jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: dardok on July 05, 2018, 02:34:52 PM
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https://www.semanticscholar.org/paper/U-shaped-osteotomy-in-management-of-paranasal-H%C3%A9rnandez-Alfaro-Garc%C3%ADa/a470963ed660acea1ec721dcbba927dae217ebd4
I had a recent ceph taken and I have a severe paranasal deficiency that would warrant this case.
I would actually become quite good looking with this sort of advancement.
I showed this to my surgeon and he agreed, although he said I would essentially be a "guinea pig" as he had never heard of this procedure before.
He cited possible complications such as inadequate blood supply to the osteotomized area leading to death/relapse as well as just relapse in general over the long term.
Do you guys think the surgeon who wrote this procedure just made this paper to pad his stats, and it is not actually safe? I have contacted a few surgeons about this procedure but the literature is so scarce I do not know what to do or think.
I would only do it if the complications themselves were not severe and the result was stable.
And if this is not viable my only other alternative is to get extractions, pushing my upper jaw back to cause an underbite and then getting bimax, which would be a long and costly process.
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I don't think the risks are terribly high. It looks like an awesome procedure.
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Alfaro is very WELL KNOWN and very innovative. So, if this is one of his innovations, it might take some time for others to do same.
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I don't think the risks are terribly high. It looks like an awesome procedure.
How can I better understand the risks of it and find long term follow up data? There does not seem to be much other sources on this specific surgery.
I'm hoping to contact the original author as well as another surgeon in korea who also did a study on this.
I need to know that the risk of relapse or necrosis are low in order to go through with this or im going to be f**king my body and bank up for nothing.
Also is this paper itself enough for a surgeon to duplicate this procedure. My surgeon is not a hack, he actually wrote some of the first papers on CCW, but he also said he is going to eyeball the exact movement once my face is cut open (lol).
Is there any way I can get alfaro and him to talk to each other. It seems simple enough and otherwise my only option is to go to spain/korea.
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I've read through your past posts and for the most part, it appears you are looking for a NO RISK at all procedure*.
* I'm looking for no erosion resorption and no infection risk that sits well on the skin and maintains its structure.
Not only that but, 'ideally', you would like your Canadian doctor/s to perform SPECIALTY procedures that only a small handful of doctors (not in Canada) are conversant/skilled at doing whether they be paranasal implants** or innovative paranasal displacment surgery by Alfaro.
** Where to get paranasal implants done in canada?
Let's get REAL. For all intents and purposes, these procedures can be considered ESOTERIC procedures LIMITED to doctors of KNOWN capacity to perform them
a: Your Canadian doctor/s is/are not going to be as conversant as is a doctor KNOWN for putting in paranasal implants. (Name of doctor is listed in the bibliography of the article you cited.)
b: Your Canadian doctor/s is not going to be as conversant in performing Alfaro's isolated paranasal displacement surgery as is the innovator of it.
c: What ever the inherent risks are with paranasal implants or Alfaro's isolated U shaped osteo of the paranasal area, they would tend to be even HIGHER in the hands of doctors who are not PIONEERS or 'movers and shakers' in the particular venue you are seeking.
If I wanted paranasal implants, I would go straight to the doctor listed in the bibliography who is expert in putting them in (Yaremchuck). Alternatively, if I wanted a BONE CUT instead, I would go straight to Alfaro. Although seeking out those 2 experts for EITHER don't make the inherent risks of the surgery go away, you shouldn't even be thinking about having your Canadian doctor perform EITHER. I mean it's intuitively obvious to me that the risks would be HIGHER in the hands of doctors who are not the 'movers and shakers' or 'innovators' of these types of surgeries.
Moral of story: STOP THINKING about any possibility of your Canadian doctor performing this. How on earth someone wanting the LOWEST risk possible for an ESOTERIC surgery would have ANY expectation that their local doctor could carry this out with expectation of a LOWER risk than the experts have, I will never know. Can't fathom the reasoning because to ME, it's irrational expectation/ PIPE DREAM.
Doesn't matter if you did not specifically say you 'expected' your doctor to be able to carry this out with lower risk than the experts in this. Your posts belie you harbor some kind of subconscious expectation that your Canadian docs will be in same capacity of the 'grand wazoos' of the type of esoteric surgeries you are wanting. I also pick up the 'vibe' of that type of thinking when you say your 'only option' (here the phrase is used in the PEJORATIVE sense) is to go to .. (eg. the EXPERTS in this as IF they are the LESSER option). It's a 'Can't have the horse take the donkey.' type of thinking. BUT where your priorities are MIXED UP where the Canadian doctor is the 'horse' and the EXPERT(s) in this is the 'donkey' It's the other way around. The expert(s) in this is/are the HORSE(s) and your Canadian doctor(s) is are the DONKEY/donkeys.
That said, if you want to know MORE about this 'U' type osteo, PRIORITIZE your consult with Alfaro. He's going to know more about whether or not you are a good candidate for it and what the risks are IN HIS HANDS.
Oh, did I forget to mention that the answer is 'NO' regarding your Canadian doc doing this for you?
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I've read through your past posts and for the most part, it appears you are looking for a NO RISK at all procedure*.
*
Not only that but, 'ideally', you would like your Canadian doctor/s to perform SPECIALTY procedures that only a small handful of doctors (not in Canada) are conversant/skilled at doing whether they be paranasal implants** or innovative paranasal displacment surgery by Alfaro.
**
Let's get REAL. For all intents and purposes, these procedures can be considered ESOTERIC procedures LIMITED to doctors of KNOWN capacity to perform them
a: Your Canadian doctor/s is/are not going to be as conversant as is a doctor KNOWN for putting in paranasal implants. (Name of doctor is listed in the bibliography of the article you cited.)
b: Your Canadian doctor/s is not going to be as conversant in performing Alfaro's isolated paranasal displacement surgery as is the innovator of it.
c: What ever the inherent risks are with paranasal implants or Alfaro's isolated U shaped osteo of the paranasal area, they would tend to be even HIGHER in the hands of doctors who are not PIONEERS or 'movers and shakers' in the particular venue you are seeking.
If I wanted paranasal implants, I would go straight to the doctor listed in the bibliography who is expert in putting them in (Yaremchuck). Alternatively, if I wanted a BONE CUT instead, I would go straight to Alfaro. Although seeking out those 2 experts for EITHER don't make the inherent risks of the surgery go away, you shouldn't even be thinking about having your Canadian doctor perform EITHER. I mean it's intuitively obvious to me that the risks would be HIGHER in the hands of doctors who are not the 'movers and shakers' or 'innovators' of these types of surgeries.
Moral of story: STOP THINKING about any possibility of your Canadian doctor performing this. How on earth someone wanting the LOWEST risk possible for an ESOTERIC surgery would have ANY expectation that their local doctor could carry this out with expectation of a LOWER risk than the experts have, I will never know. Can't fathom the reasoning because to ME, it's irrational expectation/ PIPE DREAM.
Doesn't matter if you did not specifically say you 'expected' your doctor to be able to carry this out with lower risk than the experts in this. Your posts belie you harbor some kind of subconscious expectation that your Canadian docs will be in same capacity of the 'grand wazoos' of the type of esoteric surgeries you are wanting. I also pick up the 'vibe' of that type of thinking when you say your 'only option' (here the phrase is used in the PEJORATIVE sense) is to go to .. (eg. the EXPERTS in this as IF they are the LESSER option). It's a 'Can't have the horse take the donkey.' type of thinking. BUT where your priorities are MIXED UP where the Canadian doctor is the 'horse' and the EXPERT(s) in this is the 'donkey' It's the other way around. The expert(s) in this is/are the HORSE(s) and your Canadian doctor(s) is are the DONKEY/donkeys.
That said, if you want to know MORE about this 'U' type osteo, PRIORITIZE your consult with Alfaro. He's going to know more about whether or not you are a good candidate for it and what the risks are IN HIS HANDS.
Oh, did I forget to mention that the answer is 'NO' regarding your Canadian doc doing this for you?
You are very right. I am going to see Dr Alfaro for a consult. My only concern is that I noticed high volume surgeons tend to be conservative and in the event that he (possibly) says no I will be s**t out of luck.
There is a korean fellow who also used this technique who would be my only other option, and he doesnt seem to do commercial surgeries:
http://www.koreascience.or.kr/article/ArticleFullRecord.jsp?cn=OOMSBS_2009_v31n6_485
I would be pretty much be forced to see a surgeon who has not done it before.
Would it possibly help if I saw a top class surgeon such as Deschamps or Gunson?
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Personally, I'd rather just have bimax than have a paranasal osteotemy with a doctor who's never done one -- or anything of the sort -- before, even if the doctor is well respected.
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You are very right. I am going to see Dr Alfaro for a consult. My only concern is that I noticed high volume surgeons tend to be conservative and in the event that he (possibly) says no I will be s**t out of luck.
There is a korean fellow who also used this technique who would be my only other option, and he doesnt seem to do commercial surgeries:
http://www.koreascience.or.kr/article/ArticleFullRecord.jsp?cn=OOMSBS_2009_v31n6_485
I would be pretty much be forced to see a surgeon who has not done it before.
Would it possibly help if I saw a top class surgeon such as Deschamps or Gunson?
The Korean guy seems to be doing the 'U' osteo in combination with Lefort 1 and bimax if i speed read correctly. So, not isolated 'U' osteo as Alfaro seems to do.
Let me put it this way, the RISK PROFILE of your Canadian guy doing it is now '0' BECAUSE he never did it before and if he f**ks up with YOU being the FIRST to do with him, his risk profile will be 100%.
Again, this is an ESOTERIC type surgery. It looks like it's Alfaro's 'baby'. So, I would not extrapolate that Gunson or Deschamps would nurture it either.
...and NO, you are NOT 'forced' to see a surgeon who has not done it before. That is DANGEROUS thinking. Risks get HIGH when you seek out doctors to do something who are LOW on the learning curve of that thing or who would rather just do what they do well already.
If Alfaro says 'no' then assume you are not the ideal candidate for it which could be a recipe for disaster if you got someone else not conversant in it to do it instead.
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The Korean guy seems to be doing the 'U' osteo in combination with Lefort 1 and bimax if i speed read correctly. So, not isolated 'U' osteo as Alfaro seems to do.
Let me put it this way, the RISK PROFILE of your Canadian guy doing it is now '0' BECAUSE he never did it before and if he f**ks up with YOU being the FIRST to do with him, his risk profile will be 100%.
Again, this is an ESOTERIC type surgery. It looks like it's Alfaro's 'baby'. So, I would not extrapolate that Gunson or Deschamps would nurture it either.
...and NO, you are NOT 'forced' to see a surgeon who has not done it before. That is DANGEROUS thinking. Risks get HIGH when you seek out doctors to do something who are LOW on the learning curve of that thing or who would rather just do what they do well already.
If Alfaro says 'no' then assume you are not the ideal candidate for it which could be a recipe for disaster if you got someone else not conversant in it to do it instead.
The korean guy has done the surgery though. Even if he does it in conjunction with a lefort it does not mean the surgery is related or required to do in conjunction.
I will just write off my guy in that case then. He is very competent and was one of the first to write papers on CCW but like you said the risk is unknown for him.
Do you recommend I do a video consultation with Alfaro first or make the trip to Spain? If I need to save more money I will do so but I do not want to spend more than is necessary.
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The korean guy has done the surgery though. Even if he does it in conjunction with a lefort it does not mean the surgery is related or required to do in conjunction.
I will just write off my guy in that case then. He is very competent and was one of the first to write papers on CCW but like you said the risk is unknown for him.
Do you recommend I do a video consultation with Alfaro first or make the trip to Spain? If I need to save more money I will do so but I do not want to spend more than is necessary.
In person consults where they have measuring tools and diagnostics is always better.
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That said, if you want to know MORE about this 'U' type osteo, PRIORITIZE your consult with Alfaro. He's going to know more about whether or not you are a good candidate for it and what the risks are IN HIS HANDS.
Oh, did I forget to mention that the answer is 'NO' regarding your Canadian doc doing this for you?
Thank you for posting that. It *really* needed to be said.
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I appreciate the input
I am also worried due to the fact that alfaro does very high volume that he may overlook my case or give a bad result.
But I guess alfaro is my best shot and whatever happens my fate would be in his hands.
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I appreciate the input
I am also worried due to the fact that alfaro does very high volume that he may overlook my case or give a bad result.
But I guess alfaro is my best shot and whatever happens my fate would be in his hands.
This statement just drives home the point I was making regarding what I picked up as to your thinking/decision making process. Basically, you WORRY WRONG. So, now you are worried about the the EXPERT in the (estoteric) procedure you want giving you a bad result. But NOT worried at all prior about your Canadian doctor with NO experience doing it wrong.
Here again, your statement (which comes from somewhat of an irrational thinking process) reflects you are (still) 'settling' for the EXPERT who can do a/the procedure FAST and you use the term 'HIGH VOLUME' in the pejorative (negative) sense. Being able to do something FAST reflects SKILL especially when cutting into the maxilla where to the best of my knowledge blood loss is minimized when that's over and done with FAST (as opposed to a LOW VOLUME doctor who's never done it before--like your Canadian doctor--who would need to go SLOW to do it!).
The only reason I can think of for this irrational thinking process is that maybe your INTUITION is telling you not to have it at all and instead get the standard full bimax/maxfax with your Canadian doctor along with possible plucking of the pre-molars to do it OR to just the implants (from an expert in paranasal implants) instead.
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Thank you for posting that. It *really* needed to be said.
;)
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This statement just drives home the point I was making regarding what I picked up as to your thinking/decision making process. Basically, you WORRY WRONG. So, now you are worried about the the EXPERT in the (estoteric) procedure you want giving you a bad result. But NOT worried at all prior about your Canadian doctor with NO experience doing it wrong.
Here again, your statement (which comes from somewhat of an irrational thinking process) reflects you are (still) 'settling' for the EXPERT who can do a/the procedure FAST and you use the term 'HIGH VOLUME' in the pejorative (negative) sense. Being able to do something FAST reflects SKILL especially when cutting into the maxilla where to the best of my knowledge blood loss is minimized when that's over and done with FAST (as opposed to a LOW VOLUME doctor who's never done it before--like your Canadian doctor--who would need to go SLOW to do it!).
The only reason I can think of for this irrational thinking process is that maybe your INTUITION is telling you not to have it at all and instead get the standard full bimax/maxfax with your Canadian doctor along with possible plucking of the pre-molars to do it OR to just the implants (from an expert in paranasal implants) instead.
No, I think from my ceph this is the procedure that was made for me. I would accept your input if you want to take a look at it
I would just appreciate some patient input and coordination when working with the surgeon which I know sometimes doesn't happen with the big wig types.
So your saying pretty much cooperating or not that this should be the only doctor to do that procedure on me. And I am inclined to agree which is why I am going to see him for a consult.
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No, I think from my ceph this is the procedure that was made for me. I would accept your input if you want to take a look at it
I would just appreciate some patient input and coordination when working with the surgeon which I know sometimes doesn't happen with the big wig types.
So your saying pretty much cooperating or not that this should be the only doctor to do that procedure on me. And I am inclined to agree which is why I am going to see him for a consult.
Post it ON BOARD and I will take a look at it. What my saying breaks down to is that if you think this procedure was made for you, than seek out the doctor that does it and rule out the doctor/s that DON'T do it.
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Post it ON BOARD and I will take a look at it. What my saying breaks down to is that if you think this procedure was made for you, than seek out the doctor that does it and rule out the doctor/s that DON'T do it.
So I also concacted the surgeon behind the, other paper, Park- Young Wook. http://kpubs.org/article/articleMain.kpubs?articleANo=OOMSBS_2009_v31n6_485
From the emails he told me he would be willing to come overseas to do the surgery provided the expenses are paid. He says he travels to vietnam ever year to show procedures.
He also said I am free to visit him.
This is a very good offer considering that Alfaro has not even responded yet and his prices may be much higher. However there is less information about this guy and we dont know if he has the volume of experience alfaro does.
Presumably from the paper alone hes done this procedure dozens of times at the least.
What do you think, should i see him or alfaro?
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So I also concacted the surgeon behind the, other paper, Park- Young Wook. http://kpubs.org/article/articleMain.kpubs?articleANo=OOMSBS_2009_v31n6_485
From the emails he told me he would be willing to come overseas to do the surgery provided the expenses are paid. He says he travels to vietnam ever year to show procedures.
He also said I am free to visit him.
This is a very good offer considering that Alfaro has not even responded yet and his prices may be much higher. However there is less information about this guy and we dont know if he has the volume of experience alfaro does.
Presumably from the paper alone hes done this procedure dozens of times at the least.
What do you think, should i see him or alfaro?
From the abstract of the paper, he is doing the the U osteo WITH a Lefort 1 and NOT as a stand alone procedure as in Alfaro's paper.
I've already given you my take on consulting with the doctor who is conversant with doing the ISOLATED procedure that YOU have targeted yourself as being a candidate for. However, if you find other doctors who do this, there is no harm in going on MULTIPLE consults as in adding another doctor to your consult list, presently consisting of ONE doctor; Alfaro.
[Abstract
Postoperative skeletal stability was evaluated in combination of Le Fort I and U-shaped osteotomies for superior repositioning of maxilla in bi-maxillary surgeries in 30 consecutive patients. The fifteen patients underwent Le Fort I osteotomy alone and the other fifteen patients underwent Le Fort I and U-shaped osteotomies. In all patients, the maxilla was first osteomized and fixed with absorbable plates system. A bilateral sagittal split ramus osteotomy (BSSRO) of the mandible was then carried out and fixation was performed using absorbable plates. Maxillo-mandibular fixation with rubber ring was used for two weeks post-operatively in all patients. Lateral cephalograms were obtained pre-operatively, 1 day post-operatively, 6 months after surgery. The changes in anterior nasal spine (ANS), point A, upper incisior (U1), and point of maxillary tuberosity (PMT) were examined. The maxillas in the fifteen patients of both examination group were repositioned nearly in their planned positions during surgery and no significant post-operative changes in the examined points of the maxilla were found. These results suggest that a combination of a Le Fort I and U-shaped osteotomy is a useful technique for reliable superior repositioning of the maxilla. The post-operative change in the maxilla using this combination osteotomy was comparatively stable.]
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So the guys reception is absolutely terrible. I call in several times and it's clear they dont speak english so I ask if they have any english speaker on staff. I get a hang up every time.
I submitted an application for a consult online but have not heard back in weeks about it.
I call the Valencia branch, they tell me to wait 15 minutes and call back, I call back in 15 minutes getting a message that the location is closed.
Im f**king amazed honestly. I'm not sure how they treat other international patients but how the f**k does this guy become successful with receptionists who only speak spanish.
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So the guys reception is absolutely terrible. I call in several times and it's clear they dont speak english so I ask if they have any english speaker on staff. I get a hang up every time.
I submitted an application for a consult online but have not heard back in weeks about it.
I call the Valencia branch, they tell me to wait 15 minutes and call back, I call back in 15 minutes getting a message that the location is closed.
Im f**king amazed honestly. I'm not sure how they treat other international patients but how the f**k does this guy become successful with receptionists who only speak spanish.
i consulted with alfaro, and this was not my experience at all. their receptionists always spoke english, always responded promptly and were always on time.
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So the guys reception is absolutely terrible. I call in several times and it's clear they dont speak english so I ask if they have any english speaker on staff. I get a hang up every time.
I submitted an application for a consult online but have not heard back in weeks about it.
I call the Valencia branch, they tell me to wait 15 minutes and call back, I call back in 15 minutes getting a message that the location is closed.
Im f**king amazed honestly. I'm not sure how they treat other international patients but how the f**k does this guy become successful with receptionists who only speak spanish.
It's clear they don't speak English. So you asked something in English and expected them to understand you. Classic.
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He's away on vacation until the end of August anyway.
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It's clear they don't speak English. So you asked something in English and expected them to understand you. Classic.
Because they say OK hold on a second and then hang up. I even said I do not speak spanish in there language.
I think your are assuming too much buddy.
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i consulted with alfaro, and this was not my experience at all. their receptionists always spoke english, always responded promptly and were always on time.
Did you call the instituto maxillofacial?
From my experience that is not possible. Or maybe im just really unlucky xd.
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Because they say OK hold on a second and then hang up. I even said I do not speak spanish in there language.
I think your are assuming too much buddy.
I assumed what you stated in the FIRST place that it was 'CLEAR they did not speak English'. So, tell me how 'clear it was that they did not speak English' when they told you 'Ok, hold on a second'. You just negated your first statement.
Would it be too much for me to assume that you started out here with a stick up your ass finding reasons to avoid the guy in the first place.
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Lol, knowing a simple phrase =/= speaking the language
xd
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I assumed what you stated in the FIRST place that it was 'CLEAR they did not speak English'. So, tell me how 'clear it was that they did not speak English' when they told you 'Ok, hold on a second'. You just negated your first statement.
Would it be too much for me to assume that you started out here with a stick up your ass finding reasons to avoid the guy in the first place.
So, I am making plans to see Alfaro in Spain. What are your thoughts on the pros and cons of having surgery done in Spain?
I think that due to the language and country barrier in the event something goes wrong it will be hard to get ahold of the surgeon. Although they did say my payment would cover up to a year after and Alfaro said if the result is not good he can just reverse it.
However low risk and straightforward nature of this procedure means that this sort of complication may be rarer than say, in a double jaw surgery case.
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So, I am making plans to see Alfaro in Spain. What are your thoughts on the pros and cons of having surgery done in Spain?
I think that due to the language and country barrier in the event something goes wrong it will be hard to get ahold of the surgeon. Although they did say my payment would cover up to a year after and Alfaro said if the result is not good he can just reverse it.
However low risk and straightforward nature of this procedure means that this sort of complication may be rarer than say, in a double jaw surgery case.
In Spain....in SPAIN...in SPAIN...Barcelona...in a place rich in cultural history with beautiful architecture...wonderful food...close to Andorra where the Pyrenees are...close to the border of France. My gawd...I'd be looking at it as an opportunity to STAY THERE for a LONG TIME and NOT in terms of coming back soon.
So, you're asking the WRONG person, a Europhile who would view it as an opportunity to STAY in a place rich in cultural history for as long as possible, a chance to BROADEN one's HORIZONS.
I'd be looking at the MAP to determine how far is Seville, a place to experience Flamenco music and dancing, how far is Cordoba where they have torture museum of Spanish inquisition, how far is the Prado to view works of Goya and other master Spanish painters, how far is the Alhambra; a work of wonderful architecture, I'd want to visit the Bullfighting museum in BARCELONA, and also the Picasso Museum there, experience the Pyrenees/Andorra which are near by as is the border of France.
Suffice to say, I would NOT be thinking in terms of having surgery there as a 'con' BECAUSE INSTEAD, I would be thinking in terms of STAYING THERE for an EXTENDED period of time which would be a 'PRO' to me. The only 'con' to me, personally would be same con of other times when I visited Europe which was HAVING TO BE SCRAPED OF THE AIRPORT FLOOR to go back to US and regretting to buy a one way ticket because I didn't want to go back. But 'had to'.
If I were getting surgery in Barcelona, I would WANT to stay there for an extended period of time if I had the resources to do so. If the stay had to be 'used up' by having to have some problem with the surgery rectified, so be it because you're already there. If it didn't have to be 'used up' for any issue following the surgery, it could be spent enjoying what the location and it's surrounds has to offer.
Sorry, but hard for me, personally to 'identify' with someone who would even WANT to go back to North America soon after being in a place like Barcelona or who would not be thinking in terms of; 'How can I arrange/manage to STAY there for an extended period of time'.
You need to ask someone who doesn't think in terms of how great it would be to stay there for an extended period of time whether it's to be close enough IF there is an issue with the surgery or just be close enough to opportunities to see persons, places and things for which North America does not offer the SAME opportunities.
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In Spain....in SPAIN...in SPAIN...Barcelona...in a place rich in cultural history with beautiful architecture...wonderful food...close to Andorra where the Pyrenees are...close to the border of France. My gawd...I'd be looking at it as an opportunity to STAY THERE for a LONG TIME and NOT in terms of coming back soon.
So, you're asking the WRONG person, a Europhile who would view it as an opportunity to STAY in a place rich in cultural history for as long as possible, a chance to BROADEN one's HORIZONS.
I'd be looking at the MAP to determine how far is Seville, a place to experience Flamenco music and dancing, how far is Cordoba where they have torture museum of Spanish inquisition, how far is the Prado to view works of Goya and other master Spanish painters, how far is the Alhambra; a work of wonderful architecture, I'd want to visit the Bullfighting museum in BARCELONA, and also the Picasso Museum there, experience the Pyrenees/Andorra which are near by as is the border of France.
Suffice to say, I would NOT be thinking in terms of having surgery there as a 'con' BECAUSE INSTEAD, I would be thinking in terms of STAYING THERE for an EXTENDED period of time which would be a 'PRO' to me. The only 'con' to me, personally would be same con of other times when I visited Europe which was HAVING TO BE SCRAPED OF THE AIRPORT FLOOR to go back to US and regretting to buy a one way ticket because I didn't want to go back. But 'had to'.
If I were getting surgery in Barcelona, I would WANT to stay there for an extended period of time if I had the resources to do so. If the stay had to be 'used up' by having to have some problem with the surgery rectified, so be it because you're already there. If it didn't have to be 'used up' for any issue following the surgery, it could be spent enjoying what the location and it's surrounds has to offer.
Sorry, but hard for me, personally to 'identify' with someone who would even WANT to go back to North America soon after being in a place like Barcelona or who would not be thinking in terms of; 'How can I arrange/manage to STAY there for an extended period of time'.
You need to ask someone who doesn't think in terms of how great it would be to stay there for an extended period of time whether it's to be close enough IF there is an issue with the surgery or just be close enough to opportunities to see persons, places and things for which North America does not offer the SAME opportunities.
I dont mind a nice european vacation, you are missing my point dude... Dont get me wrong, canada is a s**thole especially this time of the year.
I was referring to the logistical disadvantages of getting surgery done outside my native country, such as priority in medical care recieved, possibility of missing details due to the language/ culture barrier etc.
It is suffice to say as a foreignor I will be second class compared to any citizen not to mention I do not even speak spanish well enough to understand anything regarding the surgery.
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I dont mind a nice european vacation, you are missing my point dude... Dont get me wrong, canada is a s**thole especially this time of the year.
I was referring to the logistical disadvantages of getting surgery done outside my native country, such as priority in medical care recieved, possibility of missing details due to the language/ culture barrier etc.
It is suffice to say as a foreignor I will be second class compared to any citizen not to mention I do not even speak spanish well enough to understand anything regarding the surgery.
On second thought, just focus on the logistical ADVANTAGES of keeping the face you have and forgo the option to have the surgery.
You don't have to speak Spanish to keep the face you have. You don't have to worry about a cultural barrier to keep the face you have, be medically de-prioritized or anything else having to do with not being a citizen of Spain to keep the face you have.
There is NO RISK of any possible medical or cultural disadvantage in keeping your own face and deciding against the surgery.
0 risk solution to the problem.
I confess, I DON'T KNOW the logistical disadvantages to keeping the face you have vs the logistical disadvantages of pursuing a surgery you cant get anywhere else. Seems more logistically advantageous to KEEP the face you have and just drop the prospect of having the surgery OR just find someone ELSE to engage on logistic disadvantages. I'm OUTTA HERE with this dilemma.
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Do I understand this procedure correctly as it's an alternative to advancing the maxilla, without moving the teeth? Like the equivalent of what a genio would be to a bsso?
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Do I understand this procedure correctly as it's an alternative to advancing the maxilla, without moving the teeth? Like the equivalent of what a genio would be to a bsso?
From the author of the paper--the doc who does it:
"When paranasal deficiencies are not accompanied by occlusal alterations, mobilization of the maxilla via Le Fort I osteotomy may not be justified. In this preliminary, report for the first time is presented a U-shaped osteotomy (USO) that mobilizes anteriorly and/or superiorly the maxillary bone surrounding the pirifom aperture."
No idea if you understand it or not. Just know that I do which is that it's an isolated movement of the paranasasal area (part of maxilla bone surrounding the pear shaped nose hole in the skull). Suited for those who need ONLY that area displaced; a bone cutting option to paranasal implants.
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From the author of the paper--the doc who does it:
"When paranasal deficiencies are not accompanied by occlusal alterations, mobilization of the maxilla via Le Fort I osteotomy may not be justified. In this preliminary, report for the first time is presented a U-shaped osteotomy (USO) that mobilizes anteriorly and/or superiorly the maxillary bone surrounding the pirifom aperture."
No idea if you understand it or not. Just know that I do which is that it's an isolated movement of the paranasasal area (part of maxilla bone surrounding the pear shaped nose hole in the skull). Suited for those who need ONLY that area displaced; a bone cutting option to paranasal implants.
I did read this description.
"When paranasal deficiencies are not accompanied by occlusal alterations, mobilization of the maxilla via Le Fort I osteotomy may not be justified."
To me, the first part sounded like this is something that can be performed when the occlusion should not be altered, which I asked if I understood correctly.
The other part sounded like the procedure can mimic the effects of a le fort 1 osteotomy and be a less invasive alternative. Else I don't understand why one would bring up that this can be done when le fort 1 is not justified. Hence my question, what kind of movements that can come out of a le fort osteotomy that seems to be somewhat like what this procedure can do. The only thing I could think of was straight advancement.
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I did read this description.
"When paranasal deficiencies are not accompanied by occlusal alterations, mobilization of the maxilla via Le Fort I osteotomy may not be justified."
To me, the first part sounded like this is something that can be performed when the occlusion should not be altered, which I asked if I understood correctly.
The other part sounded like the procedure can mimic the effects of a le fort 1 osteotomy and be a less invasive alternative. Else I don't understand why one would bring up that this can be done when le fort 1 is not justified. Hence my question, what kind of movements that can come out of a le fort osteotomy that seems to be somewhat like what this procedure can do. The only thing I could think of was straight advancement.
What I don't understand when addressing the things you don't understand is the 'neuro-linquistic connections' you make with things where you tend to get confused a lot. What I do understand is what is meant when a doctor conveys information about what he's doing. But the best I can do here is describe how I understand what he's conveying. One more try:
He's saying that this is NOT a Lefort 1 and only advancement of the paranasal area.
He's saying he can ISOLATE one part of an area (paranasal) that gets advanced in a Lefort 1
He's saying that one does NOT have to get a Lefort 1 to get that isolated area advanced
he's saying this procedure will work for people who have a recessed paranasal area who don't need the whole Lefort 1 area advanced out.
He's saying isolated paranasal deficiencies in the absence of any occlusion problems or in the absence of any need to advance the WHOLE Lefort 1 area are NOT (may not be) a justification to move the WHOLE Lefort 1 area and because that is so, he has a surgery JUST FOR THAT.
He's saying it's an alternative to a Lefort 1 for people who DON'T NEED the whole L1 but only need the paranasal area advanced out; people who have paranasal deficiencies that are NOT co-existing with occlusal problems.
ETA: It doesn't move the teeth as would the L1.
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What I don't understand when addressing the things you don't understand is the 'neuro-linquistic connections' you make with things where you tend to get confused a lot. What I do understand is what is meant when a doctor conveys information about what he's doing. But the best I can do here is describe how I understand what he's conveying. One more try:
He's saying that this is NOT a Lefort 1 and only advancement of the paranasal area.
He's saying he can ISOLATE one part of an area (paranasal) that gets advanced in a Lefort 1
He's saying that one does NOT have to get a Lefort 1 to get that isolated area advanced
he's saying this procedure will work for people who have a recessed paranasal area who don't need the whole Lefort 1 area advanced out.
He's saying isolated paranasal deficiencies in the absence of any occlusion problems or in the absence of any need to advance the WHOLE Lefort 1 area are NOT (may not be) a justification to move the WHOLE Lefort 1 area and because that is so, he has a surgery JUST FOR THAT.
He's saying it's an alternative to a Lefort 1 for people who DON'T NEED the whole L1 but only need the paranasal area advanced out; people who have paranasal deficiencies that are NOT co-existing with occlusal problems.
ETA: It doesn't move the teeth as would the L1.
Thank you very much Kavan, you're right. I make overly convoluted questions and conclussions when trying to understand these things. On the good hand, your response cleared it out to me. What I should've asked was if the part that is being mobilized is an isolated sub part of what is being mobilized in a le fort 1, which I think you replied very cleary to.
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Thank you very much Kavan, you're right. I make overly convoluted questions and conclussions when trying to understand these things. On the good hand, your response cleared it out to me. What I should've asked was if the part that is being mobilized is an isolated sub part of what is being mobilized in a le fort 1, which I think you replied very cleary to.
Yes. Correct.