Author Topic: How to vet surgeons?  (Read 4994 times)

kavan

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Re: How to vet surgeons?
« Reply #15 on: August 24, 2019, 04:38:40 PM »
ETA:  I think your surgeon has already been vetted for you and I would not stress out about further vetting. You're in a WIN situation even with linear advancement because you're in a LOSS situation NOW. You will probably come out fine.


Firstly, I could tell right off from your presentation you are very BRIGHT. So, not a thing of your being 'PRIOR' so. You still are but I understand and can empathize with how pain can disrupt the quick connections one could make in the absence of it.

Selection of something, here a surgeon, will be a function of  constraints.

Constraints can be the selection 'pool'. For example, the pool to select from is smaller when the selection pool has constraints of 'close to HOME' location and insurance paying for surgery as opposed to a larger pool with 'bigger fish' that is far away and very costly to catch. So, it's not a thing where you're drowning in a sea of choices here because it sounds like the constraints are; 'Who's the big fish in the small pond who's free to catch'.

Other constraints are those you are fortunate NOT to have, such as limited intellectual capacity. Like you're not asking about having esoteric surgeries to look like 'male model' where you need to be 'spoon fed' about what they actually are and are not. Nor are you presenting with an aimless goal in search of 'best surgeon in world' to achieve it. Basically if you know what's causing your brain not to work at full capacity, that's a whole lot better than some who don't even know they're not thinking correctly or don't start with capacity to do so.

OK, so the constraints here are that you are limited to surgeons in your vicinity and for insurance to pay for it. That constraint does not preclude the surgeon's capacity to perform MMA to give releif from apnea as to displace both your jaws and to do it where the positioning also stands to give improved facial balance. Also, the sub constraint of having a good doc narrowed down for you is a good sign.

Your case and face position from it sound pretty bad. So, this is a surgery that will bring great relief which is NOT going to make you look any worse. It's like your case sounds so extreme that even if you got the most straight forward type of MMA which is 'linear advancement', you'd still be better off. Linear advancement can be done when the PALATAL plane (defined by ANS-PNS, anterior nasal spine to posterior nasal spine) has a position where it's rotated CCW away from a horizontal; with respect to a Cartesian coordinate graph, a positive diagonal, a diagonal for which a CW rotation would align it to the x axis. So, 'forward' advancement along that diagonal brings the maxilla up and out. In fact the term; 'MMA' usually implies linear advancement for sleep apnea. It's when they travel along your 'own' palatal plane and they get the BSSO to follow. So, EVEN IF that's the plan set out for you whereas CCW posterior downgrafts are associated with aesthetic maximization, I would NOT fret about it because it sounds like you will still come out ahead given how behind your jaws are. Not to mention that this is FUNCTIONAL surgery that stands to improve your function. So, I would not fret about the surgeon 'not being Arnett-Gunson'.
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Post bimax

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Re: How to vet surgeons?
« Reply #16 on: August 24, 2019, 04:48:47 PM »
I would assume his surgeon could look at one and adjust for head orientation.

Is the Frankfurt horizontal used for ‘normalizing’ head orientation?

Maybe I am  hung up on whether head orientation for cephs impacted my own surgical planning.

I agree the OP is very likely to come out ahead even with straight MMA; though he still ought to post his plan here.

kavan

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Re: How to vet surgeons?
« Reply #17 on: August 24, 2019, 05:21:23 PM »
Is the Frankfurt horizontal used for ‘normalizing’ head orientation?

Maybe I am  hung up on whether head orientation for cephs impacted my own surgical planning.

I agree the OP is very likely to come out ahead even with straight MMA; though he still ought to post his plan here.

I don't think he has to get caught up in that sort of thing.
Sometimes the FH is not a horizont at all and different types of analysis use different 'horizontal' planes for that aren't pure horizonts either and others who select where they want their 'true vertical' to be and from there select a horizont that's perpendicular. The ceph itself should have a cephstat that shows vertical orientation.
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