Feelings of gloom set in whenever Carys Rees-Baker and her family discussed the surgery Carys needed to fix her underbite. But the shadow lifted when Carys met a team of Mayo Clinic dental and maxillofacial specialists whose compassion assured her she would be well-cared for and the treatment well worth the effort.

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Sixteen-year-old Carys Rees-Baker loves singing and performing. But two years ago, she stopped participating in plays and musical camps. The talented teen didn't want people to see her prominent underbite, which caused her mouth to turn down at the sides.

Since undergoing treatment at Mayo Clinic that involved orthodontics and oral surgery, however, Carys' self-esteem has skyrocketed. Now she's excited to share her talents and megawatt smile with the world.

"I'm more confident. I audition for shows all the time. I audition for solos all the time, and before I didn't even want to do those things," says Carys, who lives with her parents in Gross Pointe, Michigan. "A couple of days ago, I auditioned for 'Elf, the Musical.' I just got the cast list, and I got a leading role."

To Carys' mother, Margaret, the difference in her daughter since embarking on a treatment plan with Chad Rasmussen, D.D.S., in Mayo's Department of Dental Specialties, and Jonathan Fillmore, M.D., D.M.D., in Oral and Maxillofacial Surgery is nothing short of extraordinary.

"It's been life-changing, and I don't say that lightly," Margaret says. "It really has been so much more than we ever imagined."

While Carys' treatment, which included wearing orthodontic aligners and undergoing jaw surgery, noticeably improved the placement and health of her teeth and jaws, her medical team is quick to point out that Carys' beauty was always evident.

"After the surgery, when I had my conversation with the parents, I told them Carys was always beautiful," Dr. Rasmussen says. "It's just that things weren't in the right place. The goal was to get everything in the right place. It still looks like her, and she's beautiful."

Expert input eases anxiety

Carys' family knew since elementary school that Carys would require jaw surgery to adjust the misalignment of her lower and upper jaws. "Ever since then, it was a dark cloud above me — something in the future that I wished I could get rid of, but couldn't," Carys says.

When she was in eighth grade, Carys and her parents discussed with an orthodontist how Carys' treatment plan would play out. It quickly became evident that the process would be more involved and intense than they'd anticipated.

"Carys cried when we left the appointment," Margaret says. "(The orthodontist) laid out the entire plan, and I had a pit in my stomach that something didn't seem right. It was very distressing. I didn't want my daughter to have to go through jaw surgery, and I was filled with dread for weeks."

One sleepless night, Margaret got out of bed and turned on her laptop. She searched the internet for medical facilities that offered nonsurgical approaches to correct jaw misalignment. "Mayo Clinic popped up, and I thought: 'My goodness! How far away is Mayo Clinic?'" Margaret says. "I Googled it, and it said it was only 10½ hours away. I thought to myself, 'We can definitely drive 10½ hours to get an expert's opinion on jaw surgery.'"

"Dr. Fillmore could see my enormous reluctance and was so patient and kind and understanding."

Margaret Rees-Baker

Margaret called Mayo Clinic in Rochester and requested an appointment in the Department of Dental Specialties. At Carys' first appointment with Dr. Rasmussen, they spent much of their time discussing why a nonsurgical approach actually was not in Carys' best interest.

"I was able to take the time to explain to them why I didn't think correcting the teeth alone was the best approach because of the risks involved to the teeth that could potentially cause her to lose some of them." Dr. Rasmussen says. "I had time to explain what the benefit of a having the jaws in the right place would be, not only for the function, but the added aesthetic benefit."

Although surgery wasn't the family's preferred treatment course, the way it was explained by Dr. Rasmussen and Dr. Fillmore provided them with peace of mind about the process.

"Dr. Rasmussen had a way of explaining it to us that helped me understand that anything less than jaw surgery would jeopardize her losing teeth in adulthood," Margaret says. "Dr. Fillmore could see my enormous reluctance and was so patient and kind and understanding."

With their major concerns about oral surgery eased, the family decided to proceed with the treatment plan the Mayo care team had outlined. It first required extracting Carys' wisdom teeth and two malformed baby teeth. Next Carys' teeth were straightened with removable aligners, so they would come together after surgery. Finally, jaw realignment adjusted her upper and lower jawbones.

Teamwork enhances outcome

Carys chose to have her teeth extraction done at Mayo Clinic to gain familiarity and comfort with the environment. And although Carys could have received orthodontics in her hometown, it made sense for that part of the plan to take place at Mayo, as well.

"Team care is part of the rich history of Mayo Clinic," Dr. Rasmussen says. "The benefit is we can bring together the Mayo Clinic surgeons with us in the same room to come to a consensus on the treatment sequence and plan. If you do it at home, you visit the orthodontist and then visit the surgeon. And somehow the surgeon and the orthodontist, who work in different practices, have to talk. Here I have scheduled time with the surgery team. Or if I have to, I can go up to the 12th floor and stand there until I get an answer."

For Carys' orthodontics, Dr. Rasmussen recommended the Invisalign system, which entails creation of a series of trays for patients to wear. "With Invisalign, all of the planning is in the computer first. It makes me a series of trays all at once, and I can give her a number of aligners and see her every two to three months. With traditional braces, I would see patients every four weeks."

"If jaw surgery was the best option to completely get rid of (the underbite), then I would do it, especially with Mayo Clinic because it's such a good place, and I felt safe there."

Carys Rees-Baker

Carys wore the aligners throughout her freshman year of high school. As they worked to correct the tilt that her teeth had developed to compensate for the underbite, eating and singing became more difficult. Worse for Carys, the underbite itself became more prominent. "My freshman year was probably the worst year of my life," she says.

As the surgery date approached, Carys grew excited about the changes the operation would bring to her life. "I was more open to surgery than my mom because I just wanted to get rid of the underbite," Carys says. "If jaw surgery was the best option to completely get rid of it, then I would do it, especially with Mayo Clinic because it's such a good place, and I felt safe there."

On Aug. 8, 2018, Dr. Fillmore performed the operation to restructure Carys' mouth. The surgery involved bringing her upper jaw forward and moving her lower jaw back. During the operation, Dr. Fillmore separated the upper jaw that holds the teeth from the skull base and slid it forward. He also corrected an asymmetry that had developed in the upper jaw. Next, Dr. Fillmore cut and separated the lower jaw in three distinct parts and placed them in the proper positions, taking care to protect nerves and other vital structures. Small titanium screws and plates were used to secure the jawbones in their new positions.

"She was a fabulous patient," Dr. Fillmore says. "She was fairly young — 15 when we did the surgery — but she did so well. She was really mature about it and did everything we asked her to do."

Moving on with appreciation

The first few days of Carys' recovery in the hospital after surgery were difficult. "It was hard to swallow. It was hard to breathe," she says. "I felt kind of claustrophobic because I was swollen and shut down. The splint they put in your mouth makes it so you basically can't move your jaws. I was taking so many different medications, and they all needed to be liquid or crushed. It was just a lot."

The initial surgical discomfort, however, was short-lived, Margaret says. "It was only five days after surgery, and I said: 'What do you think, Carys? Are you happy that you did all of this?' and she said with complete assurance, 'Yes.' She was already happy after five days."

"The people at Mayo Clinic are unbelievable. It's been one of the great experiences of our lives."

Margaret Rees-Baker

Following Carys' discharge from the hospital, she returned home, where she had to maintain a liquid diet for six weeks. Especially on school days, eating became a chore. Each meal or snack needed to be followed by a saltwater rinse and teeth brushing to protect against infection.

"We would put a lot of different food in the blender," says Carys, who lost 10 pounds during her recovery. "One time, my mom was like, 'Let's put some meatloaf in the blender,' and I was like, 'No, that sounds really bad.'" On the flip side, at one point Carys decided to treat herself to a monster dessert and blended ice cream, cookies, milk, chocolate cake, brownies and chocolate syrup together. "That was pretty good," she says.

Throughout her experience, the care Carys received from her Mayo Clinic team exceeded the family's every expectation. "As a mother, imagining someone changing your daughter's face is pretty overwhelming," Margaret says. "But the people at Mayo Clinic are unbelievable. It's been one of the great experiences of our lives."

Exactly one year after her surgery, on Aug. 8, Carys and Margaret returned to Mayo Clinic, so her team could check her progress. The visit was a celebratory event, marked with positive reports, pictures, chocolate cake and confirmation that the family had made the right choice.

"The jaw surgery not only medically changed everything for the better, but removed that dark cloud over her head," Margaret says. "It's literally changed her life for the better, and we are grateful beyond words."

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HELPFUL LINKS

• Learn more about jaw surgery.
• Check out Dental Specialties at Mayo Clinic.
• Visit the Department of Oral and Maxillofacial Surgery.
• Explore Mayo Clinic.
• Request an appointment.

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