u/EducationalCost2658

Hi everyone,
I’m a 22-year-old male looking for some advice and insights on my current orthodontic and surgical dilemma. It’s a bit of a complex situation involving conflicting medical opinions between a public university hospital (CHU in France) and private practitioners.
My Clinical Situation:
Severe Bimaxillary Protrusion (Biproalveolie):Both my upper and lower teeth (and the underlying bone) are severely flared/tilted forward, creating a prominent "bulging" mouth effect on my facial profile.
**Spaced Teeth (Diastemas):**naturally have gaps between my teeth.
Overjet:A noticeable horizontal gap between my upper and lower front teeth (suspected Class II skeletal framework/retrognathic mandible).
The Tongue/Breathing Issue:I strongly suspect my tongue posture is the root cause. I constantly push my tongue forward against my front teeth. The catch is: if I try to pull my tongue back to its proper resting position, I literally feel like I am suffocating.My body pushes my tongue forward as a survival reflex to open up my airway. Because of this, my tongue acts like a 24/7 orthodontic appliance pushing my teeth outward.
The Conflict: Hospital (CHU) vs. Private Sector
I am looking to get traditional metal braces (I don't care about discretion, I just want efficiency). However, I am getting completely opposite opinions on whether I need jaw surgery:

1. The Private Sector: I consulted a reputable private Maxillofacial Surgeon. He fully agreed that I am a surgical candidate (likely lower jaw advancement to open up the airway and fix the profile). He gave me a formal treatment plan and a financial quote (devis). He was ready to work with a private orthodontist.

2. The Public Hospital (CHU): I also went to the university hospital to save on orthodontic costs. The CHU surgeon completely disagreed and explicitly wrote in my file that this is not a surgical case. He then contacted the hospital orthodontist (the resident/interne) to block the surgical route.
   The Upcoming Appointment & Twist:
   Tomorrow, I have my definitive appointment with the hospital orthodontist. Interestingly, during a previous talk, the orthodontist mentioned doing an "upper arch decompensation" (décompensation du haut) using the braces.
   As you know, "decompensation" means straightening the tooth angles to their ideal vertical position to prepare for jaw surgery. By uprighting the upper teeth using my natural gaps, they will move backward, which will help reduce the bulging effect and align the upper arch perfectly as a guide for a surgeon.
   My Strategy for Tomorrow:
   Since the hospital surgeon said no, but the hospital orthodontist prepared a surgical decompensation plan, I am going to propose a hybrid route tomorrow.
   I plan to tell the hospital orthodontist: "I know the hospital surgeon refused the operation. However, I have a signed agreement and a quote from a private surgeon. Since you already planned an upper arch decompensation, can we do the orthodontic prep here at the hospital, and I will get the actual jaw surgery done by my private surgeon at the end?"
   My Questions for Reddit:

3. Has anyone ever done a hybrid treatment like this (Orthodontics in a public hospital, Jaw Surgery in the private sector)? Do hospital orthodontists usually agree to prep a patient for an outside surgeon?

4. Regarding the upper decompensation: If we only upright and push back the upper teeth, how will this affect the overall surgical outcome for a Class II/retrognathic lower jaw?

5. The tongue issue: If the surgery successfully advances my jaw and opens up my airway, will my tongue naturally stop pushing forward, or is myofunctional therapy/speech therapy absolutely mandatory to prevent relapse?
   If the hospital refuses tomorrow, my backup plan is to pull my files and go 100% private (private ortho + private surgeon), even if it costs more, just to ensure the team is on the same page.
   Any thoughts, advice, or similar experiences would be highly appreciated!