jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Rico on October 17, 2014, 10:10:37 AM
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I had more consultations including Dr Z. but MM has got teoretically better sollution for me..... but at the same time there is a few bad opinions
Generally I need 2 procedures during surgery
1) release infraorbtial nerve from compression . MM has got experience with that its not dangerous ...no ther risk (OVERLOOKED CHEEK FRACTURE, INPROPERLY HEALED)
2) osteotomy of whole malar complex: MM told me that no big risk, but other surgeons tells that too high risk of diploplica (double vision) , even loss of sight. Additionally small zygomatic nerve will be damaged...but I'm afraid of any numbness. MM told me that most patients do not fell any distirbuances after destroying this small nerves (supply feeling to the side of the cheek)..However I think they has loss of feeloing, but do not bother about that... and I'm different
I'm thinking about constricting to the first procedure.... but still flattened cheek will by annoying for me...and additionally I don't know if they return me more then half of the money. I have to pay for whole surgery till tuesday, if I wont do that, they will cancel my surgery
What a mess
dont know what to do
stress is killing me.... problem with no good solution, there is no escape and i'm depressed
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MM destroys more than nerves. That's all I will say, you know my views on him.
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I know..but noone can perform such surgery... which surgeon is worth to consider also.... and not to expensive
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Thing to remember about M is that he talks a good game, like he can do anything with no trouble at all, sadly his ability just doesn't match up to that as many of us have found out to our cost.
What did Z say?
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Don't let pressure on you! You have doubts that are justified vision loss, dyplopia, permanent numbness.
Don't pay the other half of surgery fees. Search the dialog with Moammerts what are your concerns and explain him that you are not ready for surgery.
They must refund you the money maybe you pay some penalty 200-500 euros.
Don't tell him that you have no confidence in his skills as surgeon say something else..so you can go to him in the future if he is really the only one who can perform this surgery. You have good arguments that you are critical to this procedures. I think that other surgeons (Obwegeser, Triaca, Sailer, Sandro Pelo) do this surgery too. 100 percent shure is Dr. Obwegeser in Zürich he is one of the skillest surgeons what concerns reconstructive maxillofacial surgery. Ask for opinions about this specific procedure. And when you have 2-3 more opinions from experts that performs this surgery you can choose without stress. Your situation is not good to perform surgery on you believe me.
Yes I agree with this. You intentionally ignored Switzerland which has arguably some of the best maxfac surgeons in the world. It will cost you more to go there but it's worth it, imo. I'd also see if you can do an online consult with Prof Andrew Heggie.
Sandro Pelo I don't know an awful lot about, though the general opinion is that he's very thorough.
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As Modigliani asked you, what did the other surgeons you saw say? What did Zarrinbal say? Who was the third surgeon you saw?
If you want good advice from people who are knowledgeable on this board (there are several really good ones), you need to learn to write clearly. It' s not about the fact that English is not your first language. It's about the fact that you need to provide more detail, and you are not trying, asking impossible questions that no one can answer based on the little disjointed things you say. This is how you might want to try it:
I went to see Dr X.. He told me XXX, which was different from what Dr Y told me, which was XXX. Dr Z agreed with Dr X on this, but disagreed with Dr Y on this, etc.
Only when you try to write like this, people may be able to give you good advice and critically analyse what you have been told. You should never be told what to do here, that's a personal decision and you are just asking the wrong question over and over again. But people here can help you structure your mind, formulate clear and further questions for your prospective surgeon, suggest what to do next etc.
So, sit down, take your time and provide all the detail you can about your previous consults and your current concerns. Have a good dictionary beside you, re-read what you have written to make sure people can understand it before you post.
As I said, there are good and knowledgeable people here who will try to help when they can.
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FALCAO: I know now, why Dr Z has got only one bad opinion (on german forum) He do not operate very complicated cases or do not do it in more diffiicult way.
Ideal approach for my case is to cut the bone in the place where it broke and make reposition to original place. But its the hardest option, however it give the best results if it is succesful
I had 4 consultations in Poland. 3 of them told me that its impossible to be done. 4th told me that he can...but I couldnt find any opinion on internet. the 5th told me that she can do only decompression of the infraorbital nerve. but what interesting I told her I consider MM for doing that, and she told me that MM is very good option.
So 5 in Poland + MM + Z ...nothing more
DR TRIACA: I sent mail one week ago to his clinic. I wrote what I want and I havent got any response. Because of distance I always try to get some initial information including prices circa about
Do You have actual direct mail to him ?
I know some of you have bad opinions about MM. I take it into mind...however at the same time I;m completely not the same case like You. I will show you how my fractures looks like and where the cuts should take place. Noone of You have had such procedure. This is why I look with a little distance at bad opinions.... and waht about other thousands people who he operated???
OK: MM told me that line of the fracture is visible and he will cut along them. No diploplia risk, because he will not operate inside orbital. He will cut just the malar and zygomatic arch and pull the bone - lever effect - so the upper part - very thin part of the bone including orbital floor (less then 1mm of thickness) will brake resulting in release of the whole bone complex. However I don't know why during this small zygomatic nerves will be destroyed ??? he will cut at least 3cm from them . He also has got an experience with decompression surgery under microscope - what is interesting for me. If he tells the truth
Z.. told me that the line of the fracture is invisible now. He do not use 3D models, He hd a problem with reading my scans - stragne - however as you can se the line is clearly visible... He used to make full osteotomy including orbital to cut whole complex (in oposite to MM during this procedure he also get inside orbital which is dangerous), but now he doesnt, because there is risk of visual loss [of course rare but it can happen] and more likely for example 10% risk o persistent double vision...I told him about other surgeon approach, and he told me, that he is not sure, because it will be a little uncontrolled breaking, He never used to do it in that way. He also claims any movement of the whole bone may results in diploplia. However the bone move about 3mms horizontally and after fracture I diddnt have diploplia. He offered me cut a little bone around infraorbital foramen and then cut falf of the zygomatic bone.
This VR of my CT
You can see 3 points small holes on the side of zygomatic bone. Zygomatic nerves goes out there. So why in MM plan they have to be cut ? Probably during accessing zygomati arch throught the mouth. I can ask MM about other approach - perhaps near from the temple ? in Z plan there is also risk about it
AFTER FRACTURE THE BONE GONE INWARD WITH LITTLE ROTATION
img
img
The plans of MM [red line] and Z [green line] the black is what is goona to break during pulling, when the main part of the bone [the stronges] will be cut
img
NOW YOU SEE ?
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Yes I agree with this. You intentionally ignored Switzerland which has arguably some of the best maxfac surgeons in the world. It will cost you more to go there but it's worth it, imo. I'd also see if you can do an online consult with Prof Andrew Heggie.
Sandro Pelo I don't know an awful lot about, though the general opinion is that he's very thorough.
No I asked in Switzrtland - 60K Euros....its too much.
TRIACA: can't get any information from him. The domain pyramide.ch is banned. Tried to sent from different mails account without results...acutal mail needed on another domain .Do You have ? Before I go to consultation I need some initial information including prices
What do you know about costs in Pyramide.ch (dr Triaca) ?
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I sent you a PM with some contacts. I hope that helps.
Regarding Mommaerts having bad results because he operates on complex cases and Zarrinbal doesn't - I don't buy it.
I had a straight forward BSSO - how difficult do you think that is? The surgery has been around for decades. He screwed it up completely. Not according to me, according to his colleagues, other surgeons that i have seen since.
Zarrinbal does wing osteotomies which are technically demanding, otherwise there wouldn't be a handful of surgeons in the whole world that do them. I'm not trying to defend him because I have not had experience with him, but he told me he does revision cases which are very difficult and other surgeons do not dare to touch.
Mommaerts may be "cheap" on first glance, but thanks to him I spent 5 times more than I should have and I am broke.
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I sent you a PM. I hope that helps.
Regarding Mommaerts having bad results because he operates on complex cases and Zarrinbal doesn't - I don't buy it.
I had a straight forward BSSO - how difficult do you think that is? The surgery has been around for decades. He screwed it up completely. Not according to me, according to his colleagues, other surgeons that i have seen since.
Zarrinbal does wing osteotomies which are technically demanding, otherwise there wouldn't be a handful of surgeons in the whole world that do them. I'm not trying to defend him because I have not had experience with him, but he told me he does revision cases which are very difficult and other surgeons do not dare to touch.
but he do not make full osteotomies which is the best way in my case. I did some medical research / articles. However its the hardest option and more risky...because its close to eye
wing osteotomies is not my case.
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Yes, I know, what I am trying to say when you pick up a surgeon you do not judge him based on one isolated procedure, but his competence overall. He told me everything I needed to hear as well before the surgery, and look where I ended.
I am not trying to dissuade you, you are misinterpreting me. I am trying to make you go and see more surgeons, and use my PM as a start. You lived with this condition for a long time, you can live a few months more. Just make sure you are confident in your final decision, and as far as I can tell, you are still not there. There are never guarantees, and there will always be a risk you personally have to carry. It's the same with all of us here.
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I know. I'm here because I;m too afraid and still looking for more consultations.
I'm afraid if i cancel my surgery just 2 weeks before then MM put me on black list
BTW You have bad outcome when it comes only to look, or you have some damaged permamently nerve. If it was at least one year ago. You can PM about that.
DO YOU SEE BETTER MY PROBLEM ? :) I described everything
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Well, as i said probably 10 times before, I have seen many surgeons after Mommaerts and they were horrified over both the functional and aesthetical aspect of his result. I told you before it will have taken 3 surgeries by the time I am over to correct the damage he did, and i do not want to repeat myself.
Regarding your problem, yes I understand it better, but my answer is still you are asking a question that only you can answer at the end of the day. Wait for other people to respond and see if they have anything specific to say to you.
We all assume risks in our surgeries. I assume permanent sensation loss in my next surgery as well. It's my responsibility to understand how big that risk is and make a decision.
It's your responsibility to do the same in your case. In order to do so, you have to see many, many more surgeons and make an informed decision around how big the risk is with the different approaches, and then do a risk-benefit analysis.
Those surgeons that you saw in Poland must have told you that they can't help you for a reason. They thought I assume the risk is too high.
There was a guy here who had a specific, risky, procedure and he interviewed more than 20 surgeons.
You are better off spending some of that money you have saved on consults and wait more, even a whole year, than doing something you will regret for the rest of your life. I think I heard you say you are not in a real pain, rather some discomfort, nor your condition is life threatening, so you must do what's right and see many, many more surgeons.
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"Well, as i said probably 10 times before, I have seen many surgeons after Mommaerts and they were horrified over both the functional and aesthetical aspect of his result. I told you before it will have taken 3 surgeries by the time I am over to correct the damage he did, and i do not want to repeat myself. "
This is typical. They are competitors.
"It's your responsibility to do the same in your case. In order to do so, you have to see many, many more surgeons and make an informed decision around how big the risk is with the different approaches, and then do a risk-benefit analysis."
Yes. This is exactly what I'm trying to do. But there is another problem. The time... It seems I wont reapair it within 10 years and I'm getting old...and constatly stressed. Strange to feel pain and also a little not my face....its not big deformation, but little visible ..especially for me
I know everything..but every month give me more fixation about this... I mean obsessed thought. due to anxiety about this.
Teoretically I'm half dead .. and no drugs will help for that. terapy also.. I know myself. I just want to have my old face before fracture ...and as I see its impossible
"Those surgeons that you saw in Poland must have told you that they can't help you for a reason. They thought I assume the risk is too high. " yes and no. In Poand we have national health insurane. its reuired. You cannot quit from that. Any surgery is for free. However they often refuse any surgery if life is not threatened. I cant explain that. Its complicated
"You are better off spending some of that money you have saved on consults and wait more, even a whole year, than doing something you will regret for the rest of your life. I think I heard you say you are not in a real pain, rather some discomfort, nor your condition is life threatening, so you must do what's right and see many, many more surgeons. "
Right, but its very stresful. About the pain ..I can try only decompression. No risk....but leave me with a scar and still flattened side of the face ;). or access through the mouth..but in future they have to cut in the same place don;t know if this is good ? double scar ?
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This is typical. They are competitors.
100% wrong, but you are not listening so I give up. The surgeons I saw are in America and other continents and are in no way on earth direct competitors (most never even heard the name). Everyone who is established on this forum knows who I saw and when and knows that I am telling the truth.
Last piece of advice (after one hundred I have given you): if I were you, I would pursue the decompression surgery to eliminate the pain and go for a simple small silicone implant option (or even filler) which is much safer and will be probably more gratifying. There are surgeons who specialize in custom implants and who can correct asymmetry to a satisfactory aesthetic level.
Good luck! You will not hear from me again on this, as I understand now your brain is processing all the information you are getting in a very skewed way, and there is nothing else I can do to help apart from urging you to seek more opinions, starting with the contacts I gave you.
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Dr Z and many others told me that implants in my case will be not good option. Do not recommend. I asked about it...and also there is even more risk that small nerves will be damaged.
fillers, I dont want thery are not permament...I want to feel my hard bone not something soft like fat
as you see i'm very bad case
100% wrong, but you are not listening
I listen all the time. Since I'm here [only one week] I made one more consultation and 2 others are in progress... waiting for first response
I wish it was me... look at this. only one good opion :P perhap it is MM :)
http://lookyourbestuk.com/forum/viewtopic.php?f=11&t=39497
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I would heed the advice of the others and cancel your surgery payment, the last thing you need is to risk your money if they get weird about refunding. You shouldn't be having this many doubts about your surgeon at this late stage - your instinct is trying to tell you something, listen to it.
It's interesting that he now wants all the money upfront - it used to be half before surgery and half after, wonder what could have prompted such a change?
Forgive me for saying this but you don't sound mentally ready to have surgery with anyone at the moment. Keep on researching and thinking and only when you feel secure in your decision should you hand over money.
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It's interesting that he now wants all the money upfront - it used to be half before surgery and half after, wonder what could have prompted such a change?
LOL! Good point :)
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interesting. What about other clinics ? most of them wants half before ?
But not he....the clinic. His own clinic is in another city - in Sint Marteen-Latem - here I had frist consultation. In Brussels he operate in university hospital. I dont know how much he is responsible when it comes to financial of the max fac department
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12 months ago at the Brussels hospital they wanted only half before, then half after. I can't help but wonder if it's been changed due to his unhappy patients refusing to pay when they realise they've been botched. Maybe it's just a change in hospital policy, who knows ;)
I didn't know he still had his Bruges clinic, thought he was full time at UZ Brussel?
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no. he is at least 2 days a week at his own clinic. Its not far away ...only about 100km from Brussels
half before , half later..that should be
also as I've read 1-2 years ago prices were at least 2 times lower..WTF
heh I wrote message to MM as you saw...and my finger is on the button :P my finger is on the button "send".
hehe
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12 months ago at the Brussels hospital they wanted only half before, then half after. I can't help but wonder if it's been changed due to his unhappy patients refusing to pay when they realise they've been botched. Maybe it's just a change in hospital policy, who knows ;
You mean half before, half after and then some more just because their cost estimate wasn't accurate? I think I'd rather pay a full amount up front because at least then I'll know how much the damn thing will cost.
xdon82, have you consulted with any oculoplastic surgeons? This kind of stuff is right up their alley unless I've misunderstood your problem.
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haha no no no :) in my case 8500 Euros, However I might be charged more in the case when I have to stay more days in hospital, eventully additional procedures etc :D I had to sign that declaration :D
oculoplastic ? no I think its not right specialisation.. look at my pictures on this thread.. whole malar bone has to be moved
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I looked at realself.com and there were always a bunch of oculoplastic surgeons that gave advice in cases that involved malar or zygomatic fractures.
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I will take a look... however I think oculoplastic is needed when there is problem with the eye after trauma.. don't know
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I wrote to MM:
Dear Professor.
I checked confirmation and it seems put wrong IBAN code and got error on my bank reports I have to make transfer again
No problem because I have to pay till tuesday/wednesday - just 2 weeks before surgery.
But I still have a little doubt. I would like to be very concrete. Please read to the end.
On first consultation I told You that I will have bad reaction to any PERSISTENT numbness.
On approach you described me, small zygomatic nerves will be destroyed...and now I reliased we had a little missunderstanding. You told, that most people do not feel any distibrbuances post-op.
I realised too late, that probably they have distirbuances but they do not bother about this, becasue they used to want to change their face for a long time...
Perhaps you can send request to some of your patient about this. If they just do not bother or really do not feel any loss /changes of/in feeling. Unfortunately I think, its first option.
i'm not that case and loss of feeling on the side of the cheek will make discomfort me.
I have a little deal for You Professor. I know You dont like situation like this, so please do not drop my case, becasue I still want to have surgery...
I felt I would be safe in your hands and your are very skilled surgeon
For sure I would like to have decompression surgery especially when you have experience with that. Perhaps it will help and its not risky
When it comes to osteotomy I will make up my mind during our last constulation. I think we should have 3 consultations not only 2. But now its too late
Perhaps rebooking surgery ? its still almost 3 weeks before. Perhaps it will be a chance for other patient who needs to be operated faster.
Maybe You can give me a little consultation via Skype if You use it. I can pay for it.
I just not feel very good about possibility of damaging the nerves. Also do not feel good, becasue I know you will get a little angry at me.
Damaging for 100% during procedure is not the same like low risk of damage (when surgeon try to not damage)
Perhaps You can find another safe approach to save these nerves? Its important for me. Maybe i'm a good candidate to develope a little new method.
if not then please remake plan of the surgery.
Please tell receptionists (or other worker) to make new cost estimation for decompression only just in case.
But I don't know what to do. To pay whole amount of money or wait a while for a recalculation and eventually I will pay more using credit card in hospital just before surgery
I'm afraid of that If I send more then needed, I wil be charged additional strange fee and I wont get back enough of money. Please be understanding
Can you help me. Situation is stressful for me. What should I do ?
If you think that in fact we had a little missunderstanding about one or two issies and its too little time then please make a rebook possible [at least for decompression surgery]
at the same time please think about any new approach for my case to minimalize the risk of numbness
BUT PLEASE DO NOT DROP MY CASE
and I got this from him - dont know what to think ????
Dear Sir,
It just does not work your way.
All is discussed 10 times more than with other cases. Nothing changes with more talking.
My consultation lists are booked for 6 months.
If you do not prepay, than the surgery is cancelled for always. I have the right to choose the patients i like to operate. Your mails give me great distress. I hate living up to an operation with paranoia. There is enough other patients who trust me.
So no more emails please. You drive me crazy, which is not good for you!
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He's dropped you, count yourself lucky ;)
No, just read it again - if you prepay he will still deign to operate on you but don't dare ask him anymore questions ::)
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no y .... he is waiting still for prepay... but now its strange
i cant even take more information from him..nothing
i have last consultation just a day before surgery
i asked about another approach to save nerves... and he even didn't answer anything
so on a consultation a day before he will tell me that there is no other option
and then I will cancel surgery..and I even dont know how much money I will get back
or If i decide to do only decompression [simple procedure] I still do not know about costs.. probably they will take more money than should be taken
this is unfair. He left me with anxious feeling
Do you think many surgeons act in this way ?
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Trust your instincts FFS!
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haha no no no :) in my case 8500 Euros, However I might be charged more in the case when I have to stay more days in hospital, eventully additional procedures etc :D I had to sign that declaration :D
oculoplastic ? no I think its not right specialisation.. look at my pictures on this thread.. whole malar bone has to be moved
Oculoplastic surgeons are specialized in the eyelids, orbits, and the midface. So I think they can help you.
To be honest, I'm sill having a hard time knowing exactly what your problem is in the first place, as I haven't been following it before. Is it some sort of a orbital/malar fracture, is there more to the story?
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look at the beginning of the thread . I explained this. There are pictures. You can see line of the overlooked fracture. No problem with orbital. Only malar bone gone inward about 3-4mm (its too little to get significintlly decreased orbital volume causing diploplia) and rotated resulting in flat cheek. - no cheek prominence. The bone has to be cut on the fracture line and moved to the original position. In the maxillary bone there is infraorbital canal where is infraorbital nerve which supplys feeling to this part of the face:
(http://img.medscape.com/pi/emed/ckb/clinical_procedures/79926-81306-82660-140250tn.jpg)
Because the line fracture went throught the canal, there is now compression. Generally its compressed too long, but fortunately the compression is mild and I still have good feeling, but I feel pain on the whole area. Decompression at this stage gives a chance that pain may go away ..however its a gamble, because of the time which passed. But researches shows that often it helps even in prolonged cases
Decompression surgery is very simple. Problem is with moving this bone without a big risk. When you move zygomatic bone, then volume of the orbital increases and the eye may sunken causing diploplia. It must be done perfectly. But I want to do it all in one surgery
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OK, I just reread the thread and it seems like your final post confirms the questions I had in mind.
It does seem logical to go to a doctor with osteotomy background around that area. But the question is, do you actually know if MM has enough experience with malar osteotomy that distracts the entire orbito-malar complex? This is not child's play as the work involves maneuvering around the very delicate tissue of the eyes. Why not get the infraorbital nerve decompression surgery and then get an implant as falcoa suggested? It's a) far less risky and b) you'll achieve much better symmetry between your left and right malar bones. I saw a doctor in the US who did an orbital reconstruction on some very serious trauma victim. He used a custom implant that achieves 99% symmetry between the left and right orbits and is very much as straight forward as slapping on a jigsaw puzzle in its right place. All this malar ostetomy talk sounds unnecessary to me for something that has a high risk, moderate reward outcome.
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Trust your instincts FFS!
It's too late to do that when her mind is monkeying all over the place. I don't get a good feeling from any of this tbh.
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It does seem logical to go to a doctor with osteotomy background around that area. But the question is, do you actually know if MM has enough experience with malar osteotomy that distracts the entire orbito-malar complex?
So you still thinking, that I should make a consultation with oculoplastic. ? DO YOU KNOW SOME VERY SKILLED ONES IN EUROPE ?
I was thinking about implants, but too many doctors do not recommend it in my case, even Dr Z.....Zygomatic arch is also involved...too big implant has to be used to cover all of that. additionaly how you put implant not damaging zygomatic nerves ?. Look at 3 small holes on the side of zygoma.
BTW ..Refering to MM answer, my father told me, that MM put me under wall [can I say that in english? any idiom useful?]. I have no guarantee and dont know how much money the will return me if I cancel surgery one day before, or just accept decompresion surgery.
He told me that, its strange, that professionalist is not patient for the patients :) and additionally he used blackmail. - prepay or you will be on his black list forever
so I have to cancel surgery in Brussels. I dissapointed in MM. I used to have high hopes on him
Please correct sometimes my english :) It will be helpful for me to level up it
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This is typical behaviour from Mommaerts and he told me almost exactly the same thing when he told me that he doesn't want me as a patient anymore. It's amazing that he hasn't learnt a damn thing and still continues with his "I'll fix it" bulls**t and expects the patients to just accept what he says. That's exactly how you end up with patients that have unrealistic expectations. It sucks that you've already paid half the amount but surely they will pay you back if you cancel the surgery? They might charge you an administrative fee or something but unless you've signed a contract already then I don't see how they can legally withhold the money.
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So you still thinking, that I should make a consultation with oculoplastic. ? DO YOU KNOW SOME VERY SKILLED ONES IN EUROPE ?
I was thinking about implants, but too many doctors do not recommend it in my case, even Dr Z.....Zygomatic arch is also involved...too big implant has to be used to cover all of that. additionaly how you put implant not damaging zygomatic nerves ?. Look at 3 small holes on the side of zygoma.
BTW ..Refering to MM answer, my father told me, that MM put me under wall [can I say that in english? any idiom useful?]. I have no guarantee and dont know how much money the will return me if I cancel surgery one day before, or just accept decompresion surgery.
He told me that, its strange, that professionalist is not patient for the patients :) and additionally he used blackmail. - prepay or you will be on his black list forever
so I have to cancel surgery in Brussels. I dissapointed in MM. I used to have high hopes on him
Please correct sometimes my english :) It will be helpful for me to level up it
Unfortunately, I don't know any occulplastic surgeon in Europe. Having said that, I don't think you absolutely need them. I made the recommendation early on when I thought that you're complaining from orbital/eye problems. But seeing as the main complaint is related to the zygomatic bone being rotated inwards then a doctor who has experience working in the area like a craniomaxillofacial surgeon can help you, too.
You can still get the sandwich osteotomy (green line) to correct the zygomatic arch problem then get implants/filler for the rest of the zygomatic bone, depending on the severity of the problem. Try to fix your main concerns at first then evaluate the other stuff. If I were you, my main priority would decompressing the infraorbital nerve to relieve the pain and reset the zygomatic arch to its right position. Having everything done all at once adds more probability for error. So focus on these two things for now, and see how you malar bone looks after surgery.
As for the nerve holes, implants are typically designed in a way to allow the passage of the nerves through them without placing any pressure on the nerve, all of this can be worked out either by the doctor or during the planning of the custom implant.
Seeing as I don't have any experience with MM, I cannot dissuade you to look elsewhere, but looking around MM's patient in this forum should give you an idea whether you like to continue with him or not.
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generaly I can't contine with MM now, because He didnt answer me, if he can make another aproach to get access to zygomatic arch. His actual approach will cause zygomatic nerves damage. Look at my letter and what MM replied
For example: if he cen get access to the zygomatic arch from temple (under hairs) but didnt answered. I'm 1200kms from Brussels and he cant even give me a little more information via mail. HE EVEN DO NOT WANT TO REBOOK SURGERY in order to give us a little more time to make more consultations because of little missunderstanding. For me its strange behavior
doing 2 or 3 surgeries ? Most Surgeons told me that I should do it at once, because its not good to cut skin in the same place more then once.
In Poland there is project which allow to make an implant using steam cells. You know you can have your own bone. Ive been told that perhaps nowadays is still too early, but such technology should be available in few years. I think that implants are more popular in USA
I dont know If I want any foreign object in my body.
WHAT ALL OF YOU THINK ABOUT THE SITUATION MM LEFT ME IN ?
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This is typical behaviour from Mommaerts and he told me almost exactly the same thing when he told me that he doesn't want me as a patient anymore. It's amazing that he hasn't learnt a damn thing and still continues with his "I'll fix it" bulls**t and expects the patients to just accept what he says. That's exactly how you end up with patients that have unrealistic expectations. It sucks that you've already paid half the amount but surely they will pay you back if you cancel the surgery? They might charge you an administrative fee or something but unless you've signed a contract already then I don't see how they can legally withhold the money.
Gregor : SEE WHAT I WROTE TO YOU IN PM....AND THEN CONTINUE TO READ
No I haven't paid yet.
I wrote this to him one week ago: His answers are in red color.
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Hello Professor
We are going to have last consultation one day before surgery in order to talk about some small issues like whether augumentation of the orbital floor will be necessary or not, if will, then which material ..I prefer my own bone,…. You talked about some computer simulation, etc
I don’t know how much time are You going to give me on the consultation, but since I better write in english [I don’t use it in regular talk] I decided to write down all my concerns. I tried to visualise how this surgery looks like and during this process I encounterd two rather small , but important issues.
1. afraid of lost feeling in the area supplied by small zygomatic nerve. You told that this small nerve/nerves may be cut during accessing to zygomatic arch through the mouth and MOST people do not feel any distirbuances, but its unclear from the medical point of view. Perhaps just in case better try to save this small nerve/nerves. I fill nervous about this. I will discuss with you about incision in other place to get access to zygomatic arch and the disadvantages of the another approach. I hope it will be possible to have some another options.
I am not sure there is a way to avoid this.
2. Infraorbital nerve decompression. The outcome is a gamble. I know. OK. However I very care to do it ONCE and never back to the problem again. For example if the procedure will not help in the proper amount of the time after surgery [pain will be still exist] I i’m not gonna think “OK it didnt helped, but perhaps there is still compression deeper on the orbital floor” I’m thinking about exploring the whole canal and orbital floor to be sure about that - in that way I will feel more comfortable. I have read few months ago that in that case its good to explore the whole canal and orbital floor [if its save], because broken orbital floor can also compress somewhere the nerve, but it musn’t be in that case. I dont know if the CT can answer that. I saw whole article but I lost it. This is just an abstract:http://europepmc.org/abstract/med/17237691
I did recently a decompression for a German doctor. I was surprised it helped, even immediately.
That all my concerns. Nothing else. Of course we will discuss about that during consultation.
I hope that will not discourage You to help me, especially at this stage. Let me just know, is still OK ?
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Please note, that I just informed him about my concerns and didn't require any consultations via mail. I just wanted to know if he will be able to change some procedures. I was very anxious about this. I cant just go out from home/work and go to talk to him, because I live 1200kms from Brussels.
The problem was about destroying the nerves. His answer was so unclear that I wrote to him again. The message I copied here earlier in this thread
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I got answer from Dr Triaca (exactly from his secretary). He can't help me, this is what he probably said - probably because I'm not sure due to very strange quality of service in reception.
First of all domain Pyramide.ch [where he works] is banned. I tried to send form 3 differrent accounts. Nothing helped.
I sent one week ago using their website - no answer, so I didn't know if they had received. [something strange in syntax correct me]
Today I made a call to the receptionist and they told me that Doctor can't help me. For God Sake.. They could have answered me that via mail. My mail addresess are not banned.
BTW stupid receptionists :) I told them that they should send mails from any account, for example from gmail to see the error about ban. I think they didnt get it :)
F.... my case seems to scare the best surgeons.
When it comes to Switzerland, I also was thinking about Dr Sailer, but 50 000 Euros is too much for me. That told me his secretary - average cost
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generaly I can't contine with MM now, because He didnt answer me, if he can make another aproach to get access to zygomatic arch. His actual approach will cause zygomatic nerves damage. Look at my letter and what MM replied
For example: if he cen get access to the zygomatic arch from temple (under hairs) but didnt answered. I'm 1200kms from Brussels and he cant even give me a little more information via mail. HE EVEN DO NOT WANT TO REBOOK SURGERY in order to give us a little more time to make more consultations because of little missunderstanding. For me its strange behavior
doing 2 or 3 surgeries ? Most Surgeons told me that I should do it at once, because its not good to cut skin in the same place more then once.
In Poland there is project which allow to make an implant using steam cells. You know you can have your own bone. Ive been told that perhaps nowadays is still too early, but such technology should be available in few years. I think that implants are more popular in USA
I dont know If I want any foreign object in my body.
WHAT ALL OF YOU THINK ABOUT THE SITUATION MM LEFT ME IN ?
At the end of the day, you can choose to do whatever you feel is better suited for you. I'm just giving you options based on if I was in your place and had the same problem.
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At the end of the day, you can choose to do whatever you feel is better suited for you. I'm just giving you options based on if I was in your place and had the same problem.
Thank You. However, actually, I have no options.
I've heard that very good is Professor Sandro Pelo and Dr. Swennen
but most surgeons do not make full osteotomy (which gives the best result) so for 50% they wont help. Of course I will send a request to get initial information
Who can also be helpful in Europe ?
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Are you sure maxfac surgeons are the best option to help you? What about craniofacial docs, what do they do?
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I agree with Modigliani. There are trauma surgeons that work in the ER who see facial fractures almost every single day. Many maxfac surgeons are dentists with a speciality training in jaw surgery so I'm not sure how much experience they have with this kind of stuff (the path to becoming a maxfac surgeon differs in some countries though). You need to broaden your search. Since you live in Poland then I think Germany will be the best option for you since it's going to be cheaper and Germany in general has some of the most highly trained surgeons in Europe.
Paul Johnson and Sneddon in the UK might be able to help you since they have rigorous training and Sneddon has also worked as a trauma surgeon for many years (or maybe I have him mixed up with someone else). It's probably going to be more expensive in the UK than in Germany though.
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After trauma I didn't need surgery. it was simple fracture. In such case surgeon just pull the bone out using a hook and the bone go into its position and thats all. Of course in very bad cases surgery is needed. HOWEVER DO NOT MIX OLD FRACTURE WITH FRESH FRACTURE. COMPLETELY DIFFERENT THINGS. Fresh fracture is 9999999999999999999999999999999999999999999999999999999999x :) easier to repair
This doctor should have told me that that I should have gone to see max-fac surgeon [those days I didnt know about that specjalisation] Doctor who every day see traumas of the face - neurosurgeon and work in hospital didn't know that there was risk of fracture. I went to neurosurgeon - which is a colleague of my father in order to take a best possible care - What a paradox. Neuroseurgeon because after trauma I felt a little strange feeling and nothing more but a little bruise. Bruise masked a little deformation.
Modigliani: Ok but give me more info about craniofacial, names , etc - I thought, craniofacial is for upper part of face and general skull.. .max-fac for mid and lower parts.
Gregor Samsa: I had consultation with of the best surgeo in Germany. He hasn't got full solution for me. Generally the same like in Poland. They are afraid of double vision.... Wonder why MM isnt afraid about this.
I feel I wont find help and always will feel a little strange about this
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Ok but give me more info about craniofacial, names , etc - I used to think craniofacial is for upper part of face.. .max-fac for mid and lower parts.
You might be right, I'm just so used to associating them with jaw work. Can your father not advise the best way to proceed?
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Ok but give me more info about craniofacial, names , etc - I used to think craniofacial is for upper part of face.. .max-fac for mid and lower parts.
You might be right, I'm just so used to associating them with jaw work. Can your father not advise the best way to proceed?
"Can your father not advise the best way to proceed?" Don't understand. My father has no connection with medical world. He only has a coleague who is neurosuergeon. I talked to him. He didn't help. Generally at least he should pay for that stupid error.
btw craniofacial: http://en.wikipedia.org/wiki/Craniofacial_surgery
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Is there really no one locally who can perform the decompression surgery? Is it not a standard type of procedure?
Seems to me that you need to get that addressed first, then you can concentrate on augmentation.
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Is there really no one locally who can perform the decompression surgery? Is it not a standard type of procedure?
Seems to me that you need to get that addressed first, then you can concentrate on augmentation.
Decompression is not a big problem. Locally i found one surgeon who can did that, also Dr Z is able to...... Problem is to move the whole bone to restore cheek prominence.
I can go with decompression only. but I will feel good when I find full solution
at the same time Doctors advice to do it all at once.
Probably If I dont find full solution till end of the year I will make only decompression.
But still I will be a little not like me
However decompression procedure looke like this:
Incision through the mouth and foramen osteotomy - the most simple thing
but there is also possibility (not big in my case) that the compression is deeper in the canal. CT doesnt show that exactly.
So If after the first stage of decompression nothing will change after for example half a year , then surgeon has to perfom second surgery and remove orbital floor which after fracture cover the nerve. That surgical approach requires accessing to orbital which is more risky...so
So when you do full osteotomy in my case you also do full decompression which give you a certainty that there is no compression for sure and if that wont help then irreversible nerve damage occured and nothing can be done more
at the same time if you do it all at once can be a little more risky.
very difficult
You know what I think. Kinda funny is that, some not well known surgeon without any opinions [good or bad] can do that better than the most famous one. ITs just a gamble :(
There is too few opinions. In Poland I found one surgeon who can perfoem decompression only, and 2 who can perfom full osteotomy, but one of them is Monster like MM ;) the second has got good opinions generally but cant find anything about opinions in such cases
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Brussels continue negotiation with me ;) hmmm money extortion ??
I still give them 1% of chance. I mean fo 99% I have to cancel surgery.....but read this, strange
What do You think ?
PLEASE START TO READ FROM THE END
ME
All I need to know if he does have new solution for me [new surgery approach]. I asked about that and no answer still. This is important
RECEPTONIST
He will discuss your surgery during the consultation.
If you pay the ***** euro in advance, he will do the surgery.
ME
Actually I know that I have to drop repositioning bone procedure, and leave only nerve decompression, because Professor hasn’t answered me if he has got another solution (surgery approach) to prevent from zygomatic nerves damaged. Hence, I understand He doesn’t have and during consultation nothing will change
Generally its a pity that rebooking is not possible.
The whole situation is strange. It would be very nice, if Professor would give me guarantee that he has got another solution for me, which will describe me on the consultation. He knows that I want to avoid the procedures where some nerves HAS to be damaged. I told him that on the first consultation. If not I have to drop one [main] of the procedure
RECEPTIONIST
Hello Mr. ***********
Today I agreed with Prof. M****** that you would have to pay 75% of the foreseen costs.
During the consultation before surgery, he will discuss with you what will be operated.
If you decide to do the whole surgery you will have to pay the rest afterwards.
But even when you drop a part of the surgery it will never be less than***** euros.
Can we agree on this?
Thanks,
********
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LOL what a bunch of cowboys!
That hospital is without doubt the most unprofessional organisation I have ever had the misfortune to deal with. Ridiculous people, all of them, Mommaerts suits them well.
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This whole thing looks like one big hot mess.I say drop him like a hot potato.
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To honor of the bad experiences from Modigliani, Falcao and Plosko with Moammerts your attitude is immature.
On what you want out? Forcing the Prof. to do a new technique it's ludicrous....even if he will you don't do surgery by him I feel it. Don't span the arch too much it can be that your attitude against him will be contraproductive for searching a future surgeon when he will be infromed from MM.
How old are you 14-16?
First thing is if you don't thrust the surgeon then it's not good for surgery because he feels it and the risk is big that he don't do the best.
Believe me every surgeon will be irritated about your childish attitude.
Your letter to him is unprofessional and you let him know that you don't trust him entitled unjustified.
I know a very good surgeon in italy who is specialised in orbital cheek zygoma reconstruction he is a cranio and a maxfac. I have seen very good results from disfugerd people after accident etc. This man will 100 percent know how your malar complex can be moved more forward without destroying nerves etc. or at least he can say you if the MM techique ist justified or not. He has many patient from russia, ucraina, poland because he is one of the best in europe he made this november a meeting with Arnet and other maxfacs.
He is also friend of H. Obwegeser the first that has done le fort surgery. And that's will say something because Obwegeser are not friend with many swiss maxfac.
But I don't say you the name because you must first demonstrate that you are a upright person.
Or stay in Poland and wait till the bone breed is established what's an old hat Sailer do this since many years for the zygoma cheeks and it will cost you a fraction of what you believe to pay to other swiss surgeons. If you don't clearly explain the surgeon what you will no one can say you the tarifs. And of course I give you a recommandation.
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You don't understand. There is standard to cut zygomatic arch from the temple / behind hair to avoid destroying zygomatic nerves. You are not in topic. Many aproaches doesnt mean new techniques. MM just told me one option. You don't know whole case
How can You be sure that e has very good plan ? tell that for the people who are victim of his errors ...
To put bone after accident in right please is very simple.
Problem is to cut it again after healed improperly
Doesnt matter
Can't You just write the name of that surgeon from Italy ? I will contact with him
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Of course I understand. There is a basic why nobody cuts in the zygomatic arch. You proved it again that you are ungratful and cheeky. You want information about somebody that don't understand????Good luck!!!
Yes I agree with everything. You are right
Just please give me a name of that surgeon I would be thankful.
By the way: " There is a basic why nobody cuts in the zygomatic arch" - please tell me more
"you can possibly gain a new technique trough my case"
i never said that. It was not me. Read again - but doesnt matter
I need help. If you know such good surgeon juest please tell me the name, etc more info
IS IT Sandro Pelo ?
You also wrote here about Professor Obwegesser ? Which clinic? Europe ?
Its important for me
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OK. THX Do You know where Obwegeser works? cant find in Google
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Triaca ? I didnt discuss anything about surgery with his secretaries. She told me that Triaca cant help me. Die she lie ?
I would like to have a consultation with Triaca, Obwegeser, italian one...etc
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Are you shure that she discuss your case with him???????And when yes if she explained him the problem correctly?????
Secretaries are not interested to ask doctors problem about unsure future patients did you understand that?
xdon82 I try to help you like other in this forum. You are mistrustful and thats why it will be very difficult to a surgeon to make the decision to make surgery on you.
I explained you that Dr. Clauser has experience in this field and I have seen amazing results but you don't believe me. So
make me a favour. Visit one of this doctors and tell us when you are convinced to do surgery everything else is waste of time. Good luck
For God Sake. Two sentences in mail is nothing complicated. Receptionist are not so stupid, especially If I rang to them 2 times, just to be sure if Doctor Triaca has seen description of my case.
I would like to have consultation with all Doctors you mentioned, including Dr Clause
and I believe you
Pleasne answer my mew PMs and tell me. how do you get info about these surgeons ?
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forget Triaca for 10'000 he would cut you only the hair :D
And you are dazed and confused without plan intimidated from MM plan. And in search of the Supersurgeon who tells you that MM is wrong but can't do surgery for you so it will come out if you don't finally give you U-turn in your strategy.
It's not the quantitiy of consultations but the quality of it. If you explain to the surgeon in that way you explain it here nobody will understand you. And one consultation to Obwegeser or Clauser is absolutely enough but a consultation with sightseeing spot not an emailexchange so he can make a picture of it.
You are unable to recognize that you are on free-wheel... bashing MM by your consultation will not fruits wear. You must be rational.
Little missunderstanding. No surgeon told me, that MM is wrong....rather some of users here. Generally MM seems OK, but not enough good / safe in my case. I want to save my all nerves.. he can't do that
Dont forget about his failed surgeries... What do you think about users here who has very bad outcome with MM ?
BTW what do U think about Dr Swenen and Dr Noorman ?
can't find where Obwegeser works. Was looking in Google and nothing, I will try again....perhaps you can help :)
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Thank You I wrote also to Obwegeser.
MM has almost good plan. If he could save my zygomatic nerves during his procedure, I would have accepted surgery.
At the same time, I wonder Why almost every european country has god famous maxillo-facial surgeon, but not Poland hmmmmm
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there are many access. today I had consultation with one polish surgeon, and he never cut zygomatic arch from mouth, only from the temple...so as you see I can find
but he think that this surgery is too hard...
Chopin and Polansky :) haha
Where are you from ?
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How is my favourite Phantom getting on in his quest? :-*
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xdon - you asked me about maxfac surgeons from England, and i can only name a few - Johnson, Thuau, and you can access a few more by searching through whatclinic, but I wouldn't advise coming to Britain for your surgery because it's more expensive than on the continent, and there's nothing to suggest that any of the surgeons here have more expertise than the ones you have already spoken to.