AboutJoel S. Teig, DMD, FABOMS Expertise I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.
Experience Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.
Organizations American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons
Expert: Joel S. Teig, DMD, FABOMS Date: 7/4/2008 Subject: Chances when splitting the mandible it cracks the wrong way
Question Dear Dr Joel Teig:
A lot of people write on the Internet there experience with Maxillomandibular advancement surgery for sleep apnea.
This one patient wrote the following which scares me.....Do you know or can you refer me to someone or an article that tell me 1) how common a bad brake like this is...just a approximate estimate would be great and 2) what is an estimate of the bad things that would happen if this happens to me???
I especially want to know because I was told my Maxillomandibular advancement surgery for sleep apnea would be more difficult because I had lower jaw advancement (split 25 years ago)
What this patient wrote was ..."but the right side mandible didn't go so well. The controlled break went the wrong direction and instead of just splitting my mandible, it cracked straight back. At this point, he had three choices. He could put everything back and wire me shut, he could try to fix the break with plates by going in through an external incision and risk killing the bones, or he could repair what little he could without additional invasiveness and back out, wire me shut and see how my body would do in helping fix the issue. He chose the third option and I am glad he did. He said surgeons tend to like to fix things, but he figured my best chances long-term were through waiting and seeing how it would heal"
He had the surgery about 2 weeks ago....so we do not know how he will heal.
So gratefully yours,
Bill
Answer Bill - I fully understand your apparent apprehension with the advancement surgery. Having had the advancement surgery 25 years ago, your surgical advancement for the sleep apnea will definitely be more difficult. The normal bone conditions in your bone, I assume, are internally scarred and the separation of the bone to allow the advancement may be difficult. I don't know the surgeon you are using, but I think an alternative advancement approach, if the surgeon feels it may be difficult for the sagittal split, may be the best for you. The surgeon really needs to do a proper radiologic exam in advance, maybe a CT scan, to actually view the internal bone. There are a number of different possible surgeries for the advancement. The surgeon needs to review these and if he feels uncomfortable with them, you may need to see a specialist more comfortable.
I hope you can be done by your surgeon, but if not a different one, even if it requires a little travelling may be best. If you have additional questions, feel free to contact me again.
