Author Topic: Extremely good results ?  (Read 5403 times)

Rico

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Extremely good results ?
« on: May 23, 2015, 02:12:26 PM »
Is it possible ? the nerve not recovered fully only in 2% of patients ? http://www.europeanreview.org/wp/wp-content/uploads/379-384.pdf

So if only 19% (average) of patients have temporary problem with feeling after surgery and only 2% after 1 year, then why so many orthognatic patients has altered sensation on the face ?
« Last Edit: May 24, 2015, 10:39:35 AM by Rico :) »

PloskoPlus

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Re: Extremely good results ?
« Reply #1 on: May 23, 2015, 04:02:26 PM »
Is it possible ? the  nerve not recovered fully only in 2% of patients ? http://www.europeanreview.org/wp/wp-content/uploads/379-384.pdf

only in 2% people nerve not recovered fully ?


So if only 19% (average) of patients have temporary problem with feeling after surgery and only 2% after 1 year, then why so many orthognatic patients has altered sensation on the face ?

I have upper lip paraesthesia more than 7 months after surgery.  Long term upper lip disturbance is apparently really rare.  So it's just my luck.

molestrip

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Re: Extremely good results ?
« Reply #2 on: May 23, 2015, 08:21:23 PM »
I've actually spoken to a few patients with upper lip paresthesia actually. My sample size isn't huge but it seems to be correlated by surgeon so I think it comes down to technique. Numbers are all over the board for nerve sensation recovery. The most cited number I see is 10% will have permanent nerve loss. From my interviews, I'd put that number much higher, between 50% - 90% depending on how you define "not fully recovered" and the type of procedure done (my sample is biased by the riskier procedures). 2% sounds like about the right number for those who are bothered by it but there's nearly always some amount of loss. And it's not just jaw surgery, all surgery is associated with some amount of paresthesia but I'd rather lose it on, say, a calf then on my lips. Some say it's a function of age, others say age just affects recovery time. A few facts are clear to me, regardless of technique: IAN is going to be stretched in a BSSO, IAN will stretch again in SG, nerves feeding maxilla are going to be cut in a LeFort, and nerves are more likely to devitalize in segmental LeForts. Even if the nerves themselves fully recover, sensation will be altered and the brain has to relearn how to feel. There are exercises that can be performed during this process to increase the chances that your brain adapts well but, strangely, none of the surgeons I've met seem to know or care about it.

terry947

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Re: Extremely good results ?
« Reply #3 on: May 23, 2015, 08:40:06 PM »
what kind of exercises?

Rico

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Re: Extremely good results ?
« Reply #4 on: May 24, 2015, 12:00:53 AM »
100% is 100%  as it was before (not 90%, not 99. not 99.9999999999999%). If someone writes in publication completely recovered nerve, he can't just change the meaning from 'completely' to 'recover to the point it's not bothering a patient'

MOREOVER IN PUBLICATION IT'S CLEAR THAT 89% OF PATIENT HAS THE NERVE NOT TOUCHED !!! or just not damaged even in 0.1%

For me it's not professional - little faking the medical data. In such situation they should underline the exact meaning.

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Even if the nerves themselves fully recover, sensation will be altered and the brain has to relearn how to feel.

no it's not true. I have damaged nerves 2 times. Sport accidents ;) All recovered to 100% . no altered sensation anymore
If there is alteration, that means no full recovery

so is it fake to get better opinions about hospital / surgeons team ?




PloskoPlus

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Re: Extremely good results ?
« Reply #5 on: May 24, 2015, 02:16:27 AM »
I've actually spoken to a few patients with upper lip paresthesia actually. My sample size isn't huge but it seems to be correlated by surgeon so I think it comes down to technique. Numbers are all over the board for nerve sensation recovery. The most cited number I see is 10% will have permanent nerve loss. From my interviews, I'd put that number much higher, between 50% - 90% depending on how you define "not fully recovered" and the type of procedure done (my sample is
biased by the riskier procedures).
I did not even consider the possibility of upper lip sensory disturbance.  Any surgeon's website you go to, they only speak of lower lip numbness post BSSO or genioplasty.  That had me really worried. I was therefore mightily relieved to hear that I would require only upper jaw.  No I don't have a reference point having not had lower jaw surgery, but to me upper lip nerve disturbance is far more annoying that any lower lip numbness could be.  You use your upper lip for pretty much everything.

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There are exercises that can be performed during this process to increase the chances that your brain adapts well but, strangely, none of the surgeons I've met seem to know or care about it.
My surgeon told me that at the 12 month mark hardly anyone complains of nerve issues - either because the nerves have recovered, or they stop noticing it. 
I think the higher cut I had has something to do with this.  From Keller's quadrangular LF2 paper:
Infraorbital Nerue Dysfunaction
Reported as temporary upper lip numbness, occurred in 10 patients with a mean duration of 3.4 months (range, I to 12 months). Reported upper lip numbness at the last evaluation occurred in 3 patients with a mean dtuation of 9.6 years (range, 9 months to " 15 years). Objective nerve fturction testing was not performed.


This could be one of the reasons LF2 is rarely performed and even LF3 is preferred in its place.

Rico

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Re: Extremely good results ?
« Reply #6 on: May 24, 2015, 02:32:21 AM »
I have distirbuance (good feeling , but strange, and little painful) of upper lip, side of the nose, whole cheek, lower eyelid

all of this due to medical error :/ f...

I see here connection with my problem, but Keller's paper is not my case - I have compressed nerve ;) probably now irreveraible damage...but since i have only very slight  hypoasthesia, so perhaps most fibers are alive , but just altered function due to slight compression.  All tests shows only mild disfunction, but only surgery can show how really it is....only if this nerve won't be severly damaged.. mild damage is max what can be done to have at least minimal chance to got symptoms relief.

This is why I was looking at some statistics about nerve damaged related to surgeries on face

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nerves feeding maxilla are going to be cut in a LeFort,

Why ?  What I know mostly infraorbital nerve feeds main part of maxilla and zygoma. Cutting this nerve is an critical error. Any other nerves ?
Perhaps you talking only about teeth nerves ? which can reroute, Their functions are doubled ;) look at map of the teeth nerves

« Last Edit: May 24, 2015, 02:50:46 AM by Rico :) »

PloskoPlus

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Re: Extremely good results ?
« Reply #7 on: May 24, 2015, 04:15:15 AM »
Outer branches of infraorbital the nerve will be cut during a Le Fort I.  It's simply unavoidable.  The big problems arise when you cut or stretch the trunk of the nerve.

Rico

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Re: Extremely good results ?
« Reply #8 on: May 24, 2015, 08:36:56 AM »
Outer branches yes... but a surgeon told me this often somehoew recover. How if nerves are cut ? kinda rerouting ?  When I look at teeth nerves I see them kinda doubled

Lazlo

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Re: Extremely good results ?
« Reply #9 on: May 24, 2015, 03:12:06 PM »
100 percent have sensation permanently altered. EVERYONE.

Rico

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Re: Extremely good results ?
« Reply #10 on: May 24, 2015, 03:27:40 PM »
Lazlo: so what is the point to write such stupid things in publications ?  Surgeons try to minimalize their failures ?  and not 100% I found some patients who really have not altered sensation after 1 year postop. really 100%

Rico

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Re: Extremely good results ?
« Reply #11 on: June 02, 2015, 06:28:53 AM »
Sinn's paper  96% patients restored 100% of nerve functions in the meaning as it was before surgery...

again possible ?  Why I feel that data from publications does not match the reality :( ?

http://www.ncbi.nlm.nih.gov/pubmed/2299455
PS for me , the group is too small, however very old publication

Rico

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Re: Extremely good results ?
« Reply #12 on: June 03, 2015, 02:46:11 AM »
no thoughts :) ?

PloskoPlus

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Re: Extremely good results ?
« Reply #13 on: June 03, 2015, 02:59:57 AM »
Sinn's paper  96% patients restored 100% of nerve functions in the meaning as it was before surgery...

again possible ?  Why I feel that data from publications does not match the reality :( ?

http://www.ncbi.nlm.nih.gov/pubmed/2299455
PS for me , the group is too small, however very old publication
No-one knows really.  I have pretty bad upper lip mucosa and teeth paraesthesia 8 months after Le Fort I.  I did not expect this at all.

Gregor Samsa

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Re: Extremely good results ?
« Reply #14 on: June 03, 2015, 03:33:24 AM »
I have pretty bad upper lip mucosa

How does that manifest itself?