I'm trying to choose 1 of 2 surgeons..and I can't decide

[Rico]

I found 2 surgeons, who can perfom my surgery. Both have almost identical surgical plan

First surgeon, do not use computer navigation to put my malar bone in proper position
He can also decompres my nerve. He claims it's easy and only slight damage can occour

Second use computer navigation,
but he thinks the nerve decomprssion is tricky. it may be OK (only slight damage which recover easily AT LEAST to the point before surgery) or even much worse (severe damage possible - total gamble)

I wonder if any well known good surgeon may have interest to encourage me to undergo surgery.. I mean the situation when a surgeon is too optimistic or he knows the risk is little bigger than he says...

eh do not know what to do

[geijutsu]

What makes the first surgeon so sure that it's easy, does he have experience with nerve decompression? First hand experience trumps fancy computer imagining imo. But that's only if you're sure he's done enough of that kind of work before.

[Rico]

it's very rare procedure. Both of them made probably only a several nerve (generally in skull) decompressions in whole practice

first told me it's easy USUALLY to decompres this nerve - so it means he done it
the second he generaly has made some nerve decompressions

every case is different. Probably I can be the first one with exact problem connected 2 problems

OK I will try to ask in streight way how many ion decompression they made. but I do not know if they answer for such question

the problem is not with cutting the bone around the nerve, but with stretching in repositioning malar bone. The skin must be deteached from the bone and the genetle pulling is necessary.. so the nerve will be stretched a little. The second one told me the stretching is gamble here. In some patients nerve recover fully in some not. He try to be gentle as possible. I do not know if you see it. what i;m talking about.

about stretching issue I hear first time from the second surgeon. So I did not ask about it the first one.. but the first one said it's easy.....

UPDATE: Both of them have performed malar bone repositionns with good results (It's not so common procedure). but the first one not using computer navigation. I have to add here that a surgeon can't see the results looking at soft tissue, because during surgery I become swelled in short time. He needs some measurements comparing to the other side.  So the first one do it during surgery. The second one makes a CT again, do calculations how much this bone must be moved and he do it the same same way as the first surgeon + he watch at the screen of computer if such new position is enough good (based on planning) if not, make some little corrections.. Even during installing miniplates he can still check the position .... IT'S NOT THE SAME AS PROCEDURE ON JAW / PART OF MAXILLARY. IN THAT CASE A SURGEON HAS MUCH MORE REFERENCE POINTS - for example positions of the teeths. The second one during surgery puts a device into my mouth. He took imprint (probably not good word) of my teeth and during surgery he put a device into my mouth which is going to be so called static reference point. All calculations will be in reference to that point. It's very smart solution, because drilling in my forehead is not necessary (neurosurgeons install this on the top of the head / forehead) and even if this device loose it stability a surgeon can correct it - just settle it correctly in my mouth and keep it closed teeth are not going to change their position during surgery ...I hope This is not helpful in nerve decompression, because more risk is connected just with pulling the soft tissue for this particular nerve as claims the second surgeron


I asked about navigation surgery the first one, but he told it's not necessary in my case..too little movement, however most surgeons refused to make surgery because they told me the movement is too little and they are not able to put it in right position manually.
I was looking for the publications of the first surgeon in that topic to check if he really has comparison - with or without CAS and nothing I can find. I wonder if the first one really has done some CAS (computer assisted surgery)

OK I asked them in straight way. but I always doubt if surgeons are really honest at some points

[Rico]

first one answered, he made dozens (I'm surprised)... but he wrote "the nerve" -  in his answer there is no word "infraorbital". So as you see the answers are not exact and I can't push it. Generally THE means a person refers to the previous statement. This is how it works in English. If I'm writing about infraorbital nerve and he uses word "the nerve" , then correclty it means he talking also about infraorbital nerve   but english is not his primary language nor perfect (mine too), so I can't rely on that  

I UPDATED THE UPDATE  - green text in previous post

What makes the first surgeon so sure that it's easy, does he have experience with nerve decompression? First hand experience trumps fancy computer imagining imo. But that's only if you're sure he's done enough of that kind of work before.

How can I be sure ?  it' not something you can see on pictures / examples. It's only talking. Asking about medical recording is not possible here I think

A question to Earl user , who had modified LF3
Your surgeon did not tell you nothing about doing it using computer ? How he knew how much your bones had to be moved. Did you have any planning ? calculations on CT ?

[Rico]

I also asked (during meeting), if they think I risk a lot having this surgery

the first one answered immedietely: "no no no no"
the second one looked at my photo on screen and after 2 seconds told me: "no"

what am I doing here this is brutal

[geijutsu]

I will try to respond at a later time. This is a lot to take in at once so I gotta re-read it few times.

[molestrip]

Surgeons are known to be a highly narcissistic bunch. Surgery is like building a house. You get a lot of money while it's being built but afterwards you have a lot of incentive to move on to the next customer quickly. They simply don't care much what happens to patients after surgery completes. Often times, patients with bad outcomes won't even tell them. They lose faith and move on to another surgeon to fix it. Unless it's their area of interest, they won't be doing detailed surveys months and years out and research has little to no impact on their practice. There is inherent risk in surgery and it's difficult to measure, as new outcomes are always discovered.

In your case, I would think the risks are comparable to implants. About 60% of people are happy with them on realself. They don't seem to reverse well and that's part of the low satisfaction rating. I think for someone whose done it a few hundred times, the more serious risks (motor nerve damage, muscle damage, non-union, infection, etc) are low. Knowing your personality, the "less serious" risks like increasing or not fixing your asymmetry, worsening your gaunt look, or sensory changes, those are nominally low but not comfortably low considering what's at stake. To a surgeon, if your only complaint is that you look worse afterwards, that's not a disaster. A disaster to him is the patient next door who ended up in the ICU for the next 4mo.

[Rico]

They have done at least dozens of such surgeries. I won't find a surgeon who done more, because it's not so common procedure.
Both of them have documented that. I can see data. Most patients are satisfied / very satisfied.
satisfied - means good, but not perfect - very mild deformation still exists 
very satisfied - means perfect

They are specialised in zygomatic-orbital areas. Most surgeons only do surgeries on jaw / maxilla


One surgeon (I consulted in my country) told me that one of them (abroad) I'm going to choose is also a good man (of course I know which one, it's not important to say his name now) Do you think such opinion matters ?

UPDATE:
The second one answered - also dozens decompressions

The first one works only in private clinic now  (earlier in public one, too)
the second only in public clinic - hospital

[Optimistic]

Very interested to know how this plays out with a modified LF 3 like what earl got and what I plan to get.

Did Earl ever answer these questions

If not I'll be asking Sinn when I consult with him shortly.

[Mark505]

Very interested to know how this plays out with a modified LF 3 like what earl got and what I plan to get.

Did Earl ever answer these questions

If not I'll be asking Sinn when I consult with him shortly.

0 bits of information so far (excluding that stamp sized potato pics) . i'll just have to wait for someone to undergo this s**t first and then report back.

[Optimistic]

0 bits of information so far (excluding that stamp sized potato pics) . i'll just have to wait for someone to undergo this s**t first and then report back.

Communicating with Earl reminds me of being at a strip club. Pure masochism.

[Mark505]

Communicating with Earl reminds me of being at a strip club. Pure masochism.

in strip club u at least see something.