Tuesday, March 26, 2013

Initial Consultation


During the initial consultation, the doctor takes pictures and makes some visual measurements of the jaws, teeth and face to identify the potential surgery options. This is the time to ask what kind of hardware and recovery process is involved with treatment.  I was originally quoted with both upper (lefort 1) and lower (BSSO) surgeries.  The surgeon’s assistant had a model of a skull which showed the procedure and demonstrated how the jaws would be moved along with sample screws/plates.  For the upper jaw I would be getting four plates with multiple screws for each plate.  For the lower jaw I would only have 3 screws per side, but that they would have to make some external cuts to put those screws in, meaning I would have some minor scars under my chin.  The typical treatment involved being banded shut for 6 weeks (most commonly without the splint in) and the bands would get progressively looser.  I would have to be on a liquid diet for 6 weeks.  Typically people lose 5-10 lbs but should not try to lose more as that’s not a healthy way to lose weight.  They also explained it was a day surgery (23 hour stay) and that with upper jaw surgery, after the surgery is complete, I will have a tube down my nose into my stomach to keep blood out and prevent me from throwing anything up.  They also mentioned that if I do have to throw up sometime, its fine, I won’t choke because liquid in = liquid out.  I would also get a pair of safety scissors to cut open the bands in case I am choking for some reason.

 
The surgeon said I would not return until the orthodontist was done aligning the teeth within the jaws.  At this time, they sent a preauthorization to the insurance company proving medical necessity for surgery approval.  They submit copies of the molds of your teeth, x-rays, and a description of the problem along with a letter from the doctor.  In my case, I also had a letter from my ENT stating that correcting my rethnogenic mandible would improve breathing and reduce my sleep disturbances (apnea).  I received a letter about 6 weeks later stating that all aspects of the surgery had been approved.
Long list of questions for the surgeon