Lefort I and BSSO revision

[Dharma]

I had the above about 2 weeks ago to help resolve sleep apnea after a motorcycle accident when I was young resulting in abnormal jaw growth. I had orthodontia in my teens which, while fixing my bite, seems to have caused further breathing and esthetic issues.   

After surgery, I ended up with some esthetic and functional complications.  I was banded after surgery but these were removed because I had a very strong globus sensation and difficulty swallowing easily--posteriorly, my airway seems clear but, strangely, the space between my palate/uvula and back of my tongue is smaller?  My mouth hangs open now and if I close it the sensation and swallowing difficulties return--its very claustrophobic feeling.  I also have some hearing issues which is apparently due to significant stretching of the Eustachian tube with the large advancement I had.  Lastly, the esthetic outcome has been very poor.  Obviously, I still have significant swelling, but I would say 80% of it down and I can easily feel the bony structure underneath the soft tissue--this, along with seeing the angle and location of my incisors, I can infer the final product with a degree of confidence.  Despite a 12mm+ MMA forward with slight CCW and a 10mm genio, my chin is still significantly behind my lips and I now have profound mesognathic projection--I look like I have an extra large mouth guard in at all times--quite "chimpish." 

This whole thing has been incredibly devastating. 

So my q's:

Anyone experienced with revisions?  In particular, revisions very shortly after the initial surgery?  Anybody have issues with their hearing--was is resolved?  How?  Do we know how much more risk there is with nerve damage and other things with a revisions given that I will have very little time to recover from this one before I jump back in? 

What a mess....

Thanks.
 

[jawsaw]

I am sorry you are going through this. I am a little over three weeks and I am also curious about the possibility of a revision. My swelling went down incredibly fast. I was told i look more like someone at 5 weeks, when I was at 2 weeks. Perhaps what you are seeing really is because you are still swollen. Your bone structure is NEW. Your muscles need to adapt. My facial muscles are sore because I am using new muscles in my face to accommodate the new structure. I couldn't close my lips for the first 3 weeks. I can now just barely close my lips. Things are changing. As the tissue heals inside your mouth, things will tighten up before they gain back some elasticity.

I brought up the aspects of my surgery that I think need revision and he didn't disagree. He did (respectfully) brush off my concerns and said that at this point recovery and healing are the main focus. I asked if any other former patients had concerns similar to what I addressed, and he said I am not the only one. That made me feel good. It needs to be stated that I don't think that the treatment plan was wrong, but I do think something was overlooked. I asked if he has done any revisions in situations similar to mine and he said the only revisions he has done were in situations where there were problems with hardware. He said that he has never done a revision where everything went according to plan. At the next appointment I told him I am still concerned about what was formerly addressed and he said it wasn't forgotten, but it is too early to contemplate. I am pretty sure that unless there is an emergency they won't operate on someone until they are fully healed.

[Dharma]

Heyo

Thanks for the reply.  I spoke with my surgeon via email a couple times yesterday and sent pictures with all my concerns.  He was not opposed to discussing a revision.  I meet with him on Tuesday (4/5/16).  He also had never done revisions after an MMA, though he said he once did a revision on after a genio in the past (done solely for cosmetic reasons, per his patient's request).  He implied that if we did do a revision, it could be as early as a few weeks--enough for the acute healing, I guess.

We're going to nab a CT on Tuesday and do some cephalometric analysis to get some objective info on the esthetic component as well as, hopefully, some insight into some of my functional issues. 

We'll see I guess!   

Either way, its is (ever so slightly) comforting to hear what your doc had to say about others not feeling great about things initially.