Openbite, Crossbite, Edge To Edge Jaw Surgery Case Study

My Experience with Jaw Surgery

By Erin Galbraith
http://xbites.blogspot.com

Introduction

On July 20, 2007, at the age of 30, I had both upper and lower jaw surgery at Stanford Hospital in Palo Alto, California. Although I was 30 years old, I had been mentally preparing for this surgery since my mid-20s when I really came to grips with the fact that my bite was way off and surgery would be the only way to correct it. It took me a few years before I could get the courage to start the entire process. Once I decided to do it, I was fully committed. I get email asking me if it was worth it. YES, it was! I know it’s scary, but jaw surgery can make a huge difference in several ways. I strongly encourage anyone that contacts me to really consider it, because despite the discomfort and everything I’ve gone through, I’ve ended up with a functional bite, happier jaw joints, a nice smile and cosmetic benefits. I’m so glad I did it!

Getting Started…What to do?

You are going to need an orthodontist that specializes in surgical cases and regularly works with a surgeon to fully treat the patient. Obviously they should also treat adults! You’re going to need a surgeon that specializes in orthognathic (jaw) surgery. Sometimes these surgeons have different initials after their name: MD, DMDs, or DDS. Overall, what is most important is that they are qualified and experienced to treat you.

It can be tricky to determine which one you should see first, or how you should go about finding either of them. I was very confused when I started! I decided to see an orthodontist first because I could see anyone (insurance paid the same in and out of network). I chose someone that was recommended to me. Right away she knew I was a surgical case, so I brought my health insurance list of covered oral-maxillofacial surgeons. She shouldn’t really recommend any because all of the people she regularly worked with were out of my network. (This is a bad sign, by the way!) So I picked one and hoped that they could still work together. Down the road this did NOT work out well and my treatment even got delayed because of their communication issues and lack of communication with me.

And about a year and a half after I started, my orthodontist “fired” me for being too much trouble, I think. Oddly, she gave me a full refund (without me eve asking) which is suspicious. So, I went back to my surgeon and told him what happened and he recommended another orthodontist that he worked with regularly. I met with the new orthodontist (who didn’t usually take on transfer patients but sort of did it as a favor to the surgeon) and we had a great relationship. His office staff was much better and my orthodontist was really great as well. It was a much better situation!

If I had to do it over again (with my same insurance), I would have seen a surgeon first, then gotten a referral to an orthodontist. Then again, if you pick an orthodontist first that happens to work closely with a surgeon that is covered by your insurance, then that will work too

Insurance Coverage & Cost Of Jaw Surgery

This was one of my top concerns and is something that stalled me in the “getting started” process. It can all be really overwhelming. Insurance companies are notorious for turning down surgeries and turning down jaw surgeries for being “cosmetic.” So really the most important things when considering insurance is:

1. Is the provider (surgeon) covered by your insurance plan?

2. Will your surgery get deemed as a medical procedure and therefore covered? (Your surgeon will build a case for this if this is what s/he believes.)

Now on to the cost. There will be costs for the surgery, surgeon, anesthesiologist, and hospital room. Different doctors and places will have different costs, so this is something you will need to research, especially if insurance is not covering your surgery. As far as my surgery went, I was in the hospital for 3 days and had the upper and lower jaw surgery. According to the insurance bill I saw, it was about $80,000. Thanks to insurance, I paid less than $1,000 out of pocket.

Don’t forget the cost of braces, too. If you’re already in braces, you know the cost, but it is an additional cost. This can usually range between $5000 to $8500. It depends on your case and your orthodontist.

My main issue was with my upper jaw. It was too small, and it was set too far back. In upper jaw surgery, they can move your jaw back, forward, widen it, and change the tilt… a lot of things! My tilt was adjusted, palate widened, and the whole jaw was moved forward.

Lower Jaw Surgery

In addition to having upper jaw surgery, I also had lower jaw surgery. This was approved by my insurance (although I didn’t know my surgeon had requested any surgery on the lower surgery and I didn’t know why I’d have surgery on the lower). Two days before my surgery, at my pre-op appointment, my surgeon and I talked about the “plan” and what I wanted. He felt that if he was going to move my upper jaw forward, it would be better cosmetically if I also had my lower jaw moved forward. So, this was done purely for cosmetic reasons in the end, I think.  I’m not sure if it had any effect on my overall bite or jaw joint functioning.

Underbite Jaw Surgery

I didn’t have an underbite, but I had no overjet, either. My top teeth were directly on the bottom. This was corrected by moving both of my jaws forward (but the top slightly moreso). With underbite surgery, your bottom jaw will be moved back and your top jaw may be moved forward in order to achieve an ideal bite.

Overbite Jaw Surgery

I did not have an overbite. (But in overbite surgery, your upper jaw will likely be moved back and lower jaw moved forward.)

Crossbite Jaw Surgery

I had a bilateral crossbite which means my top teeth did not overlap the bottom on both sides. My top jaw was simply too small. In order to correct this, sometimes orthodontists will use palate expanders ahead of time to widen the top jaw, but this is an additional surgery because the palate must be broken first. Luckily I did not have to go down that route (after 3 expanders from the ages of 7 to 12, I was DONE with those things! Yes, they are torture devices.

My surgeon ended up breaking my palate (see pictures) in order to widen the jaw. He did it without even cutting the roof of my mouth. I don’t know how that was done, or how much of any of it was done, but it’s pretty cool!

Open bite jaw surgery

I had a bit of an open bite which was corrected by moving the top jaw into its new position. With all of the breaking and moving, it closed the open bite.

Numbness From Jaw Surgery

Numbness is always a concern for people going through jaw surgery, especially lower jaw surgery, where more nerves are severed or damaged.

You will be quite numb for the first several months after the surgery, but you are likely to feel “sparks” and tingles. This is a good sign! It means that your nerves are mending.

Usually you’ll read that numbness lasts about a year. Unfortunately, that hasn’t been my case. My surgery was 2 ½ years ago and I still have some numbness. However, I do have sensation in every spot (even if it’s tingly and not correct feeling) so I have hope that one day I will have normal feeling in my face. Some days are better than others. My surgeon said the type of feelings I’m having in my chin are associated with tiny little nerves that are mending and they can take years to fully mend. So, I’m hanging in there and hoping for the best.

It can be a little annoying not to have full (or correct) feeling in your face, but at least for me, it was well worth it!

Pain Associated With Jaw Surgery?

I would say that there is discomfort after jaw surgery, and not necessarily pain. The surgery to take the plates out of my bottom jaw was much more painful than my huge upper/lower jaw surgery! This is because of the nerves that are severed during a jaw surgery. You’re going to wake up with discomfort but I found that the tubes in my throat were what hurt more than the actual jaws. In fact, that barely registered! And any tubes that are in your throat (to help you breathe or remove fluid/blood from your stomach) are only in place for about 24 hours after surgery. During that time, you’ll have plenty of Morphine or an equivalent pain-killer. After my surgery, I had an IV button that allowed me to press it once every 10 minutes. With the doctor’s approval, I got it to deliver medication every 7 minutes. I was so out of it that I would be in and out of consciousness and I would just press the button whenever I woke up. Sometimes someone would tell me if it had been 7 minutes. Sometimes I just pressed it. Trust me, you’re not going to be alert enough to know what you’re doing after this surgery!

After a day, they start to wean you off morphine and they started giving me Vicodin. I think my jaw joints felt pressured and that was causing pain, but I had so much numbness that I really didn’t feel much pain in my mouth. I got out of the hospital after 3 days and was then just on codeine syrup. I took that every few hours and that kept the pain under control. I probably did that for a few more days until it was gone and then switched to Advil to help with the pain and encourage the swelling to go down.

Jaw Surgery Pictures Before, During, After

You are welcome to view my public albums and choose the pictures most appropriate for the before/after pictures.

Before: picasaweb.google.com/BeforeJawSurgery

After: picasaweb.google.com/JawSurgery

Alternatives To Jaw Surgery?

There really are no alternatives to jaw surgery. Once you are a grown adult, your top jaw is fused so there is really no chance at moving it with braces alone. You might be able to move the teeth, but you won’t move the jaw. Teeth can constantly move throughout your lifetime and moving them alone won’t be effective. It’s also unlikely to give you the lasting results that you’re looking for.

Jaw Surgery Weight Loss?

I lost about 10-12 lbs. following jaw surgery. I actually lost the most the 3 days I was in the hospital because my body was going through so much and I was barely able to take in any liquids from my clear liquid diet. I had IVs, but I was barely to drink more than a little cup of water before I was discharged. I had to be able to take in fluids before they’d let me out of the hospital.

I was not good about my diet post-surgery. I didn’t follow regular meal time, nor did I try to maintain calories. I “ate” when I felt like it, which wasn’t that often. I lived on milkshakes that consisted of ice cream, Boost/Ensure, and coffee creamer flavoring.

I didn’t gain the weight back for several months.

Swelling After Jaw Surgery

I had a LOT of swelling and bruising following my surgery (see photos). However, it improved every day. I took a picture every day to document the improvements and by day 14 almost all of my bruising was gone and my swelling was down by a great deal. I looked pretty normal! I just looked different because the surgery had changed the structure of my face.

 I found that icing my face regularly helped heal the swelling AND it felt so great!!

Jaw Surgery Risks

Well, there are always risks with any surgery. You will be under general anesthesia and that has risks. The doctor, nurses, and anesthesiologists will tell you the risks. I believe the risks are pretty low. You might want to do a little searching on google.com to learn more. I did some searching on Google and also studied my hospital’s surgical site to learn more about risks. Be sure to follow all of the instructions that you are given before and after your surgery.

 

Some other risks to consider:

1. Numbness that may be permanent

2. Conflicts with your orthodontist or surgeon*

3. Jaw joint issues that may need to be addressed, prolonging your treatment*

4. Pain leading to excessive weight loss*

*These three things actually happened in my case.

I recommend that you discuss all of the risks with your surgeon.

Jaw Surgery Without Braces?

As far as I know, this is not possible. If you want jaw surgery, they are going to want to put your teeth/bite in the position that is ideal post-surgery. In order to this, you’ll need braces. Most people need braces pre and post surgery and this is normal and to be expected.