Jaw Surgery

Welcome to Dr. Rimer’s practice of JAW SURGERY / ORTHOGNATHIC SURGERY. Both he and his staff are dedicated to helping you understand the meaning of orthognathics (simply, the correction of deformities of the jaws and facial bones by surgically moving them into normal form and function) and how we may be able to help you.

Dr Rimer started his specialist training at Michael Reese Hospital in Chicago in 1978 where he completed a one-year residency. He then completed a three-year residency in Oral and Maxillofacial Surgery (jaw surgery), including orthognathics, implantology, bone graft reconstruction, preprosthetics and TMJ surgery at Jackson Memorial Hospital/University of Miami Medical School. He was then accepted for a fellowship for one year, specializing in orthognathic surgery and jaw reconstruction. Dr. Rimer is in private practice in Boca Raton, Florida.

He is recognized as a national and international authority in orthognathic surgery. Not only as it relates to orthodontic patients but also those requiring advanced prosthetic and restorative procedures in conjunction with unfavorable jaw relationships.

Differences in jaw structures arise as a result of altered growth rate (too fast or too slow). Other factors include traumatic injuries or some kind of surgery. It may even be a hereditary problem. Jaw growth problems may be diagnosed from a very early age to well into middle age and often benefit greatly from surgical correction.

The field of jaw surgery is very sophisticated and thus requires a multidisciplinary team with an interdisciplinary approach from your initial exposure to this type of treatment to final completion of your individual treatment plan. To this end, either prior to our during your active treatment phase and occasionally following treatment, you may be asked to see other specialists in related fields, besides Dr Rimer. These team members could include your orthodontist, dentist, other dental specialists and family physician and occasionally a psychologist, speech pathologist, periodontist, plastic surgeon and otolaryngologist and even a cosmetologist. The reasons for any of these specialists requiring to meet you will be explained when it becomes necessary to refer you to of these people.

Our goal and approach in this kind of jaw surgery is for our patients to gain the following:

1. The best possible functional result, (ie. to be able to eat, chew, breathe and speak properly).
2. A balanced and harmonious aesthetic result.
3. Stable results that will last a lifetime.
4. Satisfying your goals to the best of our ability in the shortest time possible with your full understanding and consent and the least amount of surprises.

We are sure that as you are guided along the treatment plan recommended for your particular problem, you are going to have many questions. All these concerns will be answered to your satisfaction as they arise.

JAW SURGERY (orthognathics) incorporates not only the surgical aspect of correcting a dentofacial deformity, but includes the entire group of specialists and their particular expertise and skills to treat you in the best possible way we know of today. The field of surgical orthodontics – JAW SURGERY – has grown remarkably in the last decade, affected by new concepts, instrumentation and the development of new surgical procedures and diagnostic accuracy.

SFOT (Surgically facilitated osseogenic therapy) is one of these new advances.

There will be many new terms, concepts and ideas which you are about to be exposed to. Your treatment is going to require many steps, so we would like to introduce you to a typical sequence of events that would normally occur.

Why do you need Jaw / Orthognathic Surgery?

• Your lips do not meet in your natural bite
• Your jaw protrudes noticeably forward
• Your chin is receded backward
• Your face seems unbalanced
• You have open space between your upper and lower arches when your mouth is closed
• You have breathing difficulties during sleep
• You find yourself breathing primarily through your mouth
• You have difficulty chewing and/or swallowing food
• You have excessive wear on your teeth
• You have ongoing jaw joint pain
• You suffer with chronic headaches

1. The Initial Consultation:

You have been referred to our office by a friend, one of our patients, your orthodontist, dentist, physician or yourself. At this time, there will be a brief exchange of your concerns and desires and the feasibility of our ability to treat you. We want to be assured that your expectations are realistic. At this time, a general sequence of events for your treatment will be explained to you. It will be a time for us to get to know each other. We encourage you to bring a friend, relative, spouse, etc.

2. The Orthognathic Records Session:

This will include the following:

• A photographic session.
• Special digital x-rays designed to study the configuration of your facial bone structure.
• Dental impressions / scans of your teeth for the purpose of making study models. It is through these records and their analysis that a correct diagnosis is made and a treatment plan is synthesized.
• A thorough clinical examination and history.

3. Final Consultation:

At this time, the diagnosis and treatment planning of your case will be outlined to you and the specific sequencing of events will be explained. Your x-rays, study models and photographs will all be reviewed and other visual aids may also be used. The cost of your treatment and financial arrangement options will be discussed. Please bring spouse, parent or close friend for this important consultation.

4. The Psychological Consultation:

This consultation is recommended by Dr Rimer. It is optional in most cases but we have found this consultation to be very beneficial to our patients. This is a positive and supportive aspect of your treatment plan. This visit gives you an opportunity to explore your motivations and expectations for surgery, and how best to prepare your family for post surgery events.

5. Speech Evaluation:

This is for patients who have a speech articulation impediment or have had a cleft lip or palate. A base line analysis of your speech is necessary to ascertain changes that may occur as a result of treatment. We are learning more and more about the effects that disharmony of the facial bones has on speech. A high percentage of our patients notice an improvement in their articulation once this balance is achieved. Speech is one of the most complex of all human functions. A base line analysis of your speech is necessary to evaluate changes that may occur as a result of orthognathic surgery.

6. Pre-Orthodontic Oral Surgery:

Occasionally it is necessary to remove wisdom teeth and/or perform other minor oral surgery before banding. This is technically easier to do before your braces are placed.

7. SFOT (Surgically Facilitated Orthodontic Therapy)

This is an advanced procedure that addresses the underlying problem of tooth size relative to insufficient alveolar bone volume and associated compromised arch forms.

To optimally enhance the functional outcome of your treatment. A major advantage of this procedure is the benefit it provides to the periodontal support of your teeth and the long term stability and retention of your orthodontic alignment in a decreased amount of treatment time. These procedures can be performed either with high tech clear aligners or routine orthodontic braces. In the past these issues were frequently ignored with long term outcomes resulting and recurrent crowding, gingival recession and even tooth loss. This modality also can have a significant positive effect on airway obstruction, breathing and sleep apnea. Dr. Rimer is recognized as one of the few Oral and Maxillofacial with an expertise in SFOT.

8. Pre-Surgical Orthodontics:

This phase of treatment is required to correctly align the teeth within the jaw bones prior to surgically correcting the alignment of the jaws themselves. This phase of treatment is required in most cases. Your orthodontist will go over in detail with you the orthodontic mechanics to be performed. Your bite and aesthetics may become worse during the orthodontic phase of your treatment. This happens because there is no attempt to coordinate your upper and lower jaws orthodontically. Instead, the orthodontist concentrates his efforts on aligning and leveling the teeth over their respective arches independently. Sometimes this is done in individual segments. This will all be explained to you. Your bite becomes worse because of the existing disharmony of the affected bones.

9. Round Table Conference:

You will be invited to attend a round table discussion (LA JAWS) with the SR Team, our staff and former patients. This is recommended to help cover as many areas as possible for the purpose of preparing you for orthognathics in general and the jaw surgery in particular. Pre and post operative patients gather together informally to discuss motivations, expectations, fears, the hospitalization and surgery, family preparation and some of the personality changes that occur as a result of the orthognathics. We encourage and welcome you to bring anyone with you, even friends who may have a similar problem to yours but don’t know how to get started in the treatment of their particular problem. These sessions are held every few months and you will be informed as to the time and location.

10.Final Pre-Surgical Records:

These records are taken prior to surgery and are similar to the ones taken at your pretreatment records appointment. They are needed prior to surgery for measurements and assessment. From these records, we will do model surgery, a prediction tracing and fabricate a surgical splint. This is to bring accuracy and predictability to the surgery. Preparation for your surgery will be outlined with an exact diarized time schedule. It will be necessary in most cases, to donate one or two units of your own blood in preparation for the surgery. This is all coordinated for you to make this experience as easy as possible.

11.Surgery:

Each particular case is different. Your particular problems and specific details of the planned surgery will be explained with the assistance of visual aids so that you have

a good understanding of what is to be done. You will receive details pre and post operative instructions and dietary information and recommendations. Time will be spent on a detailed informed consent and you will then be asked to sign a personalized operative permit. All surgery is done at the hospital with the aid of an assisting jaw surgeon (oral and maxillofacial surgeon). The hospital stay is usually an average of one to three days, depending on the extent of your surgery. The details of your surgery will be explained and in all cases visual aids will be used so that you have a good understanding of what is to be done. Members of the SR team are available to spend time with you to explain, from a patient’s point of view, the hospital and surgical experience. These former patients may also be requested to visit you during your hospitalization for continued support.

12.Post Surgical Orthodontics:

4 to 6 weeks following your surgery your orthodontist will begin the “fine tuning” or refining of your bite to gain the best possible occlusion for you. As a result of your surgery, the bones will be in a “softened” condition, therefore your teeth will respond quickly to conventional orthodontic forces. Your orthodontist will see you more often, during this phase of your treatment. Once this has been completed usually about 4-6 months, your braces will be removed and you will be asked to wear retainers. This will also include a period of jaw exercises or muscular rehabilitation.

13.Post Treatment Records:

These records will be similar to your initial ones. In some cases, they will be repeated annually. They are taken to evaluate the changes that have occurred and to give us a base line for stability studies.

14.Post Treatment Dentistry:

Any required dentistry such as crowns, bridges or any other restorative work that was delayed until your braces were removed, can now be completed. Your family dentist will be kept informed as to your progress through your orthognathics, including your surgery and your placement retainers. The timing of required post treatment dentistry will be coordinated in cooperation with the orthodontist.

15.Post Treatment Psychological Assessment:

This consultation may be recommended or you may feel you want to discuss the “new you”, specifically, improved jaw function, facial appearance and most often, a more positive mental attitude and personal confidence. The effects of surgery upon your personality and self esteem are reviewed. You may discuss which ways of coping worked best for you and how the surgery was most effective and perhaps supply information that could be supportive to other patients just beginning the orthognathic surgery process.

16.Post Treatment Speech Reevaluation:

We are interested in the effect your treatment has had on your speech improvement. Patients who were speech evaluated prior to orthognathics will return for a post treatment evaluation. There is a possibility that with the new arrangement of your

articulators, you may experience distortion of some sounds. If this problem persists, you may want to schedule a therapy session or two to learn new habits to correctly position your articulators during speech.

17.Cosmetology:

In some cases, we will recommend consultation with a cosmetologist relative to hair styles, make-up, clothing, etc. The changes that you will undergo as a result of this treatment may give you incentive to seek consultation in these areas. Dr Rimer works very closely with a number of plastic and reconstructive surgeons as well. Many times adjunctive procedures, for example a rhinoplasty, may be indicated. This is usually performed approximately 9 to 12 months after your jaw bone reconstruction to allow for the bones to adequately remodel, muscles to stabilize and completion of most of the orthodontic treatment. This then gives the reconstructive surgeon who is part of our team, a proper idea of your final form and function to facilitate the best results.

18.Our Surgical Support Team – the SR Team:

Our patients are very important to us. They have the best understanding of how we have treated them, their hospital experience, how their expectations and understanding of jaw surgery were met. The SR Team is a group of patients who have had orthognathic surgery. You will have a one on one opportunity to meet them, as well as at the Round Table Conferences. They will even lend support during your stay in the hospital and after surgery, if needed. All post operative patients are invited to become members of the SR Team.

We look forward to you becoming one of our special patients and thank you for allowing us to treat your particular problem. If you have any special questions, please do not hesitate to ask us for an explanation.