= MY SURGERY = Problem with Jaw , need opinions PICS

[Rico]

Hello

Once again. I had zygomatic bone (whole complex) reposition due to overlooked old fracture (healed improperly causing little concave chick and infraorbital nerve compression)

I had some harash time after surgery due to lack of knowledge about  the heaing process. I got few times a panic. I got even infection, but is cured. During my second staying in hospital I had time to discuss with my surgeon and I understand it better. I have better approach
Moreover I started to see nice cheek profile
I have no enophthalmos - checked properly (and I see that). Everything seems to be good.
Still have some little sweelling.. one day little bigger another day smaller. Is that normal ?

When infection stopped, the yellow secretion started to come out from my wound inside my mouth (incision) and swelling increased significantly again - that was weird. After few days I do not see this secretion and swelling is mild. I wonder what kind of process it is. Even my surgeon was little surprised that happened. He told me it's rare and he did not expect that, then he claimed it's normal. I don't understand. Who knows ?

Now it's 4 weeks since surgery. Actually I have minimal feeling (barely feel)

However there is one concern. I need your opinions
Please look here  http://jawsurgeryforums.com/index.php?topic=5068.0 - I made this topic earlier


Below is a copy:
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[..]

4 weeks since surgery. [..] I can't open my mouth fully. my normal occlusion amplitude is at least 4cm

now only 3cm.  Reported that to surgeon, because I noticed little piece of bone on the right zygomatic arch , what significantly reduce distance between coronoid process and arch. The surgeon told me that it will be OK, when the swelling is gone, that there is enough space....hmmm, but

On the picture (below) I have opened my mouth only in half (second day after surgery)

The question is, do coronoid proces + masseter muscle + temporal muscle have enough space there while I try to open my mouth fully ?
Generally I can't find enough good model of how it works

Who know something about this ? or who know someone who may know ?

PS I do not know why surgeon left that in this condition.I'm worried there is no enough space. This is my only concern and probably as the rest was... it's not a problem.. but I have to check   what if this piece will be bigger due to bone healing  -growth

LOOK AT THE MOVIE:
https://www.youtube.com/watch?v=dCVnGFxd9Uw

[Rico]

It’s about  enough room for all soft tissues including muscles (like temporal) in the zygomatic arch area to protect them from any irritation (and complications) while mandible is moved in all directions (even sideways) having in mind that little piece of bone (the one I showed in the previous messages) may become bigger (bone growth after cut)

That’s my only concern now. Nothing more

No one can help me ?

[Lazlo]

I really don't know man. I mean I have never had this surgery. The only person I know who had something similar is Earl and he doesn't really participate on these forums. He had full feeling return and had no mouth opening problems as far as I know. So I can't help you any further. I'm sure yours will be fine in a few months though. Maybe get someone to do some facial movement therapy.

[Rico]

i have minimal proper occlusion amplitude. - 3 cm. So Ihave no problem with eating. but I should have 4cm (like before surgery).  It's just 4 weeks after surgery.  Surgery went quite good. Probably problem will go away...I  have consultation with my surgeon in half of Jan so I'm gonna discuss with him about that.  I'm gonna have miniplates removinh in few months. He always can cut this little piece of bone if it will be necessary. I just wanted to get some opinions

[Rico]

Is it good to make limfatic drainage (massage) on the area when a bone heals ? - still no union - too early. It will connect in next 3-4 weeks.

[Rico]

I just realised LF3 is much simpler procedure

this is LF3 ? If Yes , then my was not close to LF3 hmmm. I was wrong

[Rico]

I got one opinion on other forum ( I think from a doctor) :
 
I think the zygoma is reduced with bad realignment. the spheno-zygomatic suture is not realigned correctly, so the badly reduced right zygomatic arch interferes with (touch) the coronoid process of the mandible which explain what you are going through and may cause T M J disorder later.

It's just an opinion..i'm not sure if he is right.. but something is not OK with my mandible movement and attached muscles

[Rico]

hmm when I look at zygoma arch then really I see there strangle angle...

look at the masserat muscle
where it's connected

if this is the problem than I need again zygoma reposition..

[Rico]

ok my photos.
Please take a look how my muscles work. Generally just under zygomatic arch my muscles raises a lot (number 2 on pic) much more than on the healthy side while mandibular is being opened
And on the bottom (jaw) the muscle looks strange. I marked that with blue line (1)

OF COURSE I DID NOT HAVE SUCH PROBLEM BEFORE SURGERY AND EVEN AFTER FRACTURE

I hope it's due to some mild swelling, but I'm worried that something is really malpositioned :/

[Sinsajo]

Your surgery is interesting and who you operaste that?

[Rico]

I'm not gonna tell who is my surgeon until I get some interesting opinions.

Too much you want to know without any help - to all of you

[Rico]

I know that. The problem is I do not know any good local surgeon.  All refused to help me previously
The nearest one I know is in Rome

I'm gonna write him. I made video how my mandibular works.

Now I'm not panicing...but I thought about this issue  many times... and I see something may be wrong

interesting is fact I did not have such problem after uncontrolled fracture

about my enophthalmos I see now it's not so obvious I have..but I have to wait a few months to be really sure

all of these is more tricky thanI thought

My surgeon even has NOT CHECKED how  my mandbibular works...never.. strange

UPDATE: I believe after fracture, muscles kept my bones in quite good position for good muscles works...now miniplates forced another position not good for muscles.... perhaps they are little twisted and work improperly :/

[meepmeepmeep]

i have to agree with ilovethemoon. you seriously need to try to relax. other people here have had surgery recently and your frantic topics could be causing stress for others who are going through the healing process while trying to quite their mind of their own concerns. even if you had a local craniofacial surgeon, one worth calling upon wouldn't be at your beck and call every time you have a new emergency, especially for complicated issues like the ones you bring up while only 5 weeks post op. as long as you are not in an abnormal amount pain you just need to wait it out and bring it up to your surgeon at your next follow up. maybe keep a list of your concerns, i think you will find that some of them will resolve themselves before you even have the chance to bring it up at your next appt. i hope you feel better.

[Rico]

yes i'm waiting for next consultation. The most annoying is fact i can't report anything by phone (he has not given me) and my surgeon won't answer single word via mail about any concern if I write. I wrote a few weeks ago about some my concerns and nothing. I had to wait for the check up consultation

but I should get second opinion.

I have only one thread about my issues. The others I deleted.

I've heard a lot of stories about that surgeon was telling to someone that is OK, and at the end it turned out it wasn't ok
i hve to be careful

about pain..with malpositioned muscles (if it's really problem) I will get soon - TMJ. Better to prevent than to treat...

and once again. I still have hope it's only prolonged but temporary problem...Though, I have in mind that stories....

PLEASE LOOK AT MY RIGHT ZYGOMATIC ARCH  (LEFT ON THE PIC)  THE POINT WHERE IT WAS CUT... ONE SEGMENT IS IN ANOTHER ANGLE THEN THE SECOND CONNECTED WITH WHOLE ZYGOMA.

[Rico]

BUT REALLY IT'S PARADOX.. I HAD MUCH LESS PROBLEMS AFTER FRACTURE THAN NOW... AFTER FRACTURE FROM FIRST HOURS.... IT'S SO STRANGE

75% of feeling
no problem with my mouth
no problem with prolonged swelliing - only minor..so called microswelling for a few weeks or eventually months..but you know I didn;t see it

now i still see slight swelling

paradox. to have less problems with completely uncontrolled bone reposition