jawsurgeryforums.com
Surgeon Information => Surgeon Reviews and Leads => Topic started by: LyraM45 on April 22, 2015, 06:11:59 PM
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I've been blogging my story through my jaw surgery process, but saw this board and figured it might be a good idea to leave my story here too in case anybody else is a future Kaiser Oakland and/or Dr. O'Ryan patient.
I'll try to make this short and get to the point (and apologies if I don't, since this is definitely not a short story!), and if you are interested in hearing my full story, you are welcome to check out my blog that I'll link to at the bottom of the post. I started ortho in spring of 2013 and got referred to Dr. O'Ryan for my overbite and gummy smile. I heard great things about her and got multiple referrals from a couple of Bay Area orthodontists I consulted with. Even after my nightmare of a case, the professionals I am seeing now for revision surgery to fix everything still can not believe I am a product of her work. She is definitely well regarded in the area.
I only had an initial consult, and then a two week pre op appointment. This is pretty standard for Kaiser. Speaking of Kaiser, you get what you pay for in my opinion. Now that I have seen what other max/fac care is like outside of Kaiser, it's night and day. You really are just another number with them, and the care is minimal; very treat em' and street em' approach. Anyway, I am a super informed patient as well as a scientist who understands all of the technical aspects of this procedure. I did my research, and wanted to know all the details of my case. Dr. O'Ryan would never share details with me, despite multiple requests. In particular, I wanted measurements and a surgical plan. She would just respond with something general like, "I'm going to move your lower jaw forward, your upper jaw impacted up and forward a smidge." Finally my orthodontist, after sensing my unease with this, consoled me and reminded me about how he's done a ton of cases with her and this is just how it works. Relax and trust them. I did, and proceeded with surgery.
My surgery was riddled with numerous surgical errors. I went in with a simple overbite/overjet and gummy smile, and came out severely yawed, twisted, canted, asymmetrical (both in the bite and physically looking at my face), with an overbite on one side (still class II over all, both dental and skeletal), and an anterior open bite. I came out worse than what I went in to fix. Is that a problem? Sure, but I understand mistakes happen. Not every case comes out right. Where my nightmare begins is the care (or lack there of) post op. It was evident around 3 weeks post op that something was wrong, but Dr. O'Ryan just kept giving me the thumbs up and saying everything was great. I finally pushed the issue, and she finally admits to just the cant of about 2-3mm down on the right side of my upper jaw. I told her that I was not upset, and that I more than understood that mistakes happen, but I just needed to know that we were in this together and we were going to figure out X was wrong and Y was going to be done to fix it. I got rushed out of her office, and to make a long story short, I never heard from her again. I tried multiple times through Kaiser and through direct emails to her to get an appointment to get examined and find out what else was wrong (because I could feel that there was definitely more off), but she just kept telling me to work with my orthodontist and she would be in touch. She was never in touch. This was a crucial period in time as I was 4 weeks post op, prior to any bony fusion of the osteotomies, and they could have gone in to fix everything without a total revision that would rebreak my jaw and cause a separate long healing period.
From 4-8 weeks post op, I was in the dark. My orthodontist did not step up for me for whatever reason (possibly covering up for the surgical mistakes and didn't want to throw a long time co-worker of sorts under the bus?), and by 8 weeks I wanted answers. 10 weeks post op I was able to go for my first appointment for a second opinion with Dr. Gunson. I saw a few other leading names for jaw surgery, as well as a few other more local mom and pop surgeons. All of their opinions were unanimous, and none of them could understand how I came out so crooked and twisted and not have Dr. O'Ryan step up to fix it after I was so understanding. I sent Dr. O'Ryan Dr. Gunsons records and he offered to even talk with her, but I heard nothing from her still. It wasn't until I logged a complaint against her with Kaiser that she reached out to my orthodontist and said she would talk about the records that Gunson sent and get with me. This was now 4 months post op, and 3 months since the appointment where she rushed me out of her office and she wouldn't see me after. At that point, I was done with her and was pursuing another team to handle my revision.
So, I went in with an 8mm overbite/overjet and a gummy smile with no asymmetry or other significant issues. Now I am canted 2-3mm down on the top jaw, have a 6mm overbite, both jaws are yawed (twisted) with the bottom being yawed so severely that it has physically disfigured my face and caused obvious asymmetry, midlines off 2-3mm, anterior open bite, and I still have a gummy smile. I found out after the fact that my upper jaw was moved forward a whopping 4mm (and was only supposed to come forward a "smidge" since it was already too far forward and prominent in my class II case), and because of that my lips can't close without strain, cramping, and visible dimples around my mouth and chin. I felt like I had a chimp face from day 1, and found out it's because my top jaw should not have come forward at all (if anything, backwards is where it should have gone) and she did 4mm advancement with no notice to me either pre op or post op. I am now in braces again and scheduled at the end of this year to have a total revision to try and fix all of Dr. O'Ryans mistakes. Some of them are permanent, like the disfiguring of my jaw where it's been yawed out and now bulges out on the left side of my face. Again, all of the surgical errors can me chalked up to "crap happens," but the care I received post op was not only below the standard, but it was down right immoral. You don't leave a patient hanging high and dry when they need you the most. If you make a mistake, it needs to be fixed instead of running away and pretending like it never happened and your patient isn't a human being that exists and needs you. I was VERY understanding, so it was an even bigger let down that this is how she handled my case. I know there are patients who have gotten their work done with her and things have come out great, and the same could happen to you in the future (for any future patient of hers reading this), but this is my story. This is what she did to me, and this is the professionalism she showed when the going got tough. I know I wouldn't want somebody operating on me who is going to leave you hanging high and dry if it doesn't go well. Mistakes happen. We can't expect perfection 100% of the time from these doctors who are not gods. But, what we can ask is that they are willing to work with you to make it right and put in their best effort to abide their oath and do their fiduciary responsibility when it comes to the patient. I didn't get any of this from her, and it's almost criminal. I feel violated, and my trust for any treating doctor for me in any area is now shattered, and it probably will remain so for the rest of my life. I am out thousands of dollars and 1-2 months of leave without pay from my job, but the thing that cost me the most was a piece of myself emotionally. Fine, she messed up my jaws more than they were messed up already, but the emotional damage she has done to me through all of this is irreparable, even after a successful revision surgery to fix all of the impacts from her mistakes. I would hate to see another person go through that with her, so for this reason I have to share my honest report on what happened to me.
I tried to keep this short, but it's a long story! If anybody is interested in reading up on the course of events from day 1, feel free to read my blog.
Thanks, and good luck with your jaw journeys everybody!
http://confessionsofametalmouth.weebly.com/ (http://confessionsofametalmouth.weebly.com/)
Picture: 2 weeks pre op pictured on top, and the bite on the bottom is about 5 weeks post op.
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thanks for sharing. I am very, very sad for you, yet i am sure you will fix this.
I hope and wish you the best, thanks for sharing
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Thanks :) I hope I can get this fixed too. My new team seems to be really involved, paying a lot more attention to detail vs. my first team that did not, and I feel like they genuinely care and feel really awful that I am in the position I am in and had the experience that I had. I'm not expecting perfection out of this revision, as the mistakes are so bad that this is going to be extremely challenging for them to get it 100% dead on corrected, but I am hoping it can improve the state I am in now (which is worst than my original pre op state I went in to fix!) and hopefully get me out of some of the pain/discomfort that came with being left so crooked and twisted.
Revision is slated for Dec/Jan at the end of this year. Counting the days!
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What an absolute b*tch your surgeon is, not only did she (or the rookie?) screw up what should have been a routine surgery, she completely mismanaged you afterwards. It's f*cking appalling but unfortunately all too common, so many of these clowns let their giant egos get in the way of their ethics.
Thank you for sharing your story, I know how painful it is but naming and shaming these butchers is often the only come back we have.
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I'm really sorry this happened. What I don't understand is why she didn't quietly offer you a revision at no cost. Given her volume of work, this would've been a minor hit to her income, instead of a huge reputation hit. Unless she is not that good and fears screwing up even more.
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Modigliani-- It is sad that this happened, and it's sad it happens quite often in many areas of surgical practice. As for the screw up possibly being the rookie, that is a theory on the table. There were two residents working with her the day I was operated on. I didn't know either of them. The one took charge of the case right off the bat, he's the one who wrote my long operative report, told my family how I was, took me to post op care, did my exam and discharge from the hospital the next day. My surgeon was basically hands off, so I assumed from day 1 that he pretty much did my case. This was before I suspected anything was wrong. After all of this has come to light, it made even more sense, and totally makes sense in terms of why would a good surgeon would distance herself so quickly from a mistake like this. Part of dealing with my surgical outcome would have been admitting that not only did she not do the surgery, but I suspect that maybe she didn't even stay to check the work before these guys finished me up. I've had multiple surgeons that I have seen for revision consult tell me they don't think she did the work, as they are very familiar with her work. They said my work is so sloppy and awful that it couldn't possibly be the work of a good surgeon like my primary surgeon. So, 2+2=4 for me here, but I will never know the truth there unfortunately.
PloskoPlus-- I got operated on with Kaiser. For my surgeon to do a revision on me, it would cost her nothing. This is not a private practice. She is just one surgeon within a huge HMO, and it would have zero financial impact on her.
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Ha! I joke and say that all the time. "This chick must have been drunk or something!" lol. Honestly, her drunk work probably still would have been better than what I believe is the sloppy work of her resident.
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If you haven't seen the 1 year post op post, check it out here: http://confessionsofametalmouth.weebly.com/blog/1-year-post-op (http://confessionsofametalmouth.weebly.com/blog/1-year-post-op) I go over some of the more physical things like where I am at at 1 year post op with the numbness and all. In general, I have not really gotten any additional feeling back in the last 5-6 months. I was numb across my right side up to my lower eye lid immediately post op, but my left side came out just fine. I got the feeling back in the upper half of my face really quick within 4-6 weeks post op. My lower lip and chin took a couple more months to feel any difference there. I would say by 6 months post op, that is what I've been left with. It's a strip right down the right half of my lower lip and chin. The gums across this area are also numb, tingly, and weird feeling. Conversely, I have a few spots (especially around my upper right K9) that are hyper sensitive. Both things I've learned to live with and oddly enough (maybe because of all the other things that have happened that make the numbness such a small issue in comparison) I am not losing sleep over the thought of additional numbness during the next surgery. It sucks, but there is nothing I will be able to do about it at this point.
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I am so sorry this happened to you. I wish the best for you.
I am having surgery with Felice O'Ryan and will definitely update everyone about it.
My orthodontic has had several clients that needed jaw surgery and they did it at Kaiser with great results, I met one
girl at his office once.
I also wanted to note to people reading this that I believe just as your doctors mentioned, that it was an error on the "resident's" part, perhaps.
Usually a main doctor will operate with a resident, it's optional, people can ask for only main doctors to be there, so everyone take note.
I was told by my orthodontic and research I did here and there that Felice O'Ryan is actually one of the best doctors in the country,
and that Kaiser is highly experienced in this type of surgery.
I wanted to mention this as well because I know so many people do it at Kaiser with great results, and
it can be so scary for people reading bad experiences that might be a small percentage as it happens with any procedure.
So people should look at both sides.
Nonetheless, it's important for people to be aware of their options and to understand all the risks as with any procedure.
Thank you for sharing your experience and I hope it resolves as you wish.
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Thanks for the well wishes. I am actually going in for my full revision tomorrow. I am hoping it can all be sorted out this time.
RE: resident. I knew she worked with residents. I actually signed paperwork before my surgery stating that she would be the one doing the surgery and the residents would be observing/assisting. If it was a resident error, then it's still no excuse for how she treated me after when things went terribly wrong. No excuse at all.
Research is important. Sounds like you did a lot of the same research I did. I also met one of my ortho's patients who had their surgery with her. Every ortho consult I went on had brought Dr. O'Ryan up as one of the best. The ortho I settled on had her at the top of the list, so that is who I went with for surgery. The fact is, every doctor can make a mistake. Whether it was the resident or her, it was ultimately her responsibility to step up and take care of me after, and she did the complete opposite. We can't ask for perfect results. Facts are they don't always happen and it's unfair to expect perfection. But what we can expect is that they step up and abide by their oath and do what is right to make the situation better if they can. To stand by their patient when they need them the most. Because she did not, that is where she becomes a disgrace in my eyes. I was never upset at the fact that I was botched and that there were copious surgical errors. I was upset with the treatment (or lack of) after, which I think if fair and more than warranted.
Out of my research and all of the patients I have talked to, I found most are happy with Dr. O'Ryan. I have found a few people in my shoes who ended up with wonky results and all she did was try to talk her way out of them and try to make it like it was all OK and nothing was wrong. One of them even went for a second opinion with Dr. Gunson after I urged them to (after looking at their xrays and pictures of their results and it was obvious it wasn't right and she was telling them it was all OK like she did with me) and he said they were not right and required a full revision. So, since my surgery and talking to a few of her patients, not only does she have a proven track record of not stepping up to fix things if they don't go right, she has a proven track record of not admitting or alerting you if it's off in anyway, so you should remain on your toes after your operation to look out for yourself there. I was catastrophically off. Not a little bit off, but so much off that none of the surgeons or professionals I have seen can believe I was even discharged from the hospital like I was, let alone continually smoothed over and passed off post op despite both me and my ortho telling her things weren't right. I hope you don't end up in that position and I hope that your surgery goes perfect so you don't end up in that position. While chances are your results will be good (overall chances with any surgeon for this procedure are that you'll be OK), seems like the chances are not as great that you'll receive the best care if your results aren't good.
People reading blogs and stories about surgery should read them with caution. 9 times out of 10, people posting online are doing it because they had issues. I would like to think I am a rare case, because my blog has been going since day 1, even before I got my braces on. So, it's a completely unbiased story, telling it how it's happened since day 1. I wanted it to be a perfect fairy tale story, but unfortunately it was not. So, all we can do as patients is hear these stories, take them in, evaluate it with the risk vs. reward you have to think about, and decide to do what is best for you. Unfortunately, having surgery with Kaiser and Felice O'Ryan was not what was best for me. With any surgeon you're going to have to roll the dice. A main risk is an undesirable outcome. But hopefully you have a surgeon who is willing to work with you and try to make it better if you do in fact have an undesirable outcome. It's the basic standard of care......and I didn't get that.
Good luck with the rest of your ortho and surgery! If you ever need anything down the road with regards to Kaiser/Dr. O'Ryan, feel free to send me an email off of my blog or PM here. I hope that you don't, but unfortunately I have already been counsel to several other patients of hers since my surgery. So if you end up there, you know where to find me. www.confessionsofametalmouth.com
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Another quick reply ahead of my revision surgery tomorrow-- I am hoping we can at least make what I've been left with better. My surgical plan looks solid. The ortho appears to be done much better ahead of surgery this time. My surgeon and ortho have been in much better contact and planning a lot more than my first surgery. I've gotten so much more care and attention to detail this time around. I've been sent for so many more scans, shown 3D modeling, 3D planning, had everything shown and explained to me in detail. I never got that with Kaiser, and I definitely needed it.....well, no, I DESERVED it this time. I am so twisted and canted that they aren't sure they'll be able to get it 100% perfect, but even if my surgeon can do half of what he's hoping to do, I think I'll get some relief from this awful bite and jaw positioning I've been left with.
Through all of my MRI/CAT/Xray's, I've found out I've seen some joint damage from the way my bite was left. I've lost bone on my top jaw, and some of the bone on my bottom jaw did not heal fully. They are bringing some grafting material in to fix me up just in case its needed. I also found out my septum was deviated pretty significantly, so they are going to try to center that more but more than likely I'll need another procedure down the road to fix that. If they can't fix it in revision, I might also need another jaw surgery down the road to fix the facial deformity I have on my left form the first surgery when they set my lower jaw all bowed out and new bone has healed over that creating the bulge that sticks out the side of my lower jaw. But for now, looking at setting my upper jaw back 2-3mm where it was to begin with before the first surgery (and should have stayed there-- it was never in my plan to have a 3-4mm advancement the first time given I had an overbite to begin with), untwist it in the yaw direction, shift the midlines back over 2-3mm center, and take my right side up 2.5mm to level out the cant I was left with. Lower jaw brought forward 3-4mm (where it was supposed to come total during the first surgery), untwist it and center the midlines, and level out the cant on the lower too. My surgeon has a lot on his plate to try and fix this mess, but I am really hoping he can manage at least most of it to give me some relief, because I can't live with my bite like this.
Attaching files in multiple posts since I'm limited to a certain size for each.
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Pre op pictures.
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3D surgical plan
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3D surgical plan
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Proposed movements
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I sure hope everything works out for you!
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I'm on the other side!! Things felt different from the second I woke up. Even though I was terribly swollen, I could tell my facial asymmetry was better, the cants/yaws corrected, segments untwisted, and midlines were dead on. And even through the swelling, I can close my lips more comfortably. Really thankful that it looks like I am finally on a good path with all of this and my revision surgeon has worked wonders!
Xray is today, 5 days post op. Can't believe how straight everything is! My surgeon had an absolute mess on his hands. He wasn't even sure if he could fix it all because Kaiser left me that bad, but it looks like he's done a damn good job just looking at my first pano!! Incredibly relieved doesn't even begin to describe what I am feeling right now!
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Just wanted to wish you the best of luck during recovery!
I take it should be about 10 days since your surgery, wishing you all the best :)
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Thank you!! So far so good. Have my second check up with my ortho and surgeon tomorrow and hope to get in some looser bands, and hopefully the splint is off in another week or two. :)
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how's it goin?? great to hear this good news!
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Looking good still! Big smiles from both my surgeon and ortho at my second check up. Two weeks post op today. I get my splint off in 12 days if all continues to look good. Starting to really see the huge differences this time vs. the first surgery now that my swelling is way down. Check out my latest blog updates to see some of the latest shots and a short video update on my bite!
Take a look at a few afters from the first surgery vs. afters from this. HUGE difference! Attaching them in separate posts since the file size is so limited. This shot is 2 weeks pre op (top picture) vs. about 7 weeks post op first surgery (bottom).
www.confessionsofametalmouth.com (http://www.confessionsofametalmouth.com)
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this shot about 7 weeks post op original surgery.
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Last shot is about 10 days post op this time for revision.
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wow! that's some swelling; but yeah, i can definitely see a great result beneath that swelling!
bite looks solid, face is extremely proportionate, beautiful eyes and nose!
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Thanks! My lower midlines will forever be off because I had one of my lower incisors pulled to prep for revision (making an even bigger overjet to make room to move my upper jaw back where it needed to be again), and I am still a little class II on my right, but it was planned for my ortho to have that post op for some work he needs to do. I have no clue how much longer I'll be in braces, but at least I am at the point now where I can finally be finished with braces. Looking forward to putting this all behind me. Been in the game since Jan 2013-- first round of braces and jaw surgery was 23 months, and now second round right after the first. Been a long few years!
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that must've been tough...i've had quite a few surgeries myself!
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Oh no!! Best of luck with your work too! I always hate hearing when one surgery leads to many for us!
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5 weeks post revision yesterday. Time flies! My splint was taken out a few days shy of 4 weeks, and everything continues to check out OK. My ortho has me started in bands to close up the mm or so I have open on my right side. Continuing to see such huge differences in these results as time goes on. Most of my initial swelling is gone and I'm down to the puffiness around the nose/cheeks that tends to stick around for a few more months. But overall, still looking much better this go around!
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10 weeks post reivsion! Things are still going pretty well. Still amazing to see the differences in my bite post op compared to last time post op. My team is still incredibly involved, taking great care to make sure everything is on the right track this time. From what I understand, I think I could be out of braces in about 5 months.
Some recent shots of where my bite is sitting. Still a ton of work to do to fix the angulation on my front teeth, and then I have a ton of restorative work to do with a few implants on the upper front teeth that have extreme root resorption thanks to my first round of treatment that was done all wonky. So, still a long way to go, but in terms of the surgical hurdle we cleared, things are still going well :)
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Hi Lyra
I am wondering if you had any disc issues(TMJ disc) along the way? Any clicking, grinding or displacement?
I have a mild disc displacement which has thrown my whole bite off. I have been scared to proceed with all of this due to that, but my bite being off is destroying me slowly also. :(
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I started this journey with no TMJ issues. When I came out of the first surgery so torqued, I definitely had some issues. I think it's normal immediately post op to hear some clicking or crunching though, so don't fret if that is what you're feeling. Living with my jaws so torqued for 2 years def hurt things a bit, and my right TMJ saw the most movement for correction in revision, so that disc has not been happy so far the first few months of recovery. For the first time in my life, I got full slips. And once they started, they kept on going until I slept and got full rest for the joint. Then it would be totally fine. Now, 3 months post op, I haven't had a slip or anything wonky happen in the last 3 weeks now and it feels more solid now that muscles are getting stronger and the inflammation in the area is continuing to go down as recovery progresses.
Pre op I had no TMJ issues. One of the kickers with this surgery is it can either improve or worsen your TMJ problems. Just have to roll the dice on it.
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My last update to this thread. I just hit 6 months post op and got debanded yesterday. It's really surreal to be in this position now, finally at the finish line from this nightmare. Unfortunately the nightmare is not over. I meet with my surgeon tomorrow to talk about extraction and implant plans for my 4 upper front teeth that saw the severe to extreme root resorption my first orthodontist stuck me with. So, lots of work to do on the restorative side still, but the active ortho/jaw work is finally coming to a close after 3.5 years, two rounds of braces, the first botched surgery, and the revision surgery. My team is really happy. I don't even think they were going to be able to patch me up this well, but they have. I am incredibly fortunate to have found amazing doctors to help me out of the bad place my first team left me in.
I'll be updating my website with final records and stuff when I get them. I've made a final thoughts and treatment comparison summary page: http://www.confessionsofametalmouth.com/beforeafter-treatments-comparison-and-final-thoughts.html (http://www.confessionsofametalmouth.com/beforeafter-treatments-comparison-and-final-thoughts.html)
** Edit to add: Found out at my appointment that not only am I losing the upper 4 front teeth, but now my lower incisors are on the table to go as well. So, I could be losing 7 permanent front teeth thanks to all the damage done to me in my first round of treatment. Please people, do the research when choosing your trusted treaters. Know the red flags. I wish I had!
Good luck to everybody going through this. May the odds forever be in your favor that you have doctors like my revision doctors and NOTHING like my original team. I really wish I could go back and get a do over of my first surgical experience, but I can't. Only thing I can do is help people avoid it in theirs.
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Thanks-- my revision team really did do a great job patching me up given what they were presented with when I walked through their doors! Unfortunately the teeth have to go as far as I know/understand. All 3 of my doctors have looked extensively at this, and I am pretty sure they presented to their study groups and got opinions there too. They had their suspicions even on regular films, but it was all just solidified after getting full mouth cbct done last week and looking at cross sections of these teeth. The roots look a little better on regular film because there is more root left on the front of the tooth, where the back has very little to nothing. Not just that, but the nail in the coffin is that I've lost the bone on the back too, and this is what they are trying to avoid. I need that bone to support implants, so this inflammatory process going on is not going to stop now that it's at this point. I'll continue to see root and bone resorption until the teeth are out, so the longer I sit here, the more bone I will lose and risk losing the bone I need to support the implants and stuff.
It's a super unfortunate situation. My surgeon (who's been doing this a very long time) said he never sees resorption like this. A little resorption or even cases that go past a little is pretty common, especially for what I've been through, but what I've got going is to an extreme level. I'm pretty devastated, and I think they are just as upset for me. :-\
Attached a PA from a few months ago to show you exactly what we're talking about. This tooth, even on the front where my roots are better, has almost no root left in the bone.
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