I've had several people ask me just why I was doing this. Well, here are some images of molds taken on 13 March 1989, when I was 19 years old. This is what I started this whole process with.
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Briefly, I had what was called a class III maloclusion of the mandible (my lower jaw protruded further forward from my face than my upper jaw did-- see the third picture above). A thourough, and more recent, diagnosis actually discovered I suffered from two conditions:
- a hypoplastic maxilla (under-developed upper jaw)
- a prognathic mandible (over-developed lower jaw)
- Extend the upper jaw
- Distend (shorten) the lower jaw
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This image was taken on 08 April 1999, just less than a month before my surgery. You can clearly see the protruding mandible as well as the crowding of the wisdom teeth at the back of the jaw. Removing the wisdom teeth provides more room to the orthodontist, Dr. Hiller, to move the molar's around (in my case up and down so they will have a contact point-- currently they won't have any contact at all).
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Upper Jaw
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The image you see to the left shows a skull, being held by my oral surgeon, Dr. Lynn J. Philippe, with the lower jaw completely removed (they never did that to me, by the way). Looking just below the nasal cavity, you'll see a cut running horizontally, across the entire face. That cut is called a LaForte I cut, named for the doctor who discovered that it's the 1st natural place the "face" will break (there are 3 others). They performed that cut on me using a reciprocating saw. The cut runs the entire width of the face and goes about 3.5 inches deep into the skull such that the maxilla (upper jaw) is completely detached from the skull (Dr. Philippe reminded me that the upper jaw couldn't be completely removed from the skull because of all the soft-tissue from the insides of the mouth holding it all in place, but he did indicate that he could pull it out about 3-4 inches...). They can't actually make the cuts all the way in the back to completely detach the maxilla from the skull so they use basically a surgical crow-bar to fracture the jaw from the cranium. Fun, heh?
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Although the image on the right isn't all that good because Dr. Philippe's fingers are in the way, I wanted to try to give you some idea of just how far back into the skull the cut goes. Click on the image to get a better view, if you want to. The cut goes at least as far back as his middle finger on his left hand. He mentioned that when the are working on the upper jaw and make that cut, the entire lower portion of the sinus is exposed and it takes a long time to make sure all the cuts have been smoothed out and match before placing things back together.
When they did put my upper jaw back into into place, he stuck it 5 mm further forward than it was to start with. This creates a little step in my face, which he claims will naturally smooth itself over with bone as it heals (next 10-12 weeks). They reattached the maxilla to my skull by using little tiny titanium plates and screws. The plates span the cut and two screws are placed in the skull and two in the maxilla. I'm not sure exactly how many are there, but I bet my next X-ray will tell me... (although titanium isn't magnetic, so I won't be setting off airport detectors all my life).
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Lower Jaw
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The image you see to the right shows a mandible (lower jaw) completely removed from a skull. Nothing too special about it.
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In the left-hand image Dr. Philippe is noting where they start the sagital bilateral cut performed on the mandible. It begins in the upper back, just below the TM joint where a neve enters the mandible. The cut runs from the back of the jaw to the front, parallel with the plane of the jaw.
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The right-hand image shows how they continue the cut forward, along the length of the jaw, but below where the teeth implant. They then take the cut down, towards the base of the jaw. Once completed, they use the special surgical crow-bar again to fracture the bottom-line of the jaw and the mid-line along the back portion of the jaw. Note that there are two, parallel, rubber bands holding that piece of jaw onto the model that aren't actually in a human. One other note is that you can barely see a yellow line running along the inside of the majority of the jaw where they do the cut. That is the major sensory nerve that feeds the entire right half of the lower jaw. When doing their cuts, they have to make sure that nerve stays within the jaw and not the piece they cut out. This nerve typically gets bruised from the procedure as well as the swelling that occurs afterwards. Thank goodness! It's what's numbing my mouth and preventing me from feeling any pain!
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This last image is a very good shot of just exactly what the cut looks like.
Now, how do that put all of this back together? Well, they actually do two more cuts on the bone. One occurs just forward of where they take the cut down to the bottom of the jaw. They shaved off 4.5 mm of bone, actually creating a grove that was half empty running top to bottom along my jaw. They do the same in back. This way, they can simply slide the majority of the mandible back, towards the skull, and everything snaps into place. Actually, the titanium plates and screws do that again. This time, in order to get the screws nice and perpindicular to the jaw, they need to make two small incisions on the outside of the jaw, through my skin, so they can get their screwdrivers placed just right. Kinda cool, huh?!
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Recovery
The two images below were taken on 05 May 1999, the night before my surgery.)
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The two images below were taken on 01 June 1999, 26 days after the surgery.
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The image to the right is a picture of the panographic X-ray, taken on 19 May 1999. You can see all the little titanium screws and the thin little plates used to hold the maxilla to the upper skull as well as the screws holding the two pieces of the mandible together. If you look closely, right by the screws in lower jaw (the left side of the image is better), you can see the cuts in the bone. If you look at the same place on the right side of the image, you can also trace it back to the back side of the mandible, where they actually started the cuts. Also note, you can see the holes left from where they pulled out the wisdom teeth.