Oral and Maxillofacial Surgery Expert Forum
Possible Fibrous/Non Union After Upper Jaw Surgery
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Questions in the Oral and Maxillofacial Surgery forum are answered by Dr. Michael H Kirsch and Dr. Mario Tuchman. Topics covered include teeth extractions, wisdom teeth, dental implants, bone grafting, orthognathic surgery, facial bones realignment, facial trauma repair, jaw alignment, anesthesia , jaw cyst or tumor diagnosis, reconstructive jaw surgery, temporomandibular joint syndrome (TMJ) and TMJ surgery.

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Possible Fibrous/Non Union After Upper Jaw Surgery

I had segmental upper jaw surgery 10 weeks ago and the anterior segment is very mobile. It flexes with the slightest bit of pressure and I am concerned that it has not healed properly. My surgeon assures me that this is normal and it will solidify in the next couple of months. My orthodontist disagrees but is deferring to the surgeon. I have been on a no-chew diet for my entire recovery and have been told to continue until the upper jaw solidifies. If it does not solidify in 4 months, another surgery will be required.

Is movement of the maxilla 10 weeks after segmental upper jaw surgery normal?

Is it likely to solidify in the next couple of months?

Does this situation warrant a second opinion?

If another surgery is required, is there any benefit to waiting 4 months as suggested by my surgeon, or would it be better to do surgery now?

Thank you for any input you can provide.
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Bone healing following jaw repositioning surgery typically occurs within 8 weeks.  Complete immobilization and stabilization of the bone if necessary for bone healing.

The bone segments can be held together by titanium plates and screws and/or the jaw can be wired together in the closed position.  Movement should not occur along the pieces during healing.

Some patients "feel" that the bone is moving when in fact it is not.  This is due to the sensory nerves that were disrupted during the surgery and they can give this "feeling" during normal healing.  

If you are correct and the bone is actually moving I would return to the surgeon so that they may measure the amount of movement with a ruler or calipers and follow you on a weekly basis to determine if the situation is improving.

Generally speaking, movable bone segments can form a fibrous union which is undesirable in the jaws.

First, discuss your concerns openly and honestly with your surgeon.  If you are not satisfied with their response you may want to consider getting a second opinion from a Board Certified Oral and Maxillofacial Surgeon who frequently perform this procedure.

Clinical and radiographic examination would be necessary to answer your other questions or provide any more specific information.

I hope this help.

Dr. Kirsch

Information contained within this reply is intended solely for general educational purposes and is not intended nor implied to be a medical diagnosis or treatment recommendation.  This is not a substitute for professional medical advice relative to your specific medical condition or question. Always seek the advice of your own doctor for medical condition. Only your doctor can provide specific diagnoses and therapies.
3 Comments
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Avatar_m_tn
Thank you, Dr. Kirsch. The bone is in fact moving - my dentist and orthodontist have both verified this. If I press upward on the ridge behind my front teeth (not on the teeth themselves, but on the ridge, all of my upper teeth move as a unit.

I have unfortunately had a lot of movement in the anterior segment of my upper jaw during the past 10 weeks because my lower jaw was fighting the elastics that were in place to train it into the correct bite. All night long it would open itself up and pull the anterior segment down. My surgeon was not concerned about this.

I have had very honest conversations with my surgeon and keep getting the same answer, that everything is fine and not to worry. I am worried and I believe it is time for a second opinion. Thank you for your input, it's exactly what I needed to know.
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Avatar_n_tn
I am in a similar position. I am now 4 months post op. my upper teeth in front still have about 1mm of play in them. My surgeon has told me to wait untill 5 months before desciding on further treatment. X-rays taken by my surgeon and othodauntist don't show any evidence of non-union. What is the likely hood that after 4 months this is not a non-union and just slow healing?
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Michael H Kirsch, DDSBlank
Dr. Michael H. Kirsch
Caldwell, NJ
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