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Dr. David Behrman from New York Presbyterian review

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ArtVandelay:
See the previous discussion with more technical details here: http://jawsurgeryforums.com/index.php?topic=7383.0

In short, there were surgical complications with my double jaw surgery requiring an immediate revision one week later. The revision wouldn't be any issue at all had the planned result been achieved. Yet I was left with a very poor outcome for such an invasive procedure; see for yourself, my x-rays are in the above linked thread. Afterwards, it didn't help matters when I was completely ignored and my surgeon refused to even speak with me; instead he sent out a 1st year resident unfamiliar with my case. Looking back the whole experience from start to finish felt very sloppy.

ArtVandelay:
An update now that I've almost wrapped up consultations on a revision / read my records. This is written here in case it can help others.

1.) Why I needed an immediate revision?

I feel not unlike an aircraft crash investigator piecing things together. Recall I had a L1 + BSSO done which required a revision one week later. The reason given was "I woke up hard from anesthesia".

Now I have a better sense what went wrong. My molars (#1, #16) are over-erupted and say at a slanted 45 degree angle. They don't fit properly with the rest of my bite but are functional in chewing. After my revision I still had a mild open bite which required the orthodontist to drill down the over-erupted molar as only one corner was hitting early. Since this molar is also on the side which was displaced after my first surgery what I suspect it's the reason why things went wrong. The over-erupted tooth caused my bite to hit on exactly one point and after waking up all the force of my bite was applied there and it manged to overcome the plates and drastically shift my maxilla requiring an revision one week later.

This is personal speculation since Dr. Behrman would not speak with me and instead sent out a 1st year resident who couldn't answer any of this and I doubt was familiar with my case.

2.) Poor planning

This indicates poor planning. This time around surgeons are very mindful of my over-erupted molars while Dr. Behrman never discussed them with me besides saying their fine as is. One top surgeon wants them removed prior to surgery while another wants to salvage them but drill down further.

I don't think my bite had any hope of fitting after my first surgery.

3.) Why the bad result?
The simplest explanation is true in this case: I had a poor plan which was also poorly executed.

While no surgeon will admit it during your consultations, some do not want to be judged on functional/airway/aesthetic issues. They will just care about occlusion even if they make your face severely crooked or shrink your airway or introduce any other problems. 

Compounding the problem, in my second surgery my surgeon most likely abandoned the plan, "the bite guides the surgery" I was told afterwards, without properly considering airway/retrusion. I made the mistake of thinking someone who had done this operation thousands of times and specialized in it was qualified to handle my case.

PloskoPlus:

--- Quote from: ArtVandelay on July 06, 2019, 05:09:05 PM ---3.) Why the bad result?
The simplest explanation is true in this case: I had a poor plan which was also poorly executed.
While no surgeon will admit it during your consultations, some do not want to be judged on functional/airway/aesthetic issues. They will just care about occlusion even if they make your face severely crooked or shrink your airway or introduce any other problems. 

Compounding the problem, in my second surgery my surgeon most likely abandoned the plan, "the bite guides the surgery" I was told afterwards, without properly considering airway/retrusion. I made the mistake of thinking someone who had done this operation thousands of times and specialized in it was qualified to handle my case.

--- End quote ---
100 times this!

90% of surgeons are butchers who just follow the occlusal splint.

kavan:
What ever became of the Gunson revision?

ArtVandelay:

--- Quote from: kavan on July 06, 2019, 07:51:01 PM ---What ever became of the Gunson revision?

--- End quote ---

I'm still debating between a segmental L1 verus leaving my arches as is and going with no pre-surgery orthodontics and a regular L1.

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