Severe Post-op Numbness after plate removal surgery

[eranthe]

Just a quick but urgent question ... I would be really greatful if those in the know could reply as soon as possible as I am really starting to feel quite panicked. 

As some of you know, I recently had maxillary plate removal surgery (on Monday 20th).   The history of my case is documented here in other posts, but briefly I've had a SARME, 3 Leforts (original + 2 revisions), and two plate removal surgeries ... so 6 surgeries on the maxilla in total over the last 6 years!

Usually, the signs of repair/recovery/nerves waking up (eg tingling) begin within hours of waking up from surgery, and a large degree of feeling has usually returned within the first week post-op.  However, at present my face is completely stone-cold dead numb ... from my eyelids down to my top lip.  Even the residual numbness in my lower lip left over from my bsso 5 years ago seems worse by association. 

I am really frightened that this last surgery is the final straw and my nerves have been permanently damaged and that I will never recover feeling in my face! 

Those who have seen my surgery plan will know that this time I had extensive custom plates that were placed quite high around the eye sockets, so my only hope at this stage is that the numbness is due to the degree of excavation required to get to them to remove them ... and that it will just take longer than usual to get the feeling back.

But honestly, I didn't have THIS much numbness for THIS long after any of my actual bone surgeries/osteotomies, so I am very distressed. 

[Post bimax]

Obviously it’s way too early for anyone here to say anything other than ‘wait’. But if you are that concerned I’d see a specialist ASAP. Nerve repair and/or preservation is time sensitive.

[eranthe]

Yeah sure ... I know it's really early .... I guess I'm just a bit stressed this time around as I feel like I've been so lucky to get feeling back over and over again with so many damn revisions  ... part of me is kinda expecting my luck to run out.  I'd be greatful for just the slightest little tingle right now 🙁

[PloskoPlus]

Yeah sure ... I know it's really early .... I guess I'm just a bit stressed this time around as I feel like I've been so lucky to get feeling back over and over again with so many damn revisions  ... part of me is kinda expecting my luck to run out.  I'd be greatful for just the slightest little tingle right now 🙁

They have to be incredibly sloppy to damage the ION to the point that you have permanent numbness especially with plate removal. It's a thick, prominent nerve. I'd see your surgeon ASAP. You shouldn't be totally numb after mere plate removal.

[kavan]

You've had the same/similar area cut into a number of times (6) and if my memory serves me correct, you've had a massive INFECTION subsequent to the placement of LARGE custom plates. So, I would count that as 7 traumas to the area.

I would imagine that the infra-orbital nerve has gone through a LOT in the act of removing the large custom plates post prior infection after they were put in and enough so that this would not be a straight forward plate removal or quick 'wake up'. Maybe it got STRETCHED OUT a lot.

It's too soon to tell under those circumstances and I don't think anyone here (including me) can tell you exactly what's going on other than you are early post op, it could be something where it would take longer for sensation to come back and LONGER for nerve recovery. However, it's NEVER to soon to call your doctor for post op concerns that you feel are 'urgent' or don't seem like 'normal' post op recovery.

[kavan]

They have to be incredibly sloppy to damage the ION to the point that you have permanent numbness especially with plate removal. It's a thick, prominent nerve. I'd see your surgeon ASAP. You shouldn't be totally numb after mere plate removal.

I wouldn't call what she got 'mere' plate removal given these were LARGE plates and she had a massive infection soon after they were put in and the history is multiple cuts to same/similar area. But ya, she should see (or call) her surgeon asap for explanation.

[GJ]

Why were the plates used large?

[kavan]

Why were the plates used large?

Aren't custom plates usually larger than standard ones? That or more screws/manipulation for them.

[april]

Do you have an OPG to show what your plates looked like in? How high up and how large?  Really hope sensation returns.

I saw KLS have two types of custom plates. Ones that look normal, but have a 1-2mm profile and removable connecting pieces, and another type that look wider but have a thinner profile (0.6-1mm) ETA: removed broken link

[kavan]

Do you have an OPG to show what your plates looked like in? How high up and how large?  Really hope sensation returns.

I saw KLS have two types of custom plates. Ones that look normal, but have a 1-2mm profile and removable connecting pieces, and another type that look wider but have a thinner profile (0.6-1mm) https://i.imgur.com/saRE4fKh.jpg

There were no photos in your link. I did manage to find another KLS link for titanium plates. But they say they are for osteosynthesis. (Level 1,5) for midface.

https://www.klsmartin.com/en/products/implants-cmf/titanium-osteosynthesis/

I'm assuming they could be customized.

There is another type of custom plate which I think spans more surface curvature of the bone than standard and takes more screws than a standard one. They are so nothing budges during healing process as in absolutely no wiggle room and are part of VSP design programs if the doctor wants to use them. What they have in common with the standard ones is that they are the type to be removed once all is in place.

The OP does not tell us what kind of custom plates she had, the ones MEANT to be removed after 6 months or so or the ones for osteointegration where they are meant to STAY in there. What she does tell us (requiring one to ferret out past posts about her massive infection post plate placement) is that the plates would be a constant source of infection if she didn't get them removed BUT there was a WAIT time to have them removed once the infection was under control.

IF they were for osteointegration --and I DON'T KNOW, it's just an 'if' because she uses the word EXCAVATION required to remove and to me that kicks up image of DIGGING something out-- that would have been more trauma to the ION than removing a type of plate that was meant to be removed.

Either way, it's a lot of trauma over a prior traumatized area. It's possible the nerve is being pinched or CRAMPED on in some way. Perhaps by swelling. But degree of po swelling is also not mentioned here. A nerve that gets cramped on a lot by too much pressure (or stretch) on it whether it be from swelling or something else can stay numb for longer than a nerve not in some kind of trauma zone.

What I would like to know is what did her doctor say about this.

[april]

Ah sorry not sure why it didn't work. The plates I saw are on their page for "Individual Patient Solutions".

Here is an order form for them where you can see both types (which I assume both are custom).

https://www.klsmartin.com/fileadmin/user_upload/Homepage/Products/IPS/IPS_Implants/Request_Form_Orthognathics_IPS_2018-05-03_english_reader_enabled.pdf

[kavan]

Ah sorry not sure why it didn't work. The plates I saw are on their page for "Individual Patient Solutions".

Here is an order form for them where you can see both types (which I assume both are custom).

https://www.klsmartin.com/fileadmin/user_upload/Homepage/Products/IPS/IPS_Implants/Request_Form_Orthognathics_IPS_2018-05-03_english_reader_enabled.pdf

Wonder why they call them 'implants'.

[PloskoPlus]

Wonder why they call them 'implants'.

German English?

[kavan]

I think word for implant is same in both. Something that went in would have prefix 'im', something that went on would have prefix auf. But ya, maybe lost in translation as you indicate.

[eranthe]

Thanks for the replies/discussion.  I'm fairly certain the KLS plates used were not intended to be removed in the future if it could possibly be avoided.  Aside from that I unfortunately don't have any radiology to post here with plates in.

It may also be worth mentioning that the swelling from this surgery was shocking ... much worse than with the original bimax ... and they didn't get ice to me until late that night (despite frequent requests).  So maybe the extreme swelling is implicated here?

It will be one week post-op tomorrow.  In the last 24 hours I think I've started to feel the faintest nerve sensation.  Last time I had surgery I woke up with the same sensation post-op but REALLY strongly to the point that it kept me awake at night and continued until all sensation had returned.  This time it is so faint as to be barely perceptible.

At least it's something ... I guess I just have to try and stay calm and wait ... and try to get over the chest infection I came home from hospital with 🙁