I am 20 years old and my parents do not speak English fluently.
This surgery is for my 18-year-old brother.

Here is a listing of the following problems he has:

1. Maxillary retrognathic hypoplasia.
2. Maxillary deviation to the left. Approximately 3mm.
3. Maxillary vertical deviation. Left side higher than right by 3-4mm.
4. Mandibular horizontal hyperplasia with a deviation to the right of approx. 5mm.
5. Negative overjet of approximately - 4mm

The Proposed corrections:
1. A Le Fort I maxillary osteotomy to advance the maxilla and correct the horizontal and vertical deviations.
2. Combined with a bilateral mandibular osteotomy to correct vertical, horizontal, and anterior-posterior deformities.


The surgeon has sent us a formal report/discussion:
========================================== =====================
The mandible can physically be placed in proper occlusion of the dentition with the maxilla and provide a reasonably good occlusion. However, definite problems will occur when doing this.

The mandible must be shifted left approx. 8mm from its present position.
The deviation of facial bones to the left will be accentuated by the fact that the maxilla is higher on the right, so it will displace the mandible further left. The patient's slightly retrognathic appearance will be accentuated by moving the mandible further back than would be indicated by anthrophlametric measurements. The jaw tracking functional movements with this type of deviation are unpredictable and maybe detrimental to the patient.

The greatest concern is that this may cause a cosmetic deformity, which is unacceptable. The patient would not like the way he looks. He would have to live with this every day for the rest of his life or until he decides to have another surgical correction.

It was pointed out that if the patient finds the appearance intolerable and desires a surgical correction, the cost would be more than double the present cost of one jaw. The surgery would require correction of both the maxilla and madible, and operating on the same jaw. A second time is more difficult and with more risk.

The issue about the maxilla being a significantly riskier surgery than the mandible is questionable. I have been performing these operations for 35 years and I am very comfortable doing either one. I have found that the risk factor has not been significantly different from the maxilla versus the mandible. Surgical and healing time is approximately the same.
========================================== =====================

Now the problem here is that the surgeon insists that my brother receive surgery on both the mandible and maxilla. We have consulted both the surgeon and orthodontist however the orthodontist has told us that it is his opinion that we should only operate on the mandible since there is a significantly higher risk and possible long term complications and that it was not worth the small increase in bite.

(My family were told operating on the bottom only would provide about a 85% correct bite but that the operating on both would give a 90-95%; I don't know where the orthodontist got the numbers from since I have not been at the consultations since I have just recently returned home for the summer from college to just find out about the situation)

The surgeon has noted that if we request that only the lower jaw be operated on that he “will have to think about whether he wants to perform the surgery or not" and that we might have to find a new surgeon. We have been told that the most optimal time for him to get this surgery is now since he has just recently turned 18 and the best possible window to operate is the start of July in addition to taking 6 weeks to heal, he will be starting college in September, away from home.

I personally find this a little annoying since my family has been planning this for more than two years now and that my brother has gotten braces to align his teeth for the surgery. We have been in contact with both the orthodontist and surgeon the past two years and now he might not perform the surgery? Finding another doctor is slightly complicated because out of the doctors around the area, he is the most qualified and starting with a new doctor, who knows how long we must wait before my brother can get the surgery.

I am trying to decide what is best for my brother and whether he should operate on both or just the bottom. My parents desire to get only the lower jaw surgery.

In my family, since I am the oldest child, fluent in English, and much more educated than my parents, my voice in these decisions have much more weight than both my parents and can change their opinions. I can see that either operating on both or only the lower have their upsides and downsides but I am distressed at deciding what the best is for my brother and my family. Money is a sort of an issue but trivial since the health of my brother what is the most important. And by the same reasoning, I would not put my brother in the position to have more health complications just to fix his cosmetic appearance.

I would greatly appreciate it if I could have another doctor's opinion on this matter.

Thank you for your time