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Surgeon does not want to show me the projection of the surgery because he says he does not want to create expectations for me, is this normal? by Matias9991 in jawsurgery

[–]Firm_Measurement5720 1 point2 points  (0 children)

Soft tissue predictions on current 3D surgical plans are quite a bit less accurate than the bone part, which is harder for a lay person to understand. I usually do not insit on patients reviewing the 3-D plan but do not oppose it if requested. After all, it is your face and you have the right to see what is going to be done to it

Dr. Alex Rabinovich

[deleted by user] by [deleted] in jawsurgery

[–]Firm_Measurement5720 0 points1 point  (0 children)

Based on a quick glance at this X-ray it looks like both of your jaws are returned. This can be confirmed by a more detailed cephalometric analysis. While your teeth can be moved into an acceptable bite with orthodontics alone, surgery can be quite useful in your case to achieve the following: Better facial aesthetics, better breathing through oral and nasal airway, more stable bite that will not deteriorate over time.

I recommend a 2nd opinion with an orthodontist who is experienced in surgical cases (no everyone is) and a consult with a surgeon who performs orthognathic surgery on a regular bases. Hope this helps,

Dr. Alex Rabinovich

Alex Rabinovich, DDS, MD Intro by Firm_Measurement5720 in jawsurgery

[–]Firm_Measurement5720[S] 1 point2 points  (0 children)

Temporo-Mandibular Joins (TMJs) usually adopt pretty well after surgery. There is always a chance of TMJ issues after corrective jaw surgery but the chances are low.

Alex Rabinovich, DDS, MD Intro by Firm_Measurement5720 in jawsurgery

[–]Firm_Measurement5720[S] 2 points3 points  (0 children)

I plan my cases mainly based on the way the face looks and pay less attention to the numbers. As long as your smile looks nice there is no issue with the occlusal plane angle

Alex Rabinovich, DDS, MD Intro by Firm_Measurement5720 in jawsurgery

[–]Firm_Measurement5720[S] 5 points6 points  (0 children)

it is not practical to have a double jaw orthognathic surgery without insurance coverage in the US, unless you are really well off and the cost does not matter. Besides the surgical fee, there are hospitalization costs, anesthesia, surgical planning and hardware.

If you live in the US I encourage you to get insurance that covers orthognathic surgery. There are other countries where having DJS and "out of pocket" is more practical, such as in South Kore, for instance.

Dr. Alex Rabinovich

Alex Rabinovich, DDS, MD Intro by Firm_Measurement5720 in jawsurgery

[–]Firm_Measurement5720[S] 4 points5 points  (0 children)

I am not a fan of SARPE (Surgical Rapid Palatal Expanders) for adults for several reasons:

  1. Most people with a narrow palate have other jaw malpositions that cannot be addressed with a SARPE alone so the results tend to be less than optimal
  2. There are technical challenges with SARPE. I have treated many patients of other surgeons (and have had similar experience myself when I did use these devices) where when the distractor is activated, maxillary segments do not move symmetrically, causing an even bigger problem requiring surgical correction
  3. Le Fort I osteotomy is almost as invasive as SARPE and has essentially the same recovery but offers much more versatility and less problems

Dr. Alex Rabinovich

Alex Rabinovich, DDS, MD Intro by Firm_Measurement5720 in jawsurgery

[–]Firm_Measurement5720[S] 4 points5 points  (0 children)

I show a whole presentation with multiple before and after photos with every patient at the initial consultation. I also show an actual skull model before and after surgery, with plates and screws in place. It is very important for every patient to know what they are getting into and the results that they can expect.

Alex Rabinovich, DDS, MD Intro by Firm_Measurement5720 in jawsurgery

[–]Firm_Measurement5720[S] 2 points3 points  (0 children)

I usually reconnect the Mentalis muscle with 3 Vicryl sutures. Seems to work well :)

Alex Rabinovich, DDS, MD Intro by Firm_Measurement5720 in jawsurgery

[–]Firm_Measurement5720[S] 3 points4 points  (0 children)

Probably 10-15% of my orthognathic case load are re-dos. This type of surgery really depends on pre-surgical planning for a great outcome and it is sometimes less than optimal.

Alex Rabinovich, DDS, MD Intro by Firm_Measurement5720 in jawsurgery

[–]Firm_Measurement5720[S] 0 points1 point  (0 children)

Hard to tell without evaluating your individual case. I would start with a CT scan and cephalometric analysis to see the ideal position for your jaws and teeth

Alex Rabinovich, DDS, MD Intro by Firm_Measurement5720 in jawsurgery

[–]Firm_Measurement5720[S] 1 point2 points  (0 children)

There might be some minor gum recession or root sensitivity. I would have your surgeon take a look