8 weeks post-op, under the knife again :(

[OnMyWay]

Hey,

Thought I'd follow up on my post(s) in the lower jaw surgery/apnea thread.  I had lower jaw surgery + genio. It seemed to have gone really well.  All breathing issues were resolved, and my healing seemed really fast and smooth.

Unfortunately as the weeks went by I noticed my face becoming increasingly lopsided.  When mentioned a few weeks ago to the surgeon his first response was "most faces are asymmetric"  he said he'd watch it and fix it in 6-8 months after we could be sure it wasn't still healing.  He was very good in ensuring me that he would not consider the job compete until I was happy.

Next follow-up he agreed it was getting worse and probably the screws would have to come out.  In-office procedure, no big deal, but he'd want to wait at least 6 months.

A few days ago, I was chewing, something slipped, a lot of discomfort and I went in for an emergency appointment.  X-rays showed that the bone on the left side never fused and that the screws were no longer holding bone together.    Had emergency surgery revision on Friday. 

Though the healing time won't be as long, at the moment, 48 hrs post-op feels pretty miserable.  Banded shut again, swollen (no bruising yet, *crossing fingers*).  Pain is not so bad though.  I didn't really have a chance to prepare for this though and I think that makes a big difference in how you feel afterward.  Thankfully I still had all my helpful tools from the first time (Highly recommend not throwing them out until you're given the all-clear!)

Anyway...just wanted to share that it can happen even when things seem to be going really well. I think doctors like to downplay poor results in the hopes that things will improve and you won't spend time worrying for nothing.  Of course I feel a little betrayed that he didn't put all the cards on the table right from the start, I understand he was also hoping for better.  Ultimately, he really came through for me, getting me booked for surgery less than 48hrs after discovering the issue. 

One thing of note, he did tell me that the left side posed some issue for him even in the first surgery.  Am missing 1 front lower tooth, which apparently throws everything off.  Should have had bone plate+ screws from the start, something for others to maybe consider discussing with their surgeons if there's any reason to think things may be unstable (missing teeth).

Small setback, but it will all come together. 

Pic update:  http://i1266.photobucket.com/albums/jj523/illjustputthishere/beforeAfterTemp.png

[neferkitti]

OMW, so sorry that you had to go through this again. I can certainly understand your frustration. I don't know how many times I had heard the "most faces are asymmetric" line when I told my doctors that something went wrong. Did you have a delayed or non-union at the break? It's unfortunate that you are starting the healing process over, but your surgeon did the right thing in the end. Hopefully, he'll monitor your case more closely going forward. Good tip on holding on to surgery supplies. Please keep us posted on your recovery, and hang in there .

[OnMyWay]

The situation as I understand it was that considerably more work had to be done on the left side.  He struggled more with getting the screws in and getting the angle correct.  When he went in to remove the screws and place a bone plate, he found a lot of scar tissue had grown in between the split and outer/lower side.  Whether the screws failed first or excess scar tissue forced them is hard to say.

Although he assures me otherwise, I also feel like maybe I went too fast with foods.  At four weeks I was given the okay to eat anything I wanted...just stop if it hurts.  Definitely the issue became more prominent after that.  On the other hand it seems like 4 weeks is enough time for the bone to have fused... probably would have ended up needing correction no matter what.  Sometimes correction is needed...I happened to draw the short straw, I guess.

Surgeon is here in Toronto.  I don't want to give his name as he is a good surgeon, lots of good results.  Great referrals...I'd hate to tarnish his reputation.  Of course we'll see how this revision goes.   

[neferkitti]

When he went in to remove the screws and place a bone plate, he found a lot of scar tissue had grown in between the split and outer/lower side.  Whether the screws failed first or excess scar tissue forced them is hard to say. At four weeks I was given the okay to eat anything I wanted...just stop if it hurts. Definitely the issue became more prominent after that.  On the other hand it seems like 4 weeks is enough time for the bone to have fused... probably would have ended up needing correction no matter what.  Sometimes correction is needed...
I don't want to give his name as he is a good surgeon, lots of good results. I'd hate to tarnish his reputation.  Of course we'll see how this revision goes.   

I wouldn't give his name either, especially since he did the revision as was proper protocol. A lot of surgeons kick their patients to the curb when there are union problems. Wait to see how well his care is this time around. If he takes good care of you, it will go a long way in restoring faith in these surgeons. How long will you be banded shut? Did he have to scrape the fibrous tissue away before plating? Any numbness from this second go-around? Not to pepper you with questions, but I'm curious. Hope you don't mind. From what you have written, a revision seemed almost inevitable given the scar tissue. Better to have addressed this now rather than later. Trust me. Hoping you heal well this time. Thanks for the updates!

[neferkitti]

Yeah...I think he is one of the good ones.  While I'm not so naive as to think his rush to revise was solely for my benefit (no doubt there's an element of covering his ass), he really did pull out all the the stops.  Surgery began at 7:30pm on a Friday night, certainly not office hours, and I know he had to pull in favours for the hospital to allow him the OR. I see him tomorrow (Friday) I expect the bands will be off, with follow up instruction for placement/hours.  No worries about questions. It's good to be asked.  I am a bit too much of a "go with the flow" kind of person, so I often don't think of the right things to ask until later.  This reminds of things I should be considering and getting answers for. It's astonishing to me that a surgeon would allow a patient to be left so dissatisfied....

Ha ha! Yeah, I agree about the ass covering, but it's still good that hear that he took care of the problem, regardless of motivation. Did you have a complete separation at the surgical break or did it merely loosen up enough to cause problems/pain? What did it feel like?

I found it astonishing that they didn't do the same for me early on, too. I'm still astonished. It's mind blowing, really. That deliberate betrayal is just as painful as the actual break. There was a lot of ass covering on their part, only they chose to go in a different direction, unfortunately.

Good luck to you tomorrow! I'm sort of surprised that you'll be unbanded so soon. Lots of TLC this time around .  I'm curious what he'll have to say. Will there be xrays taken? I am hopeful that all will go well with your recovery. Thanks for the update.

[ExcitablePancakes]

I need to avoid these types of threads, they'll make me more neurotic than I already am..

Hoping all is well, OP! Did you actually have to wait 48 hours before they did "emergency surgery"? I mean, screws came loose in your jaw and were no longer holding things together.. And you had to wait two days? 

[pinky]

I know this is an old topic, but I'm hoping someone will still see it and answer me. How do you know when one side of the jaw bone does not fuse together? How does it feel? I'm afraid I might be going through the same thing. I don't see my surgeon until a week from yesterday.