How common is bony notch after BSSO?

[molestrip]

I'm planning a BSSO of about 10mm and I've read about the possibility of a bony notch forming later, as seen here. How common is this complication? I can't find much in the literature about it. Is it something that's relatively easily fixed later?

[Lazlo]

I think it's VERY common unless the surgeons follow the Arnett/Gunson protocol of mixing HA paste in with platelet plasma and smoothing the osteotomy site.

I had one surgeon tell me that he would go back and sand down the notch a year later (so like have another bloody major operation).

I think Arnett Gunson have got these sort of details in the bag! That said. I mean they've friggin done surgeries where the patients have lost their teeth and stuff so they aren't perfect either.

[molestrip]

Does it smooth out over time? Are they visible, palpable, or only on x-rays? Does it typically go away with time? Is it a function of the advancement and how much risk is there with 10mm? How bad is the surgery to augment the bone later if it needs to be fixed? I don't imagine they'd be stretching any nerves at least. This lady's looks beyond horrible. I can find virtually nothing on the internet about it, aside from A/G's website, which makes me wonder how much of a problem this really is in practice. Why do you think that is? I mentioned it to another very prominent surgeon who seemed only vaguely familiar with it. He responded that it has to do with the cut chosen and with his cut it wouldn't happen.

[nrelax11]

Are these notches very noticeable to touch? Mine defiantly feels kind of bumpy, but cant you also get like deposits there that will go away after time? I forget what they're called.

[jusken]

I had surgery with Gunson.  The bumps have smoothed out quite a bit, but they're still there - barely visible (I mean I'm the only person who would notice) in photos.  I had both BSSO and a chin wedge (chin reduction), so two separate places.  It's pretty minor.

[Lazlo]

Does it smooth out over time? Are they visible, palpable, or only on x-rays? Does it typically go away with time? Is it a function of the advancement and how much risk is there with 10mm? How bad is the surgery to augment the bone later if it needs to be fixed? I don't imagine they'd be stretching any nerves at least. This lady's looks beyond horrible. I can find virtually nothing on the internet about it, aside from A/G's website, which makes me wonder how much of a problem this really is in practice. Why do you think that is? I mentioned it to another very prominent surgeon who seemed only vaguely familiar with it. He responded that it has to do with the cut chosen and with his cut it wouldn't happen.

No they don't really smooth over over time. You need to have them actually sanded down since it's a combination of bone AND soft tissue. Note the gunson patient above has them even DESPITE Arnett/Gunson's technique of HA paste and platelet rich plasma (your blood taken before surgeery a few days earlier and prepared through a centrifugue etc.). WHAT OTHER SURGEONS DO YOU THINK WOULD DO ALL THIS!? And yet still this patient has them. A/G's technique is specifically to avoid the notches. So with a regular surgeon you have them bigtime. You have to discuss it with your surgeon. It doesn't just go away. I know patients who are 30 years out of the bloody surgery who have them as bad as the woman you cite in the textbook. Peace.

[Modigliani]

I think mommaerts also do this.

I emailed him about chin widening through osteotomy route, his assistant got back to me and said "refinements (step smoothening) with HA is necessary"

Haha, good luck with that.

[molestrip]

I asked my surgeon about this and he said that he's familiar with the technique and uses it for bone augmentation. He said he doesn't do it with jaw surgeries for two reasons. First, BMPs are highly inflammatory. He mentioned some cases where it was used in the spine. He acknowledged they may have found just the right mixture though. From my research, damage from inflammation can be as significant or more than the surgery itself so this is an interesting point. Second, he didn't see a need to. He said that the bone almost always heals smoothly after a year and showed me some x-rays to demonstrate but said if it happened he could go back in to fix it. I got a second opinion from another oral surgeon I met online who said the same.

I think this simply comes down to difference of opinion and surgeon philosophy. My best guess is it happens sometimes. The guys focused on aesthetics will be more aggressive while the functional guys will be more conservative, reflecting how their customers are likely to judge them.

[PloskoPlus]

Why???

MM = BB (the Butcher from Brussels).

[molestrip]

Just an update to this old thread, I've spoken to a few people who had MMAs done and results were variable. None of them had BMP augmentation. They all had notches post-op. One said it remodeled over a year. Another said it never remodeled. The last said it got smaller but never went away and that it wasn't a big deal. Don't know what to make of this then, seems to be a crapshoot. BMP requires bone on 3 sides to work apparently and only 40% of the time still I hear.

[molestrip]

I've read they do sometimes but seems only after the problem has occurred. I'd guess there's obvious reasons for that. At a minimum, you'd need fixation I think and that may be hard to do for such a small defect. I'm surprised there isn't a resorbable glue or maybe there is? Seems like that would solve some problems.

[Sharptoys]

I had BMP applied to both the BSSO and Lefort osteotomy sites. Much more was applied to the BSSO gaps to minimize any border irregularities. Swelling was significant around those areas, but they were well clear of my airway, and dissipated well before the swelling from the surgery itself did.  Notching is still noticeable to the touch, but only (slightly) visible on the left side in certain lighting.

BMP gained a bit of a bad reputation a while back when some very dumb surgeons decided to use this effective, though highly inflammatory substance, to fuse cervical (neck) vertebrae, when BMP was only approved for lumbar vertebrae fusion. I understand the appeal of a readily available homogeneous bone graft substitute, but god damn, if you're going to use it off-label maaaaaybe make sure it doesn't--you know--block the patients' airways. Since swelling due to BMP use is extremely hard/dense, hospitals even had difficulty intubating them. Scary.