advice needed

[user 6393]

I have a medical dilemma:

By August 2009, my upper molars had narrowed so badly I had trouble getting my tongue into the roof of my mouth, which is needed in order to make certain sounds during speech. Talking became a bit of a challenge at times. At that point I was referred to an orthodontist who, in just over a years time, has made a big difference in making room in my head so I can walk, talk, and chew gum like a normal person.

Now....

My orthodontist has me slated for major jaw surgery at the beginning of January. He has been quite non-chalant, making this 3-5 hr orthognathic surgical procedure sound like a routine walk in the park. I had originally agreed to undergo the surgery in order for my teeth to have a permanent fix (my current problem being the product of bad braces as a teen), but after my 3rd meet with the surgeon yesterday suddenly everything is being presented to me in a different light and I am quite honestly, freaking out.

The plan is to break my jaws in 6-7 places and reshape my face so my teeth have a solid foundation and a proper bite. I get the mechanics of why and how, but now instead of the last 15 months of being assured that although unpleasant the surgery is very routine and not much of a worry, to being told that the chance of an "undesireable outcome" is not only likely, but to be expected and embraced before consenting.

HUH?

I knew that my age made it likely I would have some loss of feeling at the skin level on my chin, and I was willing to risk that. Yesterday the surgeon was quite frank in saying that not only is he not sure the surgery will help any of my dental problems, that there is a very good chance it will cause further head/sinus/dental pain than I am currently experiencing. Yesterday it came to light that there is also a good chance I will experience some level of permanent facial paralysis as well.

Now, understand, I did not start this treatment to try and look 18 again and perfect. I was happy with the looks of my teeth and my looks in general. My ONLY concern was the function of my speech. I don't need to have a perfect profile, I don't much care that I have a little chin. I have had that all my life, it is who I am.

Two comments the surgeon made yesterday were "I see the braces have given you much more room in your mouth than we thought possible", and "Have you considered trying out retainers and splints to having the surgery?" (this option was not offered at any time in the past)

Is it possible that the surgeon doesn't see the need for the procedure and he's trying to scare me off of it so as not to make my orthodontist look bad? Am I purely overreacting? Am I nuts to not care about my profile? Am I just being a chicken?

I am the only functional parent my kids have (they are 18 and 20), and the prospect of bouncing grandkids on my knee while unknowlingly dribbling soup/coffee/tea down my chin is less than attractive. That's "if" my heart murmured old body would survive the lengthy procedure and avoid a nasty inscisional infection that close to my brain.

The surgeon has given me until Friday to decide if I am going through with this or not.

Has anyone here had this kind of surgery at my age (almost 50)? If so, would you do it again or ???

I truly don't know what to do.....

 

[user 6393]

I should also add....

It took 30+ years with zero intervention for my teeth to become a problem.

If I could wear retainers at night while I slept to try and maintain the shape that has been achieved would it not take longer for them to get that bad again? If so, how old would I be? another 30 years maybe 40? I'd be dead already......

wouldn't I?

 

[Tyler]

Okay, sweetums... we chatted a bit about this in Seattle last weekend but now there are new facts. So here's my 2cents (which amounts to about a quarter in today's economy):

Don't do the surgery. It was my gut reaction when you told me about it and it still feels like the right answer. You speak just fine, your face is just fine, you are just fine. With this new information, is it really worth all the issues that will/could result in a surgery that is supposed to "fix" things... facial paralysis... WTF??? Tell your doc to expect and embrace THIS!!

Check out the retainers and /or splints. You're not chicken and you have every right, given this new info, to be concerned. I love Barb the way Barb is. And if you end up lisping a little along the way, I'll just love you more. Yeah, I'll probably make fun of you in private (but I think you'll have equal food for fodder in that respect! )... but I will love you nonetheless and so will everyone else who loves you.

 

[Motorcycledoc]

I'm no dentist, orthodontist or oral surgeon (I'm just a GP!), but I say cancel the surgery - there is no need to rush into this and you need to be confident it's the right thing to do before you proceed.

You need to be clear on expected benefit (short and long term), possible risks (and how likely they are to happen), risks of not having surgery, and alternatives to surgery. In general terms, I would trust the surgeon more than the orthodontist on this one - he's the one operating and the one with the surgical experience. Do what you need to do to get all the information you need to make a decision - go back to your orthodontist, back to the surgeon, get another opinion if you're not getting the information you need. Relax, take your time. You can have surgery later if you ultimately decide it is the best way to go. And I think your profile is just fine!

 

 

[exskibum]

Barb, there's no way I'd do the surgery on THAT kind of an informational exchange and need for that broad a consent under the circumstances you explained. That you were given a different impression about the surgery and its benefits and risks for 18 months, only now to get vastly different advice and a week or so to make a decision would only make me more prone to saying no, pending a second and maybe third opinion from other surgeons and/or orthodontists. I think I'd need at least the amount of time you've been given just to do the research on the net that I'd be seeking so that I could ask informed questions of the docs I'd be getting additional opinions from.

Not sure I'd waste much time speculating about what the motives of the surgeon or orthodontist you've seen might have been as possible explanation for their opinions -- I'd just rely upon second opinions after I had a better basis for asking questions. There's no reason you can't ask that surgeon some more clarifying questions in making your decision, either.

Further, and this is just my personal preference, I prefer the most conservative, least invasive procedure a doctor, dentist, surgeon thinks will work. I most trust professionals who advise patients in that vein, too. That's not to say that I can't be talked into more invasive, more complicated and riskier procedures, but I'd have to be convinced that there was a good reason to take that kind of risk and that no more conservative course of treatment would achieve essential solutions.

A chicken? Hardly. I'd never call smart cowardly or stupid brave.

 

[Tyler]

And I think your profile is just fine!

See... I'm not the only one.

 

[TomInPA]

I have lived with braces in my wife's mouth for two years now. Slowly, with regular orthodontia and dental appointments including an extraction, years of jaw malformation are being corrected. Some work lies ahead, but its getting pretty close. Radical surgery is a viable shortcut, you have to make a tough and costly decision. You might want to pursue a second (or third) opinion with an orthodontist and see if a non-surgical option is feasible. Your uncertainty simply means you need more time and information to conclude the right path for YOU to take.

 

[James Burleigh]

I'm no oral surgeon, but I DID stay in a Holiday Inn last night....

Say "time out!" and get alternate opinion(s). Feckin' doctors think they know everything. Festina lente, as those wise ol' Romans used to say: Hasten slowly.

Of course, I'm not the one with this particular medical issue, so I can afford to be cavalier. BTW, if you have any opinion about cardiologists, let me know ASAP!

Yours,

JB

 

[Khunajawdge]

OMG, what a set of memories you have brought to the fore. :blink:

I’m over 60 (barely), but my life dentally has been a blessing and nightmare.

1st, I don’t know what to suggest for you, but “if” you want to burden yourself with reading on, then here it is.

A story (actually a his-story);

When I was 19, me mum (mother) took me to an orthodontist. I didn’t really have crooked teeth, I just didn’t smile a lot. None of my teeth touched each other, other than 4 of the front teeth, so I was very hard for me to chew.

Dr. ? said: “this kid doesn’t have a cavity and probably never will have one, he has very rare form of tooth enamel = like 1 in 250,000 humans have enamel like his”. The downside is; his bite is off, and he still has 12 baby teeth. There are never going to be secondary teeth to replace the primaries as evidenced by an X-Ray of his jaws. The reason he probably (?) doesn’t smile is, most of his primary teeth are in front of his molars, and they have pushed his front teeth together, crowding them. He has suffered a deficiency in growth at the forefront of his upper skull forming a lingual bite? This is because when one’s second teeth come in, they actually help form the shape of your skull when the secondary teeth emerge and mature. “At this time, I don’t recommend pulling any of the baby teeth even though they don’t have much root left” (this remained my condition until I was 44). Furthermore he went on to say; “We will have to pull his wisdom teeth (that part was hell!), then we will fabricate and install a ratcheting mechanism adjustable weekly with a key, that will crack his skull down the roof of his mouth until new cartilage forms between the crack.

So, after 4 months, a lot of pain, eventually a buckled mechanism, he gave up and took it all out. His ‘next’ approach was to try to tilt the teeth together with a second set of braces. Thank God, this time it worked (sort of).

I was now 21, but I had the smile of a gerbil! We asked this orthodontist what should be done about the baby teeth, which would inevitably fall out? He actually said “ If you wait 20 years, a technology will be commonplace where you can have permanent teeth implanted.

Sure enough, at 44 years of age, I had my primaries pulled and 8 implants installed. Finally, I had a wide smile. Thank you Dr. ? :yahoo:

I think overall, the money and time spent, was well worth it. However, it is very important to somehow(?) find the best orthodontist/orthopedic surgeon you can. I’d recommend my 2, but unfortunately neither are any longer with us, but I am No longer a dental cripple thanks to them.

 

[FJR-RemingtonRider]

Tough delim indeed...maybe not.

Surgery of this nature, has been performed, and like most of mine I would suggest google google, there is bound

to be some folks who have undergone this procedure and probably have voiced their opinions on some board somewhere.

.

Front site, just seems like too much risk of negative possibilities vs. the maybe successful outcome.

You are doing the right thing, seek opinions everywhere on something like this.

 

[DE OPPRESSO LIBER]

I'm no dentist, orthodontist or oral surgeon (I'm just a GP!), but I say cancel the surgery - there is no need to rush into this and you need to be confident it's the right thing to do before you proceed.

You need to be clear on expected benefit (short and long term), possible risks (and how likely they are to happen), risks of not having surgery, and alternatives to surgery. In general terms, I would trust the surgeon more than the orthodontist on this one - he's the one operating and the one with the surgical experience. Do what you need to do to get all the information you need to make a decision - go back to your orthodontist, back to the surgeon, get another opinion if you're not getting the information you need. Relax, take your time. You can have surgery later if you ultimately decide it is the best way to go. And I think your profile is just fine!

 

What he said... plus dump your orthodontist.

 

[Dudewado]

Barb, just from reading what you have written, I wouldn't hesitate to skip this surgery.

Too many potential problems and unknowns for comfort. If nothing else, you can wait and see, and definitely get another opinion.

 

[dj bill]

lots of things to take in account for,the foremost question,spit or swallow.(sorry wrong topic).

i wouldnt do it.not a real confidence booster from your doc.tell him to take a flying fk at a rolling doughnut and get another opinion.

 

[beemerdons]

I'm no dentist, orthodontist or oral surgeon (I'm just a GP!), but I say cancel the surgery - there is no need to rush into this and you need to be confident it's the right thing to do before you proceed.

You need to be clear on expected benefit (short and long term), possible risks (and how likely they are to happen), risks of not having surgery, and alternatives to surgery. In general terms, I would trust the surgeon more than the orthodontist on this one - he's the one operating and the one with the surgical experience. Do what you need to do to get all the information you need to make a decision - go back to your orthodontist, back to the surgeon, get another opinion if you're not getting the information you need. Relax, take your time. You can have surgery later if you ultimately decide it is the best way to go. And I think your profile is just fine!

 

What he said... plus dump your orthodontist.

+1, Gunny. Do not do the surgery, Barb; biggest mistake in my 62 years of living was an elective surgery on my left ear (Surfer's Ear - Externa Extoma), this left me with no hearing in that ear and three followup repair surgeries. Doctors are way too quick to cut you up, your profile is fantastic! You are a Beautiful Gal, don't change that!

 

[lonerider]

What that orthodontist is proposing sounds risky to me; if you're seriously considering it, I'd get a second and possibly third opinion. If there's a less radical way to achieve a satisfactory result, I'd go for it. Back in the mid '80s, I had to have a nerve cut in the right side of my face in a failed attempt to alleviate trigeminal neuralgia. I still have some sinus problems as a result. Some docs are too quick to reach for a scalpel. I've had more than my share of surgeries (currently healing from rotator cuff repair); my rule of thumb is, I don't go under the knife unless it's absolutely necessary. Good luck to you, no matter what you decide.

 

[Fred W]

Barb,

Here's the question that may lead you to an answer to your dilemma:

What's the downside to not having the surgery right now and just continuing on your current orthodontic course of braces and retainers?

(and what's up with that surgeon giving you a deadline ultimatum?)

 

[Panman]

Barb, don't let the surgeon rush you. I know that rescheduling up in Canada can be a pain and the waiting list can be long but this doesn't sound to be something you should rush. Besides you got a good looking kisser so you don't need to mess with it anyhow!

On a side note about twenty years ago I let them cut on my throat to make more room for air as I have severe sleep apnea. The scaring just made it worst and as a side note it's easy to wind up choking as I get stuff down the wrong pipe if I'm not careful. I'm glad the surgeon is letting you know what the side effects can be.

 

[wheatonFJR]

Gunny on telling them to hold on to their shorts until this is sorted out to your satisfaction.

Do NOT rush this. If they rush you, can'em...tell 'em to take a flying leap. :glare:

Gunny also on your nice profile. :clapping:

 

[Auburn]

As others have said. Get another opinion (or two) and if you are not comfortable with the risks, don't have the surgery. If your braces and retainers are having the effect but slower, maybe that is hte best course to continue with.

EDIT: they call it practicing medicine for a reason. And then the doctor doesn't even want to be responsible for his work...