Chin muscle repair after genioplasty

[ODog]

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

You had a top surgeon my friend. I know you didn’t get the aesthetic result you wanted, but as you can see from my case there are a lot of smaller technical things that we take for granted that can go wrong.

[ODog]

FWIW... I did some quick research (I don’t have much time to spend on this as I work a lot) and the few articles I read basically stated “significant speech impairment” as a possible symptom of alveolar nerve damage.

So I’m hoping screw removal solves everything. If my nerves are damaged because I’ve had screws wedged into my nerves for 7 months, when I’ve been complaining about this problem at 2-3 months, I am going to lose my s**t. And I am going to seriously pursue a lawsuit because I am impaired right now and nobody even TRIED to help.

[Post bimax]

FWIW... I did some quick research (I don’t have much time to spend on this as I work a lot) and the few articles I read basically stated “significant speech impairment” as a possible symptom of alveolar nerve damage.

So I’m hoping screw removal solves everything. If my nerves are damaged because I’ve had screws wedged into my nerves for 7 months, when I’ve been complaining about this problem at 2-3 months, I am going to lose my s**t. And I am going to seriously pursue a lawsuit because I am impaired right now and nobody even TRIED to help.

Fingers crossed for you

[kavan]

There are nerve holes near the chin.

Nerves to the mandible, go in through a hole and come out of a hole. A hole is called a 'foramen' and one hole is to back of mandible and other (mental) one is near the chin. Canals for the nerves are inside the bone. Whole canal is called mandibular canal. The nerve(s) branch off inside of there innervating different parts. Inferior Alveolar nerve is in that canal. Goes in one hole and comes out the other. It has 2 branches and both can innervate parts of the lip.

Hard to find good illustrations on the net. Harvard Med used to (they might still) have a small museum on the top floor of the library where they had a human mandible showing the nerves (and vessels) inside the mandible and in that canal. You could see the nerves branching off to innervate the teeth and other areas. You could also see (imagine) how easy the nerves could get damaged through a BSSO cut or even a chin cut.   Anything inside the canal is something they don't see. But they can see the nerves coming out of the holes near the chin. Almost like it would be dumb luck not to damage something inside the canals which are interior to the surface of the bone.

[ODog]

Nerves to the mandible, go in through a hole and come out of a hole. A hole is called a 'foramen' and one hole is to back of mandible and other (mental) one is near the chin. Canals for the nerves are inside the bone. Whole canal is called mandibular canal. The nerve(s) branch off inside of there innervating different parts. Inferior Alveolar nerve is in that canal. Goes in one hole and comes out the other. It has 2 branches and both can innervate parts of the lip.

Hard to find good illustrations on the net. Harvard Med used to (they might still) have a small museum on the top floor of the library where they had a human mandible showing the nerves (and vessels) inside the mandible and in that canal. You could see the nerves branching off to innervate the teeth and other areas. You could also see (imagine) how easy the nerves could get damaged through a BSSO cut or even a chin cut.   Anything inside the canal is something they don't see. But they can see the nerves coming out of the holes near the chin. Almost like it would be dumb luck not to damage something inside the canals which are interior to the surface of the bone.

The question is, did the screw go through the bone and through the nerve, or is it just impinging upon the nerve? If it is the former, I wonder if I’d have total loss of sensation. Since I do have SOME feeling, perhaps the nerve is just impinged. A severed nerve should give complete loss of sensation.

[kavan]

The question is, did the screw go through the bone and through the nerve, or is it just impinging upon the nerve? If it is the former, I wonder if I’d have total loss of sensation. Since I do have SOME feeling, perhaps the nerve is just impinged. A severed nerve should give complete loss of sensation.

Cuts sever the nerve. Screws just 'screw' with them like irritate them or impinge.

[PloskoPlus]

Fingers crossed for you

Ditto.

[ODog]

Met with my surgeon. Scheduled for hardware removal next week. Upper and lower since I do have worsened sinus inflammation as well.

He said the nerve is NOT in the canal when the screws go in, in fact they reposition the nerve during the surgery, so he doesn’t know whether screw removal will help. I don’t think he thinks it’s impinging the nerve, but he did say he recommends doing removal anyway. Said something like the screw could be compressing the bone which is impinging the nerve.

But the SCREW itself is not hitting the nerve since during surgery they remove the nerve the canal and reposition it UNDER the canal. I don’t think the radiologist knows this fact.

As to Richardson’s view of muscle incarceration, my surgeon has no idea what he’s (Richardson) is talking about and says the muscle wouldn’t be trapped. There is no muscle to be entrapped, etc. Said he would take a picture of my chin during surgery to show me. But he said he’ll take a look to see if anything is snagged, anyways. But he can’t really comment on what Richardson would do.

Said he will clean up some scar tissue as well.

In summary, I’m way LESS confident that hardware removal will solve my problems since the nerve isn’t even in the canal, and I did not know this 24 hours ago.

[InvisalignOnly]

Going to India for a few days is a small price to pay for life changing result assuming it works out.

Let me guess... You've never been to India

[InvisalignOnly]

So you’re right he’s probably jacking up the surgical price. I’m sure I can negotiate somewhat. Even so, $5000 is not a lot of money to be speaking normally again.

I'm glad you got that scan done and hope the hardware removal won't be too uncomfortable and help with the issues you're facing!

Re: Richardson, I'm sure you'd gladly pay that kind of money to speak normally again and the problem is, he knows that. If he's a good doctor, he doesn't need to charge you a ridiculous amount of money just because he knows you're kind of desperate. I did a quick Google search and he's obviously very active on social media and trying to advertise himself quite aggressively - he might be good at marketing and communicating with you, but that does not make him a good surgeon and there's no evidence he knows something nobody else knows (how likely is that anyway?).

I came across this video posted by him two years ago: https://www.youtube.com/watch?v=oMuqi6X9tPo, in the comments someone asked how much the procedure cost - double jaw surgery - and he replied saying 'between USD 1000 and 5000' - that sounds a realistic price to me for double jaw surgery with genioplasty in India, not for a much smaller procedure like hardware removal or similar.

Anyway, I think you're on thr right track trying to find out if anybody else does the procedure he mentioned to you. Also, something good came out of your search for a solution since you got the CBCT done and are getting the screws removed.

[ODog]

I'm glad you got that scan done and hope the hardware removal won't be too uncomfortable and help with the issues you're facing!

Re: Richardson, I'm sure you'd gladly pay that kind of money to speak normally again and the problem is, he knows that. If he's a good doctor, he doesn't need to charge you a ridiculous amount of money just because he knows you're kind of desperate. I did a quick Google search and he's obviously very active on social media and trying to advertise himself quite aggressively - he might be good at marketing and communicating with you, but that does not make him a good surgeon and there's no evidence he knows something nobody else knows (how likely is that anyway?).

I came across this video posted by him two years ago: https://www.youtube.com/watch?v=oMuqi6X9tPo, in the comments someone asked how much the procedure cost - double jaw surgery - and he replied saying 'between USD 1000 and 5000' - that sounds a realistic price to me for double jaw surgery with genioplasty in India, not for a much smaller procedure like hardware removal or similar.

Anyway, I think you're on thr right track trying to find out if anybody else does the procedure he mentioned to you. Also, something good came out of your search for a solution since you got the CBCT done and are getting the screws removed.

Thanks very much for letting me know this!!!

I’ll get the hardware removal for free here in Canada, and then will reassess and consider Richardson if nothing improves.

[kavan]

Met with my surgeon. Scheduled for hardware removal next week. Upper and lower since I do have worsened sinus inflammation as well.

He said the nerve is NOT in the canal when the screws go in, in fact they reposition the nerve during the surgery, so he doesn’t know whether screw removal will help. I don’t think he thinks it’s impinging the nerve, but he did say he recommends doing removal anyway. Said something like the screw could be compressing the bone which is impinging the nerve.

But the SCREW itself is not hitting the nerve since during surgery they remove the nerve the canal and reposition it UNDER the canal. I don’t think the radiologist knows this fact.

As to Richardson’s view of muscle incarceration, my surgeon has no idea what he’s (Richardson) is talking about and says the muscle wouldn’t be trapped. There is no muscle to be entrapped, etc. Said he would take a picture of my chin during surgery to show me. But he said he’ll take a look to see if anything is snagged, anyways. But he can’t really comment on what Richardson would do.

Said he will clean up some scar tissue as well.

In summary, I’m way LESS confident that hardware removal will solve my problems since the nerve isn’t even in the canal, and I did not know this 24 hours ago.

Totally new one on me too that they actually remove the alveolar nerve from the mandibular nerve canal and do that to avoid any injury to it. Fascinating when you consider not even the radiologist knew that when he reported an impinging fixation screw may be the source of the symptoms. But it does look like your doc is entertaining possibly of impingement by screw pressing on bone and will remove screws.

Richardson's view of muscle incarceration, had to be guessed at; 'brain stormed' as to what it could POSSIBLY mean. I mentioned that in a prior post. A 'COULD BE' is not a definite that it is that. But 'could be (s)' are helpful to entertain because posing a 'could be' gives rise to a 'could not be' and that is what helps rule out things.


Must also be a relief to find out he didn't put screws in the alveolar nerve canal.

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

[ODog]

I also had a video call today with Richardson. He reviewed my scan, said the screws are in the RIGHT place and confirmed what my surgeon said: that the nerve is removed from the canal anyway. Said radiologist who wrote the report doesn’t know much and was looking for something.

I think he said screw removal may help my sensational numbness; said damage at 6 months is permanent if there is damage. But even screw removal won’t help my stiffness. On my job of the nerves is to supply sensation, that’s it, stiffness is not a motor nerve problem either as those are not damaged, so it can only be a muscular problem.

In terms of what he WOULD DO, he said (drain?) the fibrosis - by this I guess he means scar tissue - make sure there are no small bits of muscle fragments getting caught anywhere or snagged, and properly re-suture the cuts.

He didn’t really speak much on the INCARCERATION aspect that he mentioned earlier, in this call he was talking more about treating the fibrosis and re-suturing in the correct place. Said jaw surgeons do not think like plastic surgeons in terms of muscles being affected by the bone movements and are solely focused on the bone movements and can sometimes be careless with the re-suturing.

So the few things I took away from this was....

There’s nothing he’s suggested that I cannot get done here in Canada. At the very least I’m sure I can find a plastic surgeon here who can similar things. I’m just wondering if I can get my jaw surgeon to A) take care of the fibrosis and B) perhaps re-stitch me differently, so that I can get this done for free when he does the hardware removal.

[kavan]

I also had a video call today with Richardson. He reviewed my scan, said the screws are in the RIGHT place and confirmed what my surgeon said: that the nerve is removed from the canal anyway. Said radiologist who wrote the report doesn’t know much and was looking for something.

I think he said screw removal may help my sensational numbness; said damage at 6 months is permanent if there is damage. But even screw removal won’t help my stiffness. On my job of the nerves is to supply sensation, that’s it, stiffness is not a motor nerve problem either as those are not damaged, so it can only be a muscular problem.

In terms of what he WOULD DO, he said (drain?) the fibrosis - by this I guess he means scar tissue - make sure there are no small bits of muscle fragments getting caught anywhere or snagged, and properly re-suture the cuts.

He didn’t really speak much on the INCARCERATION aspect that he mentioned earlier, in this call he was talking more about treating the fibrosis and re-suturing in the correct place. Said jaw surgeons do not think like plastic surgeons in terms of muscles being affected by the bone movements and are solely focused on the bone movements and can sometimes be careless with the re-suturing.

So the few things I took away from this was....

There’s nothing he’s suggested that I cannot get done here in Canada. At the very least I’m sure I can find a plastic surgeon here who can similar things. I’m just wondering if I can get my jaw surgeon to A) take care of the fibrosis and B) perhaps re-stitch me differently, so that I can get this done for free when he does the hardware removal.

That sounds consistent with Reply #25 by me on this thread discussing 'DETACHING and ATTACHING back' as another 'could be' scenario which is not nerve damage.

In terms of what he WOULD DO, I will leave it to you to determine from him (or guess) what is meant by 'draining' scar tissue.

Sufficient info has been garnered/gathered in this process in addition to your having 2 direct communication channels with both doctors for a decision to be made.

[InvisalignOnly]

I’ll get the hardware removal for free here in Canada, and then will reassess and consider Richardson if nothing improves.

Good luck, I so hope you'll see some improvement! It would make me feel more confident about surgery too, as currently I'm still deliberating whether I even want this surgery due to the possible complications. Speech issues would be a real problem for me and could affect my career. You're young (unlike me), I'm sure you have a good chance of recovering well.

If you're still considering India, I can recommend a really good website - it has a lot of active members, both Indians and Westerners (including Americans / Canadians) with a lot of experience on different aspects of life in India. Some of the Western members have lived in India for years so they have a realistic idea of how things work over there. It's called IndiaMike (https://www.indiamike.com/india), you can register and post your question in the forum section. Most likely nobody will have any idea of jaw surgery but there will be people with experience of getting medical treatment / surgery in different kinds of hospitals. There might even be someone that knows about this particular doctor, or has read stuff about him in local languages, or they might know the hospital he works at.