MaxFac Surgeon refers me out for CCW Rotation

[XXRyanXXL]

Hi

I had a previous double jaw surgery in 2017, this was to correct a 10mm overbite. I also needed what's called Counter Clockwise rotation, which was the result of mouth breathing at an earlier age and caused my mandible to grow downwards and give me the appearance of a long face. After my jaw surgery, my surgeon told me he corrected my overbite, but he also acknowledged he made my face even longer now, which is very apparent. I told him can he please go back and schedule me to have the CCW ?
He didn't say anything regarding CCW, he just told me "I'll make a referral to you and you can go see ________."

So I do that, and they referred me out. This happened at least 30 times over the course of 2 years. Every surgeon I saw evaded my questions about the CCW, and they said "We don't do that here" or "I perform jaw advancements or TMJ, we never do any CCW, and you'll have to go see another surgeon who specializes in this."

What is with all this ***ery ? Every Surgeon who specializes in Maxillofacial Surgery is taught during there residency program and there school how to perform a CCW rotation, but yet when I go see surgeons they either are completely impotent or they act like they can't do this, how is this? How are they able to specialize in this field and yet they don't know how to do this operation or act like it's a specialty within the field, when it's not ? I can sit here and name the past 30 surgeons both in my area and the west coast who keep referring me out or evade my questions.

As far as my surgeon, the original surgeon who performed my jaw surgery, he will not speak a word to me now. His front desk personnel just say "He did a A+ job, are you not satisfied? I'm sorry we can't meet your expectations!" What a bunch of BS ?!

How can any surgeon make a pre-existing condition worse and not have the ability to do what is required and perform an operation they are taught to know how to do and execute? I am missing something here?

[kavan]

There is no ceph here to refer to and I can't address what ever dynamics are going on between you and many surgeons. But I can offer some CONCEPTUAL info that relates to CCW as to what it corrects and what it doesn't.
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The ROTATION of the mandible 'follows' the rotation the maxilla. So, with mouth breathing, what is (usually) going on with the maxilla is that it grows downward. So, when the mandible follows that type of growth pattern, the mandible is displaced downward and backwards. Relative to rotations, that would be a clockwise rotation. So, the concept here is that mouth breathing creates an unfavorable CW rotation of the MAXILLA and since the mandible follows what the maxilla is doing, the mandible will be displaced backwards and down in an unfavorable CW rotation.

In terms of CAUSALITY, excess downward growth of the maxilla from mouth breathing that results in unfavorable CW rotation of the maxilla will CAUSE the mandible to be set in an unfavorable CW rotation (backwards and down). That is to say, mouth breathing results in excess maxillary growth (in wrong direction) but it might not be the sole contributor that 'causes' excess downward mandibular growth or an excessively high mandibular plane angle or an excessively long and backwards chin. Excess downward mandibular growth or an incredibly high mandibular plan angle can exist in ADDITION to being forced into an unfavorable CW rotation by the maxilla. So, we can't really say that ALL unfavorable downward excess to the mandible or ALL incredibly STEEP (High mandibular plane angles) are 'CAUSED' by the unfavorable CW rotation at the maxilla. Although there is no way for me to tell if you, personally, have excesses to the MPA or excesses to chin area in addition to an excess of the OP (Occlusal plane) which CCW-r (a rotation to the maxilla) corrects, I can say that CCW-r doesn't correct all excesses that might exist to the mandible and/or chin  in addition to excess of the OP .

Unfavorable CW rotation to the maxilla causes unfavorable rotation to the mandible but unfavorable GROWTH to the mandible or an unfavorable Mandibular plane angle can be COINCIDENT (happen at same time or in addition to) unfavorable rotation to the maxilla but not actually caused by the unfavorable rotation of the maxilla.

Consider that the OP (Occlusal plane angle) and the MPA (mandibular plane angle) are 2 different angles. Although the OP can be reduced by CCW-rotation and the MPA will follow somewhat in proportional/similar reduction of its angle, CCW-r of the OP can't compensate for an excessively HIGH MPA if the MPA is FAR in EXCESS of the OP. For example (although an extreme one), say someone has a high OP that could be reduced with CCW-r BUT they ALSO have something like a 'lantern jaw' (excess growth to the mandible INDEPENDENT of what's going on with the maxilla and also excess--very STEEP-- MPA). CCW-r would not 'fix' something like that or in that type of venue. Even if not 'lantern jaw', but only an incredibly STEEP MPA that is MUCH steeper than the OP, not all of the excess steepness to the MPA can be reduced by the reduction done to the OP via CCW-r. For example, if the excess steepness of the OP is reduced by let's say 'X' degrees but the the MPA is ['X' + 'Y'] degrees, the CCW-r to the maxilla will reduce the MPA by 'X' degrees but NOT the extra 'Y' degrees of steepness that the mandible has. Geometrically impossible.

Now, let's say someone had a very long and backwards chin, a problem independent from but in addition to an unfavorable CW rotation at the maxilla. CCW-r at the the maxilla to reduce the OP would not correct that problem either. Instead, a vertical reduction of the chin (excess cut from the middle of it) and a sliding outward and upward genio would correct and that could be considered in venue of independant CCW-r type rotation to a chin that is too long and too backward.

So, all this depends on what the PROBLEM SET actually is. If the problem set of excess MPA to the mandible is DIRECTLY CAUSED by excess STEEPNESS of the OP and the excess steepness to the MPA is EQUAL (or about that) to the excess steepness of the OP, then CCW-r to the maxilla will correct the unfavorable CW rotation to the mandible. However, if there is excess growth to the chin and/or excess steepness to the MPA (or both) and that type of excess is MORE than the excess to the OP (which is reduced via CCW-r), such a problem set will EXCEED what CCW-r can actually 'fix'.

Perhaps this could be the missing information that surgeons don't explain or the missing information that many on this board have when they think CCW-r is the magic bullet for a problem set that exceeds what CCW-r is aimed at correcting.

[XXRyanXXL]

I appreciate the feedback. My question dealt with why an OMS, who is supposed to know how to do CCW+R and is trained during there residency program, doesn't know how to execute it when a patient who is deemed to have the surgery as a medically necessary operation.

You went into detail about why a patient may need CCW+R, and the if and when and procedural details.

So far, I've been declined by 30+ Licensed and Board Certified OMS, they don't have a clue how to do it!  They heard of it. I talk to them directly, when I explain to them I need CCW+R, they don't doubt me, they know I need it and the only excuse I get is "I'm referring to you Dr. ....."

I then go back and ask them have you done CCW? They ignore me. I then go back and explain to them you should know how to perform this.
They say "It is my sole discretion on what I want to perform, and right now I'm referring to you to another doctor"

The process repeats. What a crock of bulls**t!
It's called mere incompetence. A lack of training, a lack of skill.

I go back to my original OMS and they frown that other OMS referred me back to him to complete the operation.  If they don't know how to perform an operation that is regularly called for in this field, why even be an OMS?

So my next feed on this forum will be listing out all these OMS who have failed me and failed every other patient who went to them seeking help.

[kavan]

I appreciate the feedback. My question dealt with why an OMS, who is supposed to know how to do CCW+R and is trained during there residency program, doesn't know how to execute it when a patient who is deemed to have the surgery as a medically necessary operation.

You went into detail about why a patient may need CCW+R, and the if and when and procedural details.

So far, I've been declined by 30+ Licensed and Board Certified OMS, they don't have a clue how to do it!  They heard of it. I talk to them directly, when I explain to them I need CCW+R, they don't doubt me, they know I need it and the only excuse I get is "I'm referring to you Dr. ....."

I then go back and ask them have you done CCW? They ignore me. I then go back and explain to them you should know how to perform this.
They say "It is my sole discretion on what I want to perform, and right now I'm referring to you to another doctor"

The process repeats. What a crock of bulls**t!
It's called mere incompetence. A lack of training, a lack of skill.

I go back to my original OMS and they frown that other OMS referred me back to him to complete the operation.  If they don't know how to perform an operation that is regularly called for in this field, why even be an OMS?

So my next feed on this forum will be listing out all these OMS who have failed me and failed every other patient who went to them seeking help.

OK, I just wanted to explain what I did in the event that filled in a gap that surgeons don't explain. I don't have an explanation for why all the surgeons you consulted with for treatment said they could not do CCW-r. If it's CCW-r via anterior impaction, they ALL do that and learn to do that. So, no explanation I can provide if the CCW-r in question was the anterior impaction. The other type of CCW-r which is the one most talked about on this board is the CCW-r via the POSTERIOR DOWNGRAFT. That's the type where there are FEWER maxfax guys who perform it, which in turn, harks back to why suggestions as to whom to seek out for that resolve to a small handful of names of doctors who perform it and that small group is bandied about on this board a lot. So, posterior downgraft CCW-r, especially the significant ones a handful of doctors mentioned on this board do are NOT practiced by all maxfax guys.

[XXRyanXXL]

I want everyone on this forum to know the pscychology and ethics when it deals with surgeons.

In my forum state, Ohio, a bunch of lawyers got together and lobbied to have passed whats called a "Affidavit of Merit" to sue any surgeon, doctor, or orthodontist. What that means is that you must have grounds to sue for malpractice, and those grounds includes a certified Affidavit from another Surgeon who reviewed the surgeon or doctor subject to suit that there work was essentially fell below the standards of care, or in other words, was bad. To find another surgeon in the field to complain about another fellow surgeon is rare, but can be done. These laws were passed in my state to shield doctors from frivilous lawsuits, but in the process, it also shielded doctors from meritorious claims because its difficult at times to sue a surgeon without an accompanying surgeon's view on his planning or skills.

That being said, the surgeons name in my case was Deepak Krishnan.
I sued him and the lawsuit was thrown out of court without a AOM.
I wrote a formal complaint over to the Dental Board and what did they do? NOTHING!
I filed a complaint with the hospital and I received a response back on 1/29/2024 that I cannot make this surgeon finish the operation. They said I filed suit and it was dismissed and the surgeons work was "excemplary" Which is far from the truth.

This surgeon not only did NOT finish the operation, he REFUSED to send me my medical records when I requested them under HIPAA request. Again the lawyers response to this was merely WHO CARES.

When surgeons don't face imminent lawsuits or are shielded from laws or ethical concerns, there mentality changes, they are no longer mandated to abide by ethical standards. This is exactly what happened here.

I've been in contact with every surgeon who he recommended me to, and every surgeon told me to go back to him and have him finish the operation and they want NOTHING TO DO WITH ME! PERIOD!

This is an absolute GARBAGE SURGEON AND PROCESS THAT NOBODY SHOULD EVER HAVE TO DEAL WITH, PERIOD!
I did receive all my VSP after I filed 2 complaints with HHS (federal government) and they released them to me.
I have my VSP which is clearly a surgeon who has barely came out of residency program and does not need to perform any surgeries, yet he is the Chair of OMS at Cincinnati.
That being said, no surgeon in my area will take my case, nor will A&G in Santa Barbara since my current situation calls for a complex CCW + R and extensive bone grafting, most skills are out of the realm or too costly for me to see a surgeon with those qualities.

I dont mind posting my VSP on this forum to prove what I'm saying, but I have been open to critism both through my co-workers and orthodontists who laugh when they see it. I'll also post this ridiculous letter and complaint I filed with Cincinnati Holmes Hospital and my Dental Board because it's clearly a cover up. My insurance was alerted to this and they said they lost my complaint three times. This is total GARBAGE.

[GJ]

It's probably The Doctor's Company behind this. This company has made it very difficult to sue for legit claims.

https://en.wikipedia.org/wiki/The_Doctors_Company

[kavan]

It's probably The Doctor's Company behind this. This company has made it very difficult to sue for legit claims.

https://en.wikipedia.org/wiki/The_Doctors_Company

Steven J. Bensinger, one of the 'leaders' of the 'Doctor's Company' was chief financial officer of AIG, one of the companies that needed to be BAILED OUT during the big crisis crash of 2008. AIG played big role in 2008 crisis. He tried to get out with a 10 million dollar 'Golden parachute'. That outta give you an idea about the corporate directors of that company. So, ya, they would tend to be all about NOT calling doctors to task in the event of patient harm.