, and then you decide.

Best of wishes to you.

Cammie

> Hello,

>

> I am fairly new to this site. I've read alot of postings,

especially

> those by Cammie and Mike. Definite opposing views on whether to

have

> surgery or not.

>

> Mike, in your experience are you finding more people than not are

> experiencing permanent nerve damage? And does it appear age is

> playing a significant role in recovery?

>

> I have a significant overbite. I have an arthritic left joint with

> TMJ. I am 43 years old. I've been in upper braces for 4 months.

> Next month I get lower braces. The surgery for lower jaw

advancement

> of about 3-5 mm has been approved by medical coverage.

>

> Yesterday, I had an appointment with my ortho and I said I didn't

> want surgery (after researching this site). He assured me that the

> surgery was safe and the " majority " of his patients have had very

> good results. He said he would not recommend the surgery if most

of

> his patients experienced nerve damage. Yesterday I was positive

that

> surgery was not for me, now I am confused. He (as well as my

> surgeon) did say that age would play a role in recovery and they

> couldn't absolutely guarantee no permanent nerve damage, but said

it

> was unlikely.

>

> On one had, I would like to help my TMJ symptoms (but just the

braces

> alone have alleviated the problems substantially).

>

> Cammie, what procedure did you have. Was your surgery done for

> medical reasons? I believe you had lower jaw advancement, but did

> you have your jaw wired shut? Would you recommend having the jaw

> wired versus titanium plates? I've read that the slide advancement

> with plates of the lower jaw may be more risky because the nerve

can

> be damaged more easily.

>

> Thanks so much for your replies.

>

> Virginia

[Guest guest]

Just a question, from a decidedly non-scientific type.

Isn't this site a database of a sort, Mike? I know things aren't

broken down into percentages and numbers. And I know there are

certain built-in biases (you have to be good enough with a computer

to find it, and have enough access to one, as well). Still, there's a

wealth of info here about many, many experiences with this stuff.

(I didn't note the number of this post, but aren't we way up there in

the tens of thousands?)

Cammie

> > > Hello,

> > >

> > > I am fairly new to this site. I've read alot of postings,

> >especially

> > > those by Cammie and Mike. Definite opposing views on whether to

> >have

> > > surgery or not.

> > >

> > > Mike, in your experience are you finding more people than not

are

> > > experiencing permanent nerve damage? And does it appear age is

> > > playing a significant role in recovery?

> > >

> > > I have a significant overbite. I have an arthritic left joint

with

> > > TMJ. I am 43 years old. I've been in upper braces for 4

months.

> > > Next month I get lower braces. The surgery for lower jaw

> >advancement

> > > of about 3-5 mm has been approved by medical coverage.

> > >

> > > Yesterday, I had an appointment with my ortho and I said I

didn't

> > > want surgery (after researching this site). He assured me that

the

> > > surgery was safe and the " majority " of his patients have had

very

> > > good results. He said he would not recommend the surgery if

most

> >of

> > > his patients experienced nerve damage. Yesterday I was positive

> >that

> > > surgery was not for me, now I am confused. He (as well as my

> > > surgeon) did say that age would play a role in recovery and they

> > > couldn't absolutely guarantee no permanent nerve damage, but

said

> >it

> > > was unlikely.

> > >

> > > On one had, I would like to help my TMJ symptoms (but just the

> >braces

> > > alone have alleviated the problems substantially).

> > >

> > > Cammie, what procedure did you have. Was your surgery done for

> > > medical reasons? I believe you had lower jaw advancement, but

did

> > > you have your jaw wired shut? Would you recommend having the

jaw

> > > wired versus titanium plates? I've read that the slide

advancement

> > > with plates of the lower jaw may be more risky because the nerve

> >can

> > > be damaged more easily.

> > >

> > > Thanks so much for your replies.

> > >

> > > Virginia

> >Dear Virgina

> >I tried sending u a message and I pressed post instead of send so I

> >will retype as much as I can remember.

> >In reguard to permanent nerve damage. I am three wks post-op from

> >lower jaw advancement and I researched doing this surgery big time

> >before going ahead. No exaggeration I went to at least 10 oral

> >surgeons and looked up statistics on the internet for days. Most

Drs

> >told me there is a chance of anywhere from a 5 to 15% chance of

> >permanent numbness from lower jaw surgery. Statistics I saw showed

> >about 5 to 10% that ended up with permanent numbness. The Dr. that

> >did my surgery told me that in over 20 years of doing the surgery

he

> >is yet to have a patient that had permanent numbness. Although he

> >said I cd have be the first. Which I think shows that that the

skill

> >of the Dr does play a huge role.

> >As far as oral fixation vs being wired. My Dr believe that is much

> >more benefical to be wired as opposed to titanium screws for the

> >following reason. When ur fixated the joints are forced to remain

in

> >certain position which may cause TMJ problems, because it is not

> >exact science the joints may not be in comfortable position. When

ur

> >wired there is more leway for the joint to position themselves in a

> >position they are comfortable in. He written published studies on

> >this and believe whole heartly it is much better to be wired

> >especially if TMJ is an issue. I know there are great Drs. who

think

> >oral fixation is the way to go, I am just giving you my Dr's

opinion.

> >My Dr did an excellent job on me.

> >I also had an overbite like you. It wd certainly be much more

> >advantageous if they cd correct ur bite with just lower as opposed

to

> >upper and lower. My Doctor told lower jaw surgery tends to have

less

> >complications and quicker healing than upper.

> >As far as age is concerned certainly an 18yr old tends to heal

> >quicker than a 40 yr old but overall health plays a huge role. I am

> >40 an athlete and health enthuiast when it comes to diet. My Dr cd

> >not believe how little swelling I had after 2wks and quickly I seem

> >to be healing. What you digest in ur body will play be a major

> >component as well. I have been drinking a lot of water and taking

> >alot of protein drinks and healthy high protein foods blended up.

> >From the research I have done the vast majority of patients are

happy

> >they did the surgery. It was something in the high 90's

> >Three wks post-op despite the misery of being wired. I am thrilled

I

> >did the surgery. I was not unhappy with the way I looked before

> >surgery. I didnt have trouble attracting men. But I am now estatic

> >with the cosmetic improvement already. As far as TMJ I am still

wired

> >so it really is to soon to tell. The braces also greatly alleviated

> >many of my TMJ problems but if I felt the side of my face it was

> >still sore especially if I did alot of talking. Which no suprises

is

> >something I tend to do. I had to manuever my jaw to eat. I alway

had

> >popping and clicking when I ate. I have to see how things change

when

> >I get these wires out in three wks. I am looking foward to my new

> >coreectly functioning bite.

> >I know it is a very personal decision but let it be ur decision.

Dont

> >let all those people who gasp when u tell them ur considering

surgery

> >let u talk u out of it. They are not oral surgeons and

orthodontist.

> >They dont understand what ur going through. My oral surgeon even

said

> >that the way my bite was I cd probably go through the rest of my

life

> >perfectly ok living with my bite . Me personally I as very happy I

> >did it because I finally have a bite and profile and smile I am

very

> >proud of and so is boyfriend with no permanent numbness so far no

> >pain.

> >Whatever u decide I am sure it will be the right decision for you.

> >Best of Luck

> >

> >

>

> _________________________________________________________________

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[Guest guest]

Mike, if you've been around these sites long enough (I've been here

since Feb of 2001, when there were a mere 20,000 posts here), you'll

see a lot of people come through here. We hear from most of them, I

would say very few have problems. The ones that post the most appear

to have the most difficulties post-op (and they are usually short-

term issues, limited to the initial and first few months of

recovery), and that kind of skews the tone of the sites from time to

time, but there are also those of us who had a good experience and

who try to keep a presence here in order to present a balanced view.

I try to remember, for myself, that life itself is a risk. I think

there are many more risks in driving to work each day, for example,

than that I faced undergoing this procedure. Try driving down the

highway at 120 km only to stop short in a wall of dense fog, hoping

that everyone behind you (including transport trucks) stop in time

too. That day, earlier this year, several hundred vehicles were

involved, and in the short few kilometres before I was able to exit

the highway, it looked like a war zone. You never know what can

happen. I could go on with other examples, but I think you probably

get my point. We all take risks, and live with the consequences.

Good luck, and once again, I hope for relief for you from your

suffering.