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Oral Surgery/Jaw surgery problem

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3D scan n1
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QUESTION: Hi doctor,
My nightmare started when i did a jaw surgery last year (both jaws). After that my face was very asymmetric, so i went this summer to another hospital (because my 1st surgeon didn't care); they said there was a problem and that they will fix it, so i did a 2nd jaw surgery but my problem is still there. They did worse.
I still have an asymmetric face but now i have another problem : I found out i've got a "hole" in the right ramus. Another surgeon who did a 3d scan told me he can try to operate to fix the asymmetry but if it brakes, he'll have to fasten the bones but leave the jaws as they are.
Is it possible to fix this fracture (bone graft, distraction...etc) first and then reoperate ?
What would you suggest i should do ?
PS: i attached 2 pictures to show you

Thank you

ANSWER: John I am so sorry to see the results of your surgery.  I of course cannot be sure without examining you but it looks to me that the surgeon did not  tie the cut bones together after the surgery.  I cannot be sure but grafting  the bone along with fixating and repositioning the segments to align it to stabilize the bone and correct the assymetry is probably the best treatment.  The problem us to find a very skilled surgeon. Not every surgeon cando this surgery.  So you need to be confident of your doctors ability.

I wish I could help more but need to find a skilled and honest surgeon.  I you have other questions get back to me.

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QUESTION: Hi again doctor,
After a long "journey" to find a skilled surgeon who could help me to fix my problem, i finally found a surgeon who use 3d techniques and innovative surgical navigation instruments.
He did a simulation (now/after) of the surgery but he said that the result might not be as realistic as the picture shows. He said exactly that it's not possible to simulate the displacements of the 2 proximal segments and condyles. And i AGREE with that.

But in your opinion, do you think these movements and especially of the condyles are realistic ?
Because i read that when they operate, the surgeons manually try to place the condyles in its most superior and anterior position in the glenoid cavity ; and as we can see on the photos (view from below), the left condyle isn't. So maybe it's possible.
I would like to have your opinion about this please ; Because i feel in my right TMJ a lot of tension (as if my right TMJ is "overworking" ?) and i think the condyles are in an asymmetric position that will lead to pain if the surgeon doesn't put the condyles in a "centric relation". Don't you think ?

PS: i attached 2 animated GIF (i hope it works; if not i will upload on other website) to show you the movements (now/after on Front face and view from below).

Thank you for your help, and sorry for my english (i'm french).

ANSWER: John -  First of all, the animated GIF did not come through.  The tension you feel in the right side is probably due to an overworking of that side with the left not working properly.  

Placing the condyles in a centric position is of course is best, but many individuals who sustain trauma and one condyle is displaced from its position can regain normal function as the muscles attached to the condyles pull them into position.  

It is a little difficult for me to really know the results, but if the surgeon is skilled, he should be able to assist the development of normal function

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QUESTION: Sorry for the photos ; Without them i agree it's really difficult to understand me and to respond my questions.  
Now i posted them on another website, here there are the links working:

http://img1.imagilive.com/affiche/0415/5478661.gif.htm
http://img1.imagilive.com/affiche/0415/5478662.gif.htm

Can i ask you again please your opinion about this ?

Thank you in advance for your time and assistance.

Answer
John - Of course, I cannot be sure that what they show in the 3D that is accurate.  It shows that both right and left condyles are mobile.  That is not good.  It shows that during opening and closing the condyles and the jaw bones separate.  That is probably producing the instability in the opening and closing and jaw functioning.  I question why the surgeon did not fixate the two cut segments together on each side.  If he had, the condyles and the jaw would function in synchrony.

So the surgeon did not create a stable functioning relationship.  

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Joel S. Teig, DMD, Diplomate ABOMS, retired

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

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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