jawsurgeryforums.com
Education => Educational Material => Topic started by: kavan on July 08, 2019, 10:26:02 PM
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(LOTS of) Complications associated with orthognathic surgery
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342970/
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Is it plausible that the standards for performing orthognathic surgery are looser in SK, resulting in higher morbidity rates?
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Just finished the article.
"Fourteen cases of serious complications such as death and falling into a vegetative state after jaw bone surgery such as the orthognathic surgery (10 cases) and facial contouring surgery (4 cases) were reported in the period from 2000 to 2016. Causes of these complications were bleeding in two cases, respiratory problems in four cases, surgical errors in one case, and unknown in six cases. The procedures were performed by plastic surgeons in 12 cases, by dentists in one case, and in a university hospital in one case (Exact department is unknown)."
A Dentist? a f**king dentist? Are dentists allowed to do orthognathic surgery in north america or europe? I know most plastic surgeons ive spoken with, EVEN IF THEYRE TRAINED MAXFACS wont touch orthgnathic surgery cases.
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All maxfax or 'oral surgeons' start with a DENTAL DEGREE. So, all of them can be called 'dentists' because the DDS stands for Doctor of Dental Surgery. Even Gunson has the 'DDS' beside his name. But of course, also has the MD degree for specialty of maxfax surgery.
So, I guess what you mean to saY is a dentist with NO advanced maxillo-facial surgery training.
A lot of the problem, I guess can arise from lax standards of any doctor doing some type of 'cosmetic' surgery which many pro-societies in US such as the plastic surgeons take issue with.
Article is from Korean Maxillofacial, oral surgery journal. So, maybe most of their data out of Korea but I don't know. In Korea, they do BOAT LOADS of maxfax surgery and they even advertise it in the subways. So, I guess the MORE surgeries done, the more data kicks up for the complications. But all those complications are inherent with the surgery. It's just that the better doctors are going to have FEWER of them.
IMO, best thing to do is to ask for the DISCLOSURE/informed consent legal document that has all the risks on them and ask for that WAY BEFORE the surgery where, I guess most of those risks would be listed. More often than not, it's the LEAST READ document patients read. Sometimes it's even slipped to them the day of surgery where they need to sign it.
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MD became a requirement only in the 80s. Some older surgeons only have a DDS degree. I believe Sinn and Arnett do not have an MD, but Wolford is of the same vintage and does.
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Remember that kid who started a YT channel about his surgery then died days later?
That was rough to watch. I believe a female surgeon in Seattle cut a major artery.
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Remember that kid who started a YT channel about his surgery then died days later?
That was rough to watch. I believe a female surgeon in Seattle cut a major artery.
I did not know about that... that's horrible.
MD became a requirement only in the 80s. Some older surgeons only have a DDS degree. I believe Sinn and Arnett do not have an MD, but Wolford is of the same vintage and does.
Posnick (possibly retired now?) is another older surgeon who has an MD
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I did not know about that... that's horrible.
Yeah it was really surreal and tragic. He was like "see you on the other side of surgery" or something like that.
Then in the comments people said he died. Sure enough he did. I wish I could remember the surgeon...I believe it was an Asian woman from the Seattle area, and the cause was severing some major artery. I can't seem to find anything in Google. There were news articles about it at the time so I'm not sure why I can't find it.
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I did not know about that... that's horrible.
Posnick (possibly retired now?) is another older surgeon who has an MD
...and who also lives in MD.
He's in the plastic surgery 'loop'. So, a practitioner who's a member of a legit plastic surgery or facial plastic surgery society, definitely HAS TO BE and MD.
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Googled 'dental death in Seattle'. May not have come up with specific doctor who was associated with the patient death of the You Tube person. But in the search for Seattle dental mishaps, I found some other scary links. Don't mean to alarm anyone. Just sayin', since I did a search on some of this stuff, I might as well share some of the other links I came up with.
Here's one about a Melanie Lang oral surgeon who, (i think) had non MD administer IV sedation.
https://caselaw.findlaw.com/wa-court-of-appeals/1298835.html
Here's a few links about dental deaths in Seattle:
'Fifth dental death in 3 years
Student has an allergic reaction to medication after oral surgery.'
https://www.seattlepi.com/local/article/Fifth-dental-death-in-3-years-1280106.php
https://www.seattlepi.com/local/article/Enough-scrutiny-in-dental-deaths-1279293.php
If it's a matter of going to a HOSPITAL in Seattle after a complication of surgery, here's a link to deaths due to MOLD.
http://www.theprogressnews.com/news/nation/seattle-hospital-to-reopen-rooms-after-mold-death/video_b6587ac8-ff8a-5925-81ae-99e86a32014a.html
As to the header article in this link out of Korea, here's another one (about MORTALITY RATES) that counters the negative public perception that the media sometimes focuses on:
'Analysis of mortality cases related to jaw surgery reported in the mass media: a secondary publication.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5104877/
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Yeah it was really surreal and tragic. He was like "see you on the other side of surgery" or something like that.
Then in the comments people said he died. Sure enough he did. I wish I could remember the surgeon...I believe it was an Asian woman from the Seattle area, and the cause was severing some major artery. I can't seem to find anything in Google. There were news articles about it at the time so I'm not sure why I can't find it.
Did a search on 'Find a Surgeon' in Seattle area on the https://myoms.org/ website. The only female surgeons I could find with Asian sounding names was Melanie S Lang (who's not Asian but for whom I linked to a law case in my prior post.) and Ju Yon Sophie Yi (who is Asian). But who knows, the search function CRAPPED OUT on me and maybe the surgeon in question wasn't even a member. Either of those names sound familiar?
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No, neither.
Maybe it was in Oregon. It was somewhere in the PNW. Or maybe it was somewhere else, and I'm confusing cases, but I don't think so.
I remember on Yelp people attacked her, and in the YT comments on his video. I'll have to try using the search function on this site later to find it. I think it was posted here, too.
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No, neither.
Maybe it was in Oregon. It was somewhere in the PNW. Or maybe it was somewhere else, and I'm confusing cases, but I don't think so.
I remember on Yelp people attacked her, and in the YT comments on his video. I'll have to try using the search function on this site later to find it. I think it was posted here, too.
Oh well. I guess that explains why no Asian female maxfax found in Seattle that fit the bill.
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I found it: https://www.youtube.com/watch?v=q4Oc_NFhlUE
In the YouTube comments someone writes, "Does anyone have info on what artery was accidentally cut?"
The thing is, at the time there were articles about this. It was all over the news, and now I can't find any. I wonder if the surgeon demanded Google remove all the info. I remember it being a female doctor from the PWN and she did in fact sever an artery. Maybe with the video someone can find more info. His name was Justin.
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I found it: https://www.youtube.com/watch?v=q4Oc_NFhlUE
In the YouTube comments someone writes, "Does anyone have info on what artery was accidentally cut?"
The thing is, at the time there were articles about this. It was all over the news, and now I can't find any. I wonder if the surgeon demanded Google remove all the info. I remember it being a female doctor from the PWN and she did in fact sever an artery. Maybe with the video someone can find more info. His name was Justin.
OK, saw the YT video. I looked up name 'Justin Love', which was his real name and found obituary where they said he died in med procedure. But no details.
https://www.peakefh.com/obituary/love-justin
YT video said something about his needing HIP BONE to be harvested for the surgery. So, maybe it was orthopedic surgeon doing the hip harvest? If the artery was from the hip harvest, could have been the femoral artery.
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OK, saw the YT video. I looked up name 'Justin Love', which was his real name and found obituary where they said he died in med procedure. But no details.
https://www.peakefh.com/obituary/love-justin
YT video said something about his needing HIP BONE to be harvested for the surgery. So, maybe it was orthopedic surgeon doing the hip harvest? If the artery was from the hip harvest, could have been the femoral artery.
No to the hip harvest. At the time it was all over the news. It was a female orthognatic surgeon. She severed an artery during his jaw surgery.
My guess is there was a settlement because now there's nothing out there. There were not only articles but Yelp reviews bashing her.
OHSU is Oregon. I think he might have been from Washington. But yeah, PNW as I remembered.
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No to the hip harvest. At the time it was all over the news. It was a female orthognatic surgeon. She severed an artery during his jaw surgery.
My guess is there was a settlement because now there's nothing out there. There were not only articles but Yelp reviews bashing her.
OHSU is Oregon. I think he might have been from Washington. But yeah, PNW as I remembered.
O well, went to orthodoc.aaos.org (listing of ortho surgeons) before I read your post. Found one female with Asian name: Susan Lai Williams.
http://orthodoc.aaos.org/SusanWilliamsMD/?_ga=2.162048316.1447606032.1562896375-801270307.1562896375
So, that's not the one either. Too curious to find out but not getting much from searches.
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Yeah I think the $ at OSHU scrubbed the internet clean.
There's this post where he talks about his surgery (he might have named the surgeon), but Google cache says the page is gone. http://www.jawsurgeryblog.com/forums/viewtopic.php?t=2365
To me that means there was a $crub.
His sister posted on his video 4 months ago. She might be the only way to find out. I didn't see any contact info.
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Yeah I think the $ at OSHU scrubbed the internet clean.
There's this post where he talks about his surgery (he might have named the surgeon), but Google cache says the page is gone. http://www.jawsurgeryblog.com/forums/viewtopic.php?t=2365
To me that means there was a $crub.
His sister posted on his video 4 months ago. She might be the only way to find out. I didn't see any contact info.
Ya, I saw the sister's YT post and channel. But she just seems like a pre-teen who might not know doctor's name.
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Looks to be a teaching hospital. Maybe was a resident or a student.
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Looks to be a teaching hospital. Maybe was a resident or a student.
Pretty sure the resident "assisting" my surgeon wrecked my infraorbital nerve.
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A few years ago when I first heard of Justin's I remember looking it up and IIRC someone said it was the carotid artery. Whichever one it was, the discussion online was it was severed and not noticed (how could it not be noticed?) Someone (a sibling I think) had posted proper updates on either youtube or the other jaw forum at some point.
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A few years ago when I first heard of Justin's I remember looking it up and IIRC someone said it was the carotid artery. Whichever one it was, the discussion online was it was severed and not noticed (how could it not be noticed?) Someone (a sibling I think) had posted proper updates on either youtube or the other jaw forum at some point.
I take it you don't remember the surgeon?
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Nah, can't remember her name.
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Some (more) journal articles about artery injuries during oral surgey. Not sure if some of them were due to weird or unpredictable vessel anatomy. But for sure, most due to IATROGENIC INJURIES which means DOCTOR CAUSED injuries.
"Diagnosis and management of blunt carotid artery injury in oral and maxillofacial surgery."
https://www.ncbi.nlm.nih.gov/pubmed/9393397
Distressing to find that's also a risk. In this paper, they track 12 patients in a 2 year period, all of whom had BLUNT injury from the surgery with terrible neurological deficits of those that survived (didn't die from it). They say it's a rare complication. But here, they are talking about BLUNT injury which is different from artery actually being severed which is much worse.
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"Massive Hemorrhage During Oral and Maxillofacial Surgery: Ligation of the External Carotid Artery or Embolization?"
https://www.joms.org/article/S0278-2391(09)00304-8/fulltext
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"Internal carotid artery thrombosis after blunt maxillofacial trauma"
https://www.oooojournal.net/article/0030-4220(91)90548-Q/fulltext
This paper is about the artery being damaged during a LEFORT 3 and mandible angle fracture. The patients didn't die but it looked to be a 'wait and see' process until the time they noticed neurologic deficit and extreme weakness (hemiparesis) of one side of body.
"Abstract
Two cases of internal carotid artery thrombosis associated with a maxillary Le Fort III and mandibular angle fractures after maxillofacial blunt injuries are described. Both patients had delayed neurologic deficit and hemiparesis. The diagnosis was made by carotid angiography after clinical evidence of thromboembolism. Clinical aspects and etiology, with special attention to mechanism of injury, are discussed."
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"Massive Hemorrhage During Oral and Maxillofacial Surgery: Ligation of the External Carotid Artery or Embolization?"
https://www.researchgate.net/publication/26296626_Massive_Hemorrhage_During_Oral_and_Maxillofacial_Surgery_Ligation_of_the_External_Carotid_Artery_or_Embolization
That's just the FIRST TITLE of the LINK given here. On the same link, there are a BOAT LOAD of articles/case studies about massive bleeding and artery damage during maxillo-facial surgery.
Some snippets from the series of articles. Some of which are about massive bleeding even after a tooth extraction!:
"....As far as we could determine, this triangular space has not been described before [22,25,28]. Even today, penetrating injuries to the head and neck region associated with significant arterial Posterior auricular artery, 12 Superficial temporal artery, 13 Internal carotid artery, 14 Common carotid artery, 15 Superior thyroid artery, 16 Lingual artery, 17 Hypoglossal nerve bleeding constitute surgical emergencies that are frequently very difficult to handle [2,3,5,29]. The literature suggests that about 25% of penetrating neck trauma cases are associated with vascular injuries, with the internal carotid being the most frequently affected artery [5,30]...."
"Stab injury to the preauricular region with laceration of the external carotid artery without involvement of the facial nerve: A case report."
"Life-threatening bleeding after tooth extraction due to vascular malformation: a case report and literature review."
"Massive bleeding after a tooth extraction: Diagnosis of unknown arteriovenous malformation of the mandible, a case report"
"A Critical Review of the Literature and an Evidence-Based Approach for Life-Threatening Hemorrhage in Maxillofacial Surgery"
The list goes on with MANY other articles.
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A few years ago when I first heard of Justin's I remember looking it up and IIRC someone said it was the carotid artery. Whichever one it was, the discussion online was it was severed and not noticed (how could it not be noticed?) Someone (a sibling I think) had posted proper updates on either youtube or the other jaw forum at some point.
Someone saying it was 'severed' doesn't really confirm whether it was. Could have been severed or could have been generic description of BLUNT INJURY to the artery. Of course, I have no way of knowing. Just to say it not being noticed during surgery is more in line with BLUNT injury to the artery.
Check out the list of articles I dug up on injuries to the carotid artery where it's the BLUNT injuries that cause the damage that can become a 'wait and see' process in the sense they might not be noticed immediately.
I WONDER if the OSHU wrote a case study on this. If not, they should have. However, I don't know what the issues are with doing so like whether or not the family needs to approve or not.
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http://webcache.googleusercontent.com/search?q=cache:A7VdvPpcZE0J:www.jawsurgeryblog.com/forums/viewtopic.php%3Ft%3D2365%26start%3D30+&cd=5&hl=en&ct=clnk&gl=us
His surgeon's name is in this google cache link
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Carotid artery on the left side of his brain was torn? According to the poster
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http://webcache.googleusercontent.com/search?q=cache:A7VdvPpcZE0J:www.jawsurgeryblog.com/forums/viewtopic.php%3Ft%3D2365%26start%3D30+&cd=5&hl=en&ct=clnk&gl=us
His surgeon's name is in this google cache link
Nice find.
Good to see my memory hasn't failed and the surgeon has an Asian last name.
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Good find April. I managed to read that one page in the link of multi pages of many posts. But since I'm not a member of that blog, i could not read all of the posts. Anyway, I'm copying and pasting the part about the doctor's name:
"Justin had his surgery at the Shriners' Hospital in Portland, Oregon. It was performed by Doctor Anna A. Kuang, the surgeon who is in charge of the Cleft Palate program at the Oregon Health & Science University, also in Portland. I now know that it was the carotid artery on the left side of his brain that was torn. Dr. Kuang was unable to see artery tear as the carotid is in the back of the head and out of her sight at the time of the surgery. So far, I've not heard anything from the autopsy but if I learn more I will send more info if you're interested or know someone who is.
Doctor Kuang has apologized many times and even came to see Justin prior to his passing. She hasn't had an easy time either having never had anything like this happen before. I still feel it was an accident. It's just going to take time to heal. I miss him."
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But since I'm not a member of that blog, i could not read all of the posts.
I'm guessing that forum shut down. I used to be a member but I can't log on anymore.
On the topic of complications - this is a good slideshow (although definitely not directed at patients)
https://www.slideshare.net/ArjunShenoy3/orthognathic-complications
It goes through pre-surgical, intraop, and postop complications.
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I'm guessing that forum shut down. I used to be a member but I can't log on anymore.
It doesn't appear to be shut down: http://www.jawsurgeryblog.com/forums/
My guess is the admin culled old accounts that haven't logged in for a certain period of time. It's a common cleanup.
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Maybe they've stopped registrations too because when I click on register it goes to some clickfunnels website.
ETA: Managed to recover my account and log on. There's not much more info in Justin's post except
"Hi. I'm Justin's cousin and not a spammer. What we know of what happened to Justin is not clear except that in moving the jaw the artery on the left side of his brain tore open from jostled ligaments and began to bleed. Justin fought for five days but ultimately it was not enough. There are no recorded previous cases of it happening. It was an accident."
Someone in the post also linked to a different case of someone dying during jaw surgery
https://www.manchestereveningnews.co.uk/news/greater-manchester-news/docs-tried-to-save-zehan-939420
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I'm guessing that forum shut down. I used to be a member but I can't log on anymore.
On the topic of complications - this is a good slideshow (although definitely not directed at patients)
https://www.slideshare.net/ArjunShenoy3/orthognathic-complications
It goes through pre-surgical, intraop, and postop complications.
Well, that certainly is in line with the header description of 'LOTS of'.
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I'm guessing that forum shut down. I used to be a member but I can't log on anymore.
On the topic of complications - this is a good slideshow (although definitely not directed at patients)
https://www.slideshare.net/ArjunShenoy3/orthognathic-complications
It goes through pre-surgical, intraop, and postop complications.
Interesting that "Counterclockwise rotation of the mandible be avoided" is listed as one of the methods of preventing relapse (slide 70). It's indicated so often that i'm surprised it would be presented that way. I guess it's 'technically' true though.
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CCW increases relapse. Muscles win when in a battle with bone.
Large CCW is especially prone to it. If the forces are in balance you won't get relapse, in general.
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CCW increases relapse. Muscles win when in a battle with bone.
Large CCW is especially prone to it. If the forces are in balance you won't get relapse, in general.
Do the muscles gain mechanical advantage against the displacements more during CCW than straight MMA? I’m trying to visualize why it would be less stable. I’m not really familiar with facial muscle anatomy and which muscles pull which direction.
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Do the muscles gain mechanical advantage against the displacements more during CCW than straight MMA? I’m trying to visualize why it would be less stable. I’m not really familiar with facial muscle anatomy and which muscles pull which direction.
I think with CCW they're pulling more directly backward, which puts force on the TMJ.
But I'm not positive.
I was just told by several surgeons that muscle > bone in any fight/imbalance.
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Oh gosh :'( There's a member of the jaw surgery support group on facebook who died this week, a couple of days after her DJS. No word on what happened to yet.
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Oh gosh :'( There's a member of the jaw surgery support group on facebook who died this week, a couple of days after her DJS. No word on what happened to yet.
Wow, please share any updates if they will come along. Who was the surgeon? What went wrong?
Thanks.
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I saw that too april. she seemed relatively young too :(
Not sure of the details but she was from Houston TX.
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Oh gosh :'( There's a member of the jaw surgery support group on facebook who died this week, a couple of days after her DJS. No word on what happened to yet.
I read something about having diabetes. Not sure if that's a risk factor, but surgery in general surgery comes with a risk.
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Nah, well besides from her family no-one knows what happened yet or if she had any pre existing health issues. I saw that comment about diabetes and I think it was written about someone else.
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Nah, well besides from her family no-one knows what happened yet or if she had any pre existing health issues. I saw that comment about diabetes and I think it was written about someone else.
Regardless, I don't see a clear connection to jaw surgery being dangerous, but more a general surgery risk, or maybe even unrelated to that as well. There's way to little information and unfortunately accidents happen, even to people having jaw surgery.