Chin muscle repair after genioplasty

[ODog]

So I just got my CBCT back with some interesting findings:

Fixation screw impinges upon right mandibular nerve canal

“A fixation screw in the right posterior mandible appears to impinge upon the superior border of the left inferior alveolar nerve canal and extends through the mandibular alveolar process to extend through the lingual cortical plate. This impinging fixation screw may be the source of the patient's symptoms. The remaining fixation screws in the left mandible appear normal radiographically.“

[GJ]

Did they rule out the hardware pinching the muscles and/or scar tissue around the hardware?

Hey neat...GJ for the win.

Remove the screw and see if things clear up. Hopefully it didn't actually damage the nerve.

[ODog]

Hey neat...GJ for the win.

Remove the screw and see if things clear up. Hopefully it didn't actually damage the nerve.

You know GJ, the reason I didn’t take this seriously is because my surgeon never even suggested it as a possibility. Like what in the WORLD man. If I didn’t contact this Indian guy, I’d never have gotten the scan done. Wtf is wrong with people. They couldn’t even rule out possible screw impingement as a common sense, first-line differential diagnosis? What a joke. What if the longer the screw is in there, the more likely the damage will be permanent? I’m about to lose my s**t.

[GJ]

You know GJ, the reason I didn’t take this seriously is because my surgeon never even suggested it as a possibility. Like what in the WORLD man. If I didn’t contact this Indian guy, I’d never have gotten the scan done. Wtf is wrong with people.

There is A LOT of incompetence in the world...

[ODog]

Sorry guys, I actually have TWO screws impinging on the nerve canals. See below for the official findings:

Fixation screw impinges upon right mandibular nerve canal

A fixation screw in the right posterior mandible appears to impinge upon the superior border of the right inferior alveolar nerve canal and extends through the mandibular alveolar process to extend through the lingual cortical plate. This impinging fixation screw may be the source of the patient's symptoms. The remaining fixation screws in the right mandible appear normal radiographically.

Fixation screw impinges upon left mandibular nerve canal

A fixation screw in the right posterior mandible appears to impinge upon the superior border of the left inferior alveolar nerve canal and extends through the mandibular alveolar process to extend through the lingual cortical plate. This impinging fixation screw may be the source of the patient's symptoms. The remaining fixation screws in the left mandible appear normal radiographically.

[DRIVVEN]

Sorry guys, I actually have TWO screws impinging on the nerve canals. See below for the official findings:

Fixation screw impinges upon right mandibular nerve canal

A fixation screw in the right posterior mandible appears to impinge upon the superior border of the right inferior alveolar nerve canal and extends through the mandibular alveolar process to extend through the lingual cortical plate. This impinging fixation screw may be the source of the patient's symptoms. The remaining fixation screws in the right mandible appear normal radiographically.

Fixation screw impinges upon left mandibular nerve canal

A fixation screw in the right posterior mandible appears to impinge upon the superior border of the left inferior alveolar nerve canal and extends through the mandibular alveolar process to extend through the lingual cortical plate. This impinging fixation screw may be the source of the patient's symptoms. The remaining fixation screws in the left mandible appear normal radiographically.

So sorry to hear this  WTF?  I think the best way to proceed is to have someone assess the nerve damage and see whether there is any treatment that might help the damage. That way, you could have  the IAN nerve assessed and repaired (repaired means a variety of things) in one procedure. You dont want to let more time pass like what happened to me as i was told the screws “were nowhere near the canal” when they were. You are young and have a good chance of this repairing even if the impingement caused some damage. This is probably why you feel the pain in the background even at rest.

[kavan]

On your ceph; https://imgur.com/a/kbO8kWl I see screws near where the nerve holes (mandibular nerve canals) would be. But not a radiologist as to know if they were going right through them or impinging on the nerves. The reading certainly makes sense that they are given those screws are near the nerve holes.

I also see screws that look to be going through the tooth roots. But not a radiologist so no idea if the length of the screw stops before it even touches the tooth roots.

Probably explains why hard to tell from the ceph and a CBCT was needed.

Caminetti told you it was most likely nerve damage/nerve issue but also told you removing screws won't do anything. Wonder WHY he didn't offer to remove screws near the nerve holes just incase. Yet the Indian doc told you the screws were too small to be an issue.

Well, the CBCT gives enough info for the screws to be removed IN CANADA. Certainly don't want to go all the way to India just to get screws removed.

I guess if screw removal does nothing, you can then think about going to India.

[ODog]

So sorry to hear this  WTF?  I think the best way to proceed is to have someone assess the nerve damage and see whether there is any treatment that might help the damage. That way, you could have  the IAN nerve assessed and repaired (repaired means a variety of things) in one procedure. You dont want to let more time pass like what happened to me as i was told the screws “were nowhere near the canal” when they were. You are young and have a good chance of this repairing even if the impingement caused some damage. This is probably why you feel the pain in the background even at rest.

I don’t feel pain just a tension, hard to explain. No pain whatsoever.

So are you saying the screws are likely to have caused damage and that removal won’t do much? Did you have the same issue? Did screw removal help?

[ODog]

On your ceph; https://imgur.com/a/kbO8kWl I see screws near where the nerve holes (mandibular nerve canals) would be. But not a radiologist as to know if they were going right through them or impinging on the nerves. The reading certainly makes sense that they are given those screws are near the nerve holes.

I also see screws that look to be going through the tooth roots. But not a radiologist so no idea if the length of the screw stops before it even touches the tooth roots.

Probably explains why hard to tell from the ceph and a CBCT was needed.

Caminetti told you it was most likely nerve damage/nerve issue but also told you removing screws won't do anything. Wonder WHY he didn't offer to remove screws near the nerve holes just incase. Yet the Indian doc told you the screws were too small to be an issue.

To be precise I believe both my surgeon and Caminitti were referring to my chin screws when saying removal won’t do anything. Well my surgeon was at least - said it was secured directly to bone and there wouldn’t impingement. He never pointed to or commented to my mandible screws. Even Richardson was focusing on the screws on the chin I believe, because usually a large plate is used there, and also it’s the origin site of the symptoms. So perhaps they all just assumed the screws on the mandible weren’t impinging the nerve canal and focused attention to the chin screws.

Well, the CBCT gives enough info for the screws to be removed IN CANADA. Certainly don't want to go all the way to India just to get screws removed.

I guess if screw removal does nothing, you can then think about going to India.

That’s the easy answer and the most sensible option at this point, however it’s also possible that the STIFFNESS and NUMBNESS are distinct issues, where the muscle entrapment (as Richardson suggests) is causing the stiffness and the screws on the nerve canal are causing my numbness. I am not sure my surgeon can diagnose, assess, and repair an entrapped chin muscle as Richardson can do, in addition to taking out the screws.

Richardson said MENTAL nerve damage doesn’t cause stiffness , only numbness, but did not say whether alveolar nerve damage/ impingement could cause stiffness. This doesn’t really add clarity to the situation.

Perhaps as GJ told me I can ask them to also clean up whatever scar tissue is in there.

[kavan]

To be precise I believe both my surgeon and Caminitti were referring to my chin screws when saying removal won’t do anything. Well my surgeon was at least - said it was secured directly to bone and there wouldn’t impingement. He never pointed to or commented to my mandible screws. Even Richardson was focusing on the screws on the chin I believe, because usually a large plate is used there, and also it’s the origin site of the symptoms. So perhaps they all just assumed the screws on the mandible weren’t impinging the nerve canal and focused attention to the chin screws.

That’s the easy answer and the most sensible option at this point, however it’s also possible that the STIFFNESS and NUMBNESS are distinct issues, where the muscle entrapment (as Richardson suggests) is causing the stiffness and the screws on the nerve canal are causing my numbness. I am not sure my surgeon can diagnose, assess, and repair an entrapped chin muscle as Richardson can do, in addition to taking out the screws.

Richardson said MENTAL nerve damage doesn’t cause stiffness , only numbness, but did not say whether alveolar nerve damage/ impingement could cause stiffness. This doesn’t really add clarity to the situation.

Perhaps as GJ told me I can ask them to also clean up whatever scar tissue is in there.

There are nerve holes near the chin.

[PloskoPlus]

There is A LOT of incompetence in the world...

Most surgeons just want to see the back of you after surgery and will never, ever admit fault.  To me this looks like wilful negligence on top of incompetence. He could've inquired further, ordered scans, instead he was just hoping OP would just simply go away.

The whole profession is in a state of denial about all the nerve damage they cause. The fat bastard who wrecked my ION had the possibility buried in the consent form. Well after I told him that I have all this nerve damage and he refused to see me, he published another one of those zero-information papers that talked up jaw surgery and how great it is - a complete fluff piece. I don't understand how stuff like that gets published at all and he already has a ton of publications.  Anyway, in this paper he didn’t mention upper jaw surgery nerve damage as a risk AT ALL, and lower jaw surgery he estimated as 10-14% “according to one study”. This is laughable. Maybe 10-14% have enough damage to be permanently troubled by it, but in reality I’m more willing to believe that 10-14% are the lucky few to have to numbness (that they can perceive) and almost all the rest have some after lower jaw surgery.

[ben from UK]

The question is how to avoid nerve damage if the percentages are so high? Surely, there must be a way to reduce nerve damage.

[Post bimax]

Somehow I escaped a bimax and genio with zero nerve damage. If only the movements were a bit different!

[ODog]

I’m at least hopeful now that I don’t have permanent nerve damage and that it’s just the temporary impingement causing my issues. I’ll know soon enough.

[ODog]

The question is how to avoid nerve damage if the percentages are so high? Surely, there must be a way to reduce nerve damage.

Don’t put screws in the alveolar nerve canal? START there at least.