Re: Maxillary advancement - how does it work?

[Guest guest]

The cut is actually a fracture called a Leforte 1 (that's the most

common procedure, there are also Leforte 2 and Leforte 3), it's

basically a break in the face below the nose, above the gumline/roots

of the teeth. Then the jaw itself can be cut further if it's too long

(in my case, typical gummy smile) or added onto with bone either

grafted from another site (typically hip) or cadaver bone or other

sources, the added bone is only if the surgeon needs to add to the

jawbone, for example to increase the height.

Then the bone is either fixed with plates and screws (I think mine

are on either side of the nose but I can't feel them) or the

patient's two jaws are wired together until the bone heals.

Over 25 years ago, my family dentist wanted to pull four teeth and

put me in braces, I chickened out. No mention was made of a need for

orthognathic surgery. When I had my lower wisdoms out 8 years ago

(have no upper wisdom apparently), the surgeon said my case was not

too severe, I didn't look too bad, again no mention of orthognathic

surgery. It was only with my new family dentist about 4 years ago, he

was monitoring my clicking & popping jaws, that I finally got

referred to a TMJ specialist for my pain, and that's when I was

introduced to all of this. And even at that, my TMJ/ortho specialist

says he avoids surgery where possible. So I would be careful with the

malpractice thoughts!

I eventually had upper/lower/genio in August of 2002.

If you check out the links on the geocities info website, you'll

probably find some that show the actual cuts (illustrations, of

course) at http://www.geocities.com/orthognathicinfo/ My own personal

surgery tale is there as well.

Hope that helps,

[Guest guest]

I am not a surgeon, so am not qualified to answer this... But if you

want to see it, there is a video available (or at least there was

one) from the Discovery Channel. It's important, if you wish to order

it (look in the links on this site) to tell them that it's for

personal use only. Will save you a pile of $$$. As in, they charge

about $175 otherwise, or $40 for personal use.

Judging from that video -- Now stop reading, friends, if you don't

want graphics here -- They saw through the bones upstairs, and

separate the maxilla from the rest of the facial bone structure,

sometimes segmenting it along the way. This may or may not involve

work on the sinuses. Then they move things where they need to go, and

put it all back together, using screws (pins) and plates.

It is bloody, and bony. Sometimes folks need bone grafts to make

things line up adequately. Sometimes folks need some, um,

Roto=rooting sort of work to clean out the nasal stuff.

For me, all that was needed was lower (Thank you, Fates above us!)

which meant that the lower jawbones were cut, teased apart and split,

with a sliding advancement. Sometimes both jaws need work.

The really excellent news in all this is that the docs are, by and

large, most wonderful, know exactly what they are doing and how to

put us back together better than we were before. Or so I think,

anyhow.

Best wishes to you... It may be that you, as did I, went through the

orthodontic mill before these procedures became practical. Techniques

(especially the rigid fixation and the possibility of surgery done

almost totally inside the mouth) have improved enormously over the

last half century. To achieve these changes with open wounds and

external sutures was a much more difficult procedure, and the risks

were so great, I think, as to make it much more dangerous to

undertake.

Cammie

> This is kind of gruesome, but I was wondering how the docs actually

> detach, move, and re-attach one's upper jaw? It seems, well, really

> difficult, I guess. I can see how the lower jaw could be

> manipulated, but not the upper.

>

> I have had braces twice already (29/M) and am now considering doing

> what I should have done in the first palce-orthognatic surgery.

>

> Also, my 2nd ortho blamed my first ortho, who put me in braces at

> age 13 (after ordering that 7 teeth be pulled) and was done with

it.

> This seems like malpractice to me. . . too bad the statute of

> limitations has run several times over.

>

> My 2nd ortho described it as the doc cutting where the inside of my

> upper lip is in order to manipulate the upper jaw.

>

> Is that correct? I would love to ehar from anyone who has had this

> procedure.

>

> thanks-

>

> -B.