jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: jawsaw on July 24, 2015, 11:03:58 PM
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When seeking a surgeon to perform orthognathic surgery, what is an adequate amount of surgeries performed per year? One would not want to have it done by someone who does 5 procedures a year. Is 50 an okay number? That would basically be a procedure a week. This is based on the assumption that the more frequent a surgeon performs a procedure, the better they are at it. It would be hard to imagine a surgeon who does 100 'bad' surgeries a year. Should one be weary of a surgeon who performs too many procedures a year, indicating hasty conveyer belt maxo-mandibular-mill haste? 50 seems like a reasonable number to me.
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like..
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I'm beginning to think that a pretty high level of uncertainty when choosing a surgeon is unavoidable. I have seen 4 surgeons who would perform sleep apnea orthognathic surgery on me. All 4 are highly reputable in their field. The locations are Boston, NYC, Washington DC, and Rochester NY. I don't believe there is a way to make a definitive choice on who will perform the best surgery. Thoughts?
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the truth is not much data will help you in choosing
it's a gamble
ok you can choose between surgeons who had more cases like you or less. who has little better opinions..but once again, the surgeons who try to help more number of patients in more complicated cases always have more unsuccesful surgeries...
You can go to Z.. who avoid complicated surgeries and has very good reputation. The less you do the less critics ;)
I tried to aim in the middle...I mean, I ruled out too conservative and too confident ones. (too optimistic) If you know your problem well, then you can easily determine who are not enought true with you. Nowadays medicine still sucks.... still a surgeon barely can repair something in 100%. mostly never. There is no 0% and 100% in medicine.
it's surgery, not picnic..everything may happen
one surgeon told me the best way of thinking when it comes to surgery is to:
Make few consultations (not too much) check where you feel better and then
if you think that your problem is not bothering you too much - avoid surgery
if sometimes you feel OK, sometimes not (with your mostly imaginated problem) - avoid surgery
if the issue really interfere with your life , then undergo
i think it's the most important key
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one surgeon told me the best way of thinking when it comes to surgery is to:
Make few consultations (not too much) check where you feel better and then
if you think that your problem is not bothering you too much - avoid surgery
if sometimes you feel OK, sometimes not (with your mostly imaginated problem) - avoid surgery
if the issue really interfere with your life , then undergo
i think it's the most important key
interesting advice. No more further surgeries for me then by this logic.
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the true is not much data will help you in choosing
it's a gamble
ok you can choose between surgeons who had more cases like you or less. who has little better opinions..but once again, the surgeons who try to help more number of patients in more complicated cases always have more unsuccesful surgeries...
You can go to Z.. who avoid complicated surgeries and has very good reputation. The less you do the less critics ;)
I tried to aim in the middle...I mean, I ruled out too conservative and too confident ones. (too optimistic) If you know your problem well, then you can easily determine who are not enought true with you. Nowadays medicine still sucks.... still a surgeon barely can repair something in 100%. mostly never. There is no 0% and 100% in medicine.
it's surgery, not picnic..everything may happen
one surgeon told me the best way of thinking when it comes to surgery is to:
Make few consultations (not too much) check where you feel better and then
if you think that your problem is not bothering you too much - avoid surgery
if sometimes you feel OK, sometimes not (with your mostly imaginated problem) - avoid surgery
if the issue really interfere with your life , then undergo
i think it's the most important key
really good advice.
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Volume of procedures is absolutely important! I asked an oral surgeon once this exact question and his response was that he'd let any oral surgeon operated on him who made jaw surgery a major part of his practice. He didn't give me a number but he emphasized the importance of recent procedures over the total number.
Short term volume is important to maintaining skills. Studies have compared surgery to playing video games, so much so that some surgeons actually play games before procedures to warm up. Ever play a video game, get really good at it, and then come back after not playing for a while? Sure, you have a good idea of what's going on and it may come back quickly but you need practice - recent practice - in particular to be great at a procedure. Operation time is critical to success, there's hundreds of steps, and you don't want a surgeon stumbling around because he's hazy.
Long term volume is important for better handling of corner cases. Surgeons who've done hundreds of procedures will have ironed out the common mistkaes. Surgeons who've done thousands of procedures will understand all the anatomic variants. Those who've been doing it a long time will have a better understanding of the fundamentals, the alternatives, the evolution of the procedure. That's nearly impossible to replace. Those with long term experience appreciate results, others have to settle for reading the text others wrote.
That aside, surgery is business and the more procedures a surgeon is doing, the more investment they can afford to make in improving it. That means subscribing to the latest crazy expensive journals, traveling to conferences, trying all the newest technologies, reading expanded textbooks, etc. I was just looking at oral surgery textbooks tonight. Your average surgeon receives about 100 pages of training material on oral surgery. Jaw surgery textbooks can be 10 times that length. He's not going to read all that unless he has good reason to. It's no wonder my local surgeon seems to lack a fundamental understanding of the etiology of my problems.
There are surgeons with high volume who are good but not great. High volume guarantees at least average performance and it is a necessary but not sufficient condition for great performance. The opposite can be said for low volume. What are the numbers? It seems that an average bad surgeon does 10/yr, an average good surgeon 50/yr, and a great surgeon 150-500/yr. That's 1/mo vs 1x/week vs 3-5x/week. A good surgeon has done at least a few hundred surgeries and a great surgeon has done a few thousand.
It should be noted not everyone needs a great surgeon. Many problems are simple to fix and a good local guy is sufficient. The trouble is, it can be hard to determine who is routine and who isn't. The patient certainly can't tell and it appears even orthodontists can't. The orthodontist in my city whose done the most adult surgical cases called my case "very routine", having only examined by teeth but never looking at my imaging. My dentist, by contrast, called my case very extreme. The next most experienced orthodontist I found, whose done hundreds of surgeries, has admitted that even he hasn't quite seen a case like mine yet. So if all these "professionals" can't agree on who's routine and who isn't, the only way for a patient to tell where they belong is to start by consulting the great guys and see what their opinion is. The sad reality of surgery :(
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Some surgeons public (part of research) from time to time opinions of the patients relative to specific surgery procedure. (with some, but unfortunately not many pictures - but still it's something)
Notes like:
not satisfied
satisfied
very satisfied
Most surgeons in big hospitals (good ones) make a lot of surgeries.....and all of them make less or more mistakes
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interesting advice. No more further surgeries for me then by this logic.
If someone still can't answer himself, then should consider this:
Everyone with mild problems (not big "deformations") who are too sensitive too permanent nerve damages - for some people it can be really annoing - should avoid surgery. Who may be too sensitive? the one who afraid about it too much
If still can't ;)
just go... take the risk. Will be ok or not ;) You do not have whole live for thinking about one problem
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You are talking about obvious things ;)
phantom: I asked you about that one time too :)
So I wonder if there is any commission which check if the data is not manipulated in the meaning all patients results for specific procedure and period were shown in publication.
For example. The comission may check how many patients were treated for specific problem - ICD number
then check number of these patients with numbers on the publication
I chose very good hospital. Very good hospitals has very good procedures. Perhaps there is a chance that all is checked
anyone know something about it ?
manipulate results and public or dont public at all you know don't ever trust statistics that you haven't falsified yourself .
when you ask a surgeon how many succesful surgeries he has performed, he also may lie to you.
conclusion: all of this , is a gamble
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You are talking about obvious things ;)
phantom: I asked you about that one time too :)
So I wonder if there is any commission which check if the data is not manipulated in the meaning all patients results for specific procedure and period were shown in publication.
For example. The comission may check how many patients were treated for specific problem - ICD number
then check number of these patients with numbers on the publication
I chose very good hospital. Very good hospitals has very good procedures. Perhaps there is a chance that all is checked
anyone know something about it ?
when you ask a surgeon how many succesful surgeries he has performed, he also may lie to you.
conclusion: all of this , is a gamble
In Germany you can check case-numbers on www.weisse-liste.de where you can check Doctors and Hospitals. You can set the filter to avarage case numbers or above avarage.
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on tnat website, there's no maxillo facial surgeons . anyway I chose the surgeon
Triot: do you know any good german page with doctore opinions
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on tnat website, there's no maxillo facial surgeons . anyway I chose the surgeon
Triot: do you know any good german page with doctore opinions
Sure there are. I checked it by myself. (the German term for maxfac aurgery is "Mund-, Kiefer-, Gesichtschirurgie")
No, there aren't such websites or atleast there aren't any popular ones.
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Apparently there is only few surgeons. I put the name of the city and found 0 max fac surgeons... while there are at least few :)
I FOUND BETTER SITE:
EXAMPLE: http://www.jameda.de/berlin/aerzte/mund-kiefer-gesichtschirurgen/dr-ramin-zarrinbal/bewertungen/80422065_1/
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"Volume of procedures is absolutely important!"
So the best choice is MM :D
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"Volume of procedures is absolutely important!"
So the best choice is MM :D
His students are probably the ones doing the surgeries.
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"Volume of procedures is absolutely important!"
So the best choice is MM :D
Do you know how many surgeries per year he does?
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if you have to wait 4-6 months for a surgery, while average time in big hospitals is 2-3 months, then awfully a lot ;)
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Most patients do not know that some part of surgery may be done by students.
Don't be naive. Young surgeons one day has to start to oparte on real patients . They get simple small procedures to more complicated with time.
The most important is main surgeon should not allow to do anything when a case is not typical and more demanding
But when surgery is typical and "simple" he should take control in the most crucial parts, like operating very close to nerves
and main surgeon should operate only himself if a patient ask about it. However many patients are not aware about this.
and at last.. you will never know what really is gonna happen during your surgery ...whatever paper you signed
Welcome to surgery world, where nothing is clear and nothing is for sure
If you can, run like hell
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Most patients do not know that some part of surgery may be done by students.
Don't be naive. Young surgeons one day has to start to oparte on real patients . They get simple small procedures to more complicated with time.
The most important is main surgeon should not allow to do anything when a case is not typical and more demanding
But when surgery is typical and "simple" he should take control in the most crucial parts, like operating very close to nerves
and main surgeon should operate only himself if a patient ask about it. However many patients are not aware about this.
You know, I wonder if my likely permanent nerve damage is thanks to giving a young one "a go". That would really suck if it were true.
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you know even the best surgeon may damage your nerve too much. in some part it depends on your body - how much your nerve are prone to damage due to stretching.. or if you do sports, etc etc
paradoxically a novice may not damage your nerve too much (somehow) and the best one may have little less fortune in your case
nerves = gamble.
and also what means permanently nerve damaged. It's never damaged in 100% (if it's not cut)
for some it's less than 90% of normal nerve function
for some less than 99%
for same less than 100.00000000%
:) it all depends
generally I repeat it many times if anyone problem seems to be mild (not so much bothering) and if that person are very afraid of any nerve damage, I recommend avoid surgery. Mental cosequences for such person may be terrible. Some people may not bother slight feeling distirbuances on face... on some slight or even severe obsession may develop. That condition may be devastating
Obsession - constant worrying about the thing with no relief
Fortunately such reaction is rather rare, especially if a patient after surgery gets what he wants.
It's better to get what you wanted and eventually pay(loss) a little for that (costs - something for something)
than not get what you expected and loose something at the same time - that is a problem
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How to get it :) http://www.pnas.org/content/105/51/20505.full
??
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@Plosko Sucks to have permanent nerve damage :( Yeah people say surgeon skill and you see sometimes crazy s**t on here, like that guy in southern CA recently. But other than rookie surgeons mostly I think it comes down to procedure, how much stretching, how much swelling, what other work did you have done, how old were you, what anatomic variants do you have, etc. I say this readily because it's not happened to me yet! :s Never had nerve loss but experience nerve dysfunction elsewhere in my body. I couldn't imagine having that on my face, anywhere else is manageable IMO.
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I wonder if who did what would be in the Op Notes?
And by "who" I mean the surgeon Plosko hired to do his surgery or a resident/surgeon in training?
How do I even get these notes?
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Faceinit,
Thank you very much. But if I find out that an assistant did much of my surgery, then what? I don't even know what I signed off on.
And if the assistant just handed the surgeon the tools?
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like..
Find a really really good orthodontist who does a lot of the pre-surgery and post-surgery adjustments.
Then find the orthognathic surgeon he sends his patients to see to do orthognathic surgery.
The orthodontist will not send you to someone who is getting poor results - - because it reflects poorly back on the orthodontist.
Those orthodontist guys and gals are one of the major referral sources for good orthognathic surgeons. They have to work closely before and after jaw surgeries to get the ultimate right result. A friend told me about one situation where the "best orthodontist" in the city had some consistently less than good results from an academic center doing the orthognathic surgeries on his patients. He changed his referral pattern to a younger well trained orthognathic surgeon and ended up with outstanding results. In short, it may not be the number of surgeries, but it may have more to do with who trained them.
This is sort of like asking your doctor which doctor he uses for his wife or children - - When you need a surgery.
If the orthognathic surgeon can't point you to a local orthodontist that routinely refers his patients to the orthognathic surgeon you are talking to - - then you should find another place to be having that conversation.
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I'm more of an ass man
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Hmmm... a lot there. At times you confuse me a bit - - as orthodontists normally do the adjustments of the teeth through their various means. After they have done all they can do - - they then send the patient to an orthognathic surgeon to split the lower, upper, or both jaws and move them in accordance with the "plan" worked out between the two of them. Often, after the jaw surgery, the orthodontist gets the patient back for some further minor adjustments.
If the orthognathic jaw surgeon is not getting consistently good results - - it makes the job of the orthodontist much more difficult. That is the reason to find out if the orthognathic surgeon you are working with has an ongoing referral pattern from one or more orthodontists.
You do point out something interesting. It would not be surprising for there to be an increasing number of patients who self refer to a distant jaw surgeon.
But there are not going to be any 30 year old orthognathic surgeons. By the time they get to be both a plastic surgeon and trained to do jaw work - - they are going to be at least 34 or 35 years old.
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I really love fake boobies.