Mismanagement following elective orthognathic surgery to correct an overbite, resulting in the need for jaw joint replacement surgery

This clinical negligence case arose from mismanagement following elective orthognathic surgery to correct an overbite. Consequently, the claimant suffered jaw joint degeneration and the need for jaw joint replacement surgery.

As a teenager, the claimant had orthodontic treatment under the NHS. She was given a removeable retainer, and she had an overbite.

In around 2004, the claimant paid for further orthodontic treatment on a private basis. She had a fixed brace for around two and a half years. The treatment straightened her teeth and improved her overbite.

In September 2017, the claimant re-attended the orthodontist. She was worried that she was grinding her teeth and had an overbite (or an “overjet”). She was reviewed and it was documented that she had an overbite of 6mm. Treatment options were discussed, including further orthodontic treatment or accepting the overbite.

In October 2017, the claimant re-attended the orthodontist. She had considered her options and explained that she wanted to proceed with further orthodontic treatment. She was advised that she might need surgery for a good result.

In December 2017, the claimant had a joint consultation with the orthodontist and a consultant oral and maxillofacial surgeon. She was advised that surgery alongside orthodontic treatment would lead to the best result. The plan was for bimaxillary surgery, with orthodontic preparation.

Braces were fitted, in preparation for surgery.

In October 2018, the claimant consented to surgery to correct the overbite (an osteotomy). The consent form noted the serious or frequently occurring risks as swelling, pain, need for adjustment, need for re-do if relapse, numbness in her lips (temporary or permanent).

That same month, she attended the local hospital for surgery (bimaxillary osteotomy) to correct the overbite. Nothing abnormal was noted.

Following discharge, the claimant struggled with her mouth opening. In December 2018, the claimant was only able to open her mouth 11mm. By April 2019, this had improved, but only to 36mm.

The claimant complained of limited mouth opening. She also had paraesthesia in her upper and lower lip.

In April 2019, the claimant underwent manipulation under general anaesthetic. Despite this, opening was only 19mm.

In November 2019, the claimant underwent an arthrocentesis and steroid injection. The pain eased, but she was still unable to open her mouth wider than circa 20mm.

In February 2020, a CT scan revealed degenerative changes in the joint. She was referred to a specialist hospital for treatment.

Following further investigations, in November 2021 (three years from the original procedure), the claimant underwent jaw joint replacement surgery. The operation went well, and she remains under the care of the specialist hospital.

We were contacted by the claimant to investigate a clinical negligence claim.

Medical records were requested, and a witness statement obtained from the claimant.

Expert evidence was then obtained from a consultant maxillofacial surgeon. This was supportive, in that following the original surgery, the management of the claimant’s condition was substandard. With earlier, more effective treatment, the claimant would have avoided the need for jaw joint replacement surgery. The expert was re-instructed to see the claimant (pre and post jaw joint replacement surgery) to report on her condition and prognosis.

A letter of claim was sent to the defendant outlining the claimant’s allegations of negligence. Meanwhile, the value of the claim was investigated and finalised.

The defendant responded, denying liability.

Court proceedings were subsequently issued and served.

Thereafter, settlement negotiations commenced, and a financial settlement was agreed.

Christina Mallery-Nelson specialises in claims relating to surgery. If you would like to ask Christina a question about a potential clinical negligence claim, or if you have a general query about any personal injury claim, contact Christina at Thomson Snell & Passmore solicitors on 01892 701183 in confidence. We offer no win no fee agreements on the vast majority of our clinical negligence and personal injury cases.