Orthognathic surgery is to surgically reposition, restructure and realign facial bones.
It is used to correct skeletal abnormalties or deformities. To correct severe over and under bites that braces will not help and sometimes damage after accidents or injuries.
Many years ago, prior to Imaging Diagnostics to look at the joints and disc, it was used as a cure for TMJD.
It does not cure TMJD, it changes bone structure. If you have skeletal problems or misaligned jaws, this surgery may correct these problems. If these problems are contributing to TMJ problems, it may help. You will still need other treatments such as braces, splints, etc.
(If your TMJ problems are joint and/or disc related or muscular, this surgery will cause pain & problems that you never dreamed were possible.)
The jaw , either top, bottom or both is "broken" and extended or decreased and aligned according to the problem you have. (They do not actually break the bone.)
This is my experience, it could be a little different now. I did talk to a girl who had it a couple of years ago and it was about the same.
(Most of this is covered on the Release Forms, I'm not trying to scare anyone. I just want everyone to know, they are not kidding about the risks and the problems that can occur)
They normally go through your mouth. (Sometimes, you have some small incisions along your jaw line, if the mandible is involved.) They have to cut inside your mouth a pretty good bit to expose the bone. They score the bone with a diamond head bit, several times. Then they tap with a small hammer like thing and hope the bone pops apart along the scored line. Then they extend the bone using miniature titanium plates screwed into the bone or they take bone out if they are decreasing bone length or mass.
Sometimes the bone does not pop apart as it should, it shatters. This requires being wired together for 6-7 weeks for the jaw to heal and if they were not able to complete the intended procedure, you can try again.
Condylar dislocation is a big problem with this surgery and happens pretty frequently. They do tell you this "Now" on the release forms. Also, they are working all around the Trigeminal Nerves. The release form also states there is the possibility of nerve damage.
This is not information that I have just read about. I've had two of these surgeries, 3 months apart. These were in 1988 and surely they have improved on some of the techniques, but the basic surgery is the same.
Bones are broken, moved, screwed together and it takes a while to heal. There is incredible swelling, bruising, and pain. There is the possibilty of all kinds of problems. Hence, the release forms. They're posted on the board. Anyone considering this surgery should read them very closely. I am living proof, these problems can and do happen.
I have heard of a few people who have had this surgery and done well. I didn't and I know of many others who did not fare well with it either.
For future questions regarding this surgery, here are some details of orthognathic surgeries that went terribly wrong and caused many years of irreversible problems.
First, my Surgeon was extremely talented and had done many of these surgeries. We were friends before and remain so. He does not do TMJ surgeries anymore.
My TMJD was due to bad disc, joint abnomalities and muscular problems. This was unknown at the time. (No MRI's back then, 1988)
Bilateral Sagittal Split with Rigid Fixation and Genioplasty 6-88
My surgery was to extend my left mandible 6mm and the right 5mm. I also had a Chin Implant, due to receding from condylar head bone loss.
My mandibles were off by 1mm and they thought I needed extending a little. This was not a lot,(5mm is the width of a paper match) but I had all the symtoms of TMJ, so they thought this would fix it.
(I had been in orthodontics and splints for over 10 years and it did not help.)
Rigid fixation means they used screws in the bone to hold them together.
The bones did pop apart as hoped.
The first problem was major blood loss. They expect some, but mine became serious and I was transfused with many units of blood.
Next, my left condyle pulled loose. My surgeon stopped and put it back.
I started swelling and I was not breathing well. They had to put in a larger breathing tube and my condyle pulled loose again.
I had been in surgery 6 hours by this time,I was bleeding out almost faster then they could pump the blood in , my throat swelled together and life support measures had to be taken. He left the condyle and spent another hour trying to save my life. (That part worked.)
I had to wait 3 months to have this redone. I can't remember why 3 months, I only remember the swelling, bruising down to my chest and the pain of the dislocated condyle plus the ordeal I had been through to keep me breathing. (The time interval could have been due to the massive swelling and blood loss)
I had to have it redone, the condyle was an inch out of position and with the swelling, I looked like the "Elephant Man" and was in pain that demerol nor morphine would help.
Second Surgery. 9-88 Same procedure, bones popped apart, except they used wires instead of screws, hoping the condyle would stay in place. Also, my mouth was wired together 6 weeks to prevent any movement.
Every precaution was taken to prevent too much blood loss and breathing problems.
6-7 hour procedure, major blood loss requiring transfusions, swelling caused breathing problems, life support measures again.
Condyle slipped again, but not so much. It remains in that position. I almost didn't make it that time.
These surgeries caused my TMJD problems to get worse, plus I had nerve damage, a low grade infection that went undetected for about a year and I had so much bone loss, I had to have grafts. The muscles went haywire and my opening was about 5mm. It took a year just to get partially over these surgeries and many years and other surgeries to try and correct some of the damage. I never was able to open much over 19mm until a few month ago, almost 16 years later.
This may seem like a long post, but this is a very brief description of the pain & problems these surgeries caused, and I came close to death with both.
I don't know how many people have had this experience. We did have a member for a short period who had a worse experience than this, she did survive.
I believe Donna & Sharri have had some type of restructuring, I'm not sure exactly which procedures.
They didn't do well.
They found out about a year later, when MRI's became available that my TMJD was joint and disc related and these surgeries should never have been done.
I made this post for anyone who might think there is a quick fix for TMJD with some type of surgery.
Orthognathic surgery is very complicated and carries many risks.
Arthroscopies, Arthroplasties, Arthronomies and some of the others are a little less risky and seem to help some people, not all.
All of these are very serious surgeries, carry many risks and are not guaranteed cures for TMJD. I wish they were.
I pray that anyone who decides to have any of these procedures will come back and report a success.
[This message has been edited by Cymy Sue (edited 09-20-2003).]
Good Lord, Cymy Sue! I'm floored by your experiences. What you have been through! Thank you for posting your experiences with this. This is the surgery that 'some' have suggested for my son...extending the lower jaw. I've never considered it, but while reading of it on certain sites...you're led to believe that it's not 'too bad'.
I've often wanted to start a new topic concerning joint/jaw related surgeries to see how many there were, and what they entail. While I'm finding myself to be more educated concerning splint therapy as well as other therapies for TMJD as the days pass, I'm completely uneducated on surgeries. I think that quite a few here are.
Thank you again, for sharing your knowledge and experiences. You're very much needed here. Those considering procedures such as this need to hear what 'could' happen before making a life-long decision.
What you've said makes complete sense. Changing the bone structure is just that, it won't 'fix' the muscular/joint problems, they'll still remain...possibly worse.
Thanks again, Cymy Sue.
[This message has been edited by CherylLynn24 (edited 09-10-2003).]
Last edited by CherylLynn24; 11-02-2003 at 08:15 PM.
Thank you for sharing this story of your surgeries. I wish I could give you hug. I am so thankful for your sharing Cymy Sue, I am so thankful for you being here for all of us.
(((( Cymy Sue))))
I do want to make it clear, I don't post these experiences to keep anyone from having a surgery they need. As Cheryl said, the description of these surgeries usually don't sound so bad. Also, you're usually admitted and ready to go to surgery when you see the "Release Forms".
I just want everyone to know these "Releases" we sign are very serious business and these possible complications are very real. I don't know of a Surgeon who will go into this with you prior to Surgery.
I am very fortunate that I made it through these, plus a few more and am now doing pretty well.
I know there are many people who have done well with most of these surgeries I've had. I'm afraid there are more who have not done so well.
There are many people who have never gotten over some of these procedures and this doesn't include the "Implant Tragedies".
Everyone needs to be completely informed and educated about what they are having done and what to expect after the surgery. It's been my experience, that we don't get a lot of "Reality Information" beforehand from our Surgeons, regardless of how good they are or how many procedures they do.
[This message has been edited by Cymy Sue (edited 09-10-2003).]
I thank you for sharing your stories and speaking the truth about these surgeries. I have always been insistent that I would not have surgery. It's been suggested to me several times and every time I said no, not under any circumstances. I knew that being stubborn was going to work in my favor one of these days. What really scares me is that many who are willing to undergo these surgeries are very young teenagers and tend to think that surgeries equal magical cures. When someone is teenage they don't see all that is ahead and all the years of suffering that may be ahead for them. I've had TMJ problems since I was a teenager and have had a great deal of pain but I know it's nothing compared to the pain from surgery. I've had other surgeries in my life and have learned how much you can suffer from them. I do hope that those considering allowing this surgery to be done to them will read your words and take the warning seriously from someone who certainly knows what they are talking about. Again, thank you for sharing your experiences with us.
Eeek. Now I'm scared. Thanks for sharing your story, though. I can't imagine what you have gone through. I hope I don't have a similar experience!
I just found out that's the kind of surgery that's being recommended for me. Actually, I was told about it a few years ago when I first went to the orthodontist (this was before I had any tmj problems). It was suggested as a way to fix my open bite, along with braces. Now that I have tmj symptoms, my oral surgeon recommended it again. I guess the good thing is that my symptoms ARE a result of my jaw alignment, and not due to the joint in and of itself. It is a muscular problem, too, but the muscles are out of whack because the jaw is out of whack. So hopefully this surgery will work for me. That's assuming insurance will cover it, however. If it doesn't, then I'm screwed.
Thanks again for sharing! If anyone else has been through this, please share!
If the stars are aligned against you, realign the stars.
I've seen my dentist, an orthodontist, and an oral surgeon.
I was told of a tmj specialist in San Antonio. I may go to him/her to see if they concur with what the others are telling me. From everything I've read and all the research I've done on my own, what my doctors are telling me sounds feasible. However, after hearing all the stories on here, I'm much more inclined to get a second opinion. Now it's just a matter of getting some time to go down there.
If the stars are aligned against you, realign the stars.
Thanks Cymy Sue for sharing your experiences about the surgery. I'm so sorry you had to endure such pain and life threatening situations. No one should have to go through something like that. Situations like that roll through my head all the time and I imagine myself in your situation. My sister & family can't understand my extreme anxiety in dealing with this condition and what is being offered to me for treatment. They suggest that I go on anxiety medication for it to help me calm down.
So far I haven't had any surgery and really don't want any. My problems are not joint related, but bite related. The orthodontist yesterday was emphatic that if one of his family members had my situation he'd have no hesitation recommending this surgery, I believe he called it "Lefort procedure" to correct the slight open bite that I have and realign the upper jaw. He says they have come a long ways with the techniques in doing this surgery. I then brought up the fact that you can't mess around with one area of the body like this without having it affect another part, and of course he couldn't give any guarantees that this treatment would provide absolute relief afterwards either. Then a full course of braces to follow. He stated *most* people benefit. It seems I always tend to fall in the percentage where whatever I'm having done, it doesn't work as expected. So far 2 orthodontists have recommended this procedure. I have not made an appt. with a surgeon to even talk about it, but if I ever was to consider this I'd probably see 6 different doctors before even considering it.
Has anyone out there had success with this procedure?
Thank you so much for sharing. I'm going March 23rd to talk to the Dr. (Oral) surg. again. Please wish me the best. It would be so nice opening my mouth without the cracking noise and for me to feel like my face wasn't assymetrical due to the misallignment, but now I REALLY don't know if its worth it. So many people have told me to consider it hard. I have a lot going for me right now and don't know if I should risk it. I might need to realize a little popping isn't so bad and that everyone that loves me the way I am.
Please keep me in your prayers and hope that I make the right decision. THANK you sooooo much for sharing and I'm extremely sorry you had to go through all of that. Take care