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General Category => Functional Surgery Questions => Topic started by: ODog on November 03, 2019, 03:53:45 PM
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Alright this is a tricky topic and probably nobody will know anything about it but you never know...
So I had a DJS and genioplasty 7 months ago. Everything is good except I have this extreme lower lip stiffness/ frozen feeling that has persisted. I have numbness too, but surface sensation. The sensation has improved as time has gone on, the stiff feeling is exactly the same. The PROBLEM I have with this stiff feeling is mostly that it affects my speech and my lower lip feels like it lacks proper mobility. It both feels uncomfortable to talk and I sound more garbled than pre-op.
This is not in my head. I have had clients at work ask me at 6 months post op how my recovery is going, and when I say fine but my mouth is really stiff, they say, “I noticed.” So it’s an objective problem, not subjective or in my head.
The surgeons I consulted in Canada, including Cameniti, say that the tightness is from nerve damage; it’s from the nerve playing “tricks.”
However I connected with somebody online who has had similar issues as me and she recommended an Indian craniofacial surgeon who claims he can help. His Instagram page is here: https://instagram.com/drsunilrichardson?igshid=a1l97ihgqgt9 (https://instagram.com/drsunilrichardson?igshid=a1l97ihgqgt9)
According to Richardson, he has been doing revision genioplastys for patients with these issues since 2002. He has sent me 2 surgery videos of such cases where the patients complained of speech issues post genioplasty and were cured after he revised. He claims he can offer me huge if not total relief.
I think he believes there are 2 main causes of this tightness in the lower lip and chin: fixated plate impinging on the muscle, which many of us know of, or accidental incarceration of the muscle complex of the chin, which is something I’ve never heard personally.
He has said to me, “mental nerve damage only causes numbness, not stiffness.”
After reviewing my scan, he said the screws wouldn’t be an issue with me because they are very small, but it’s more about how the segment was brought forward. He continued: “ Usually I see what’s called a incarceration of the muscle or the muscle complex when patients have such complaints. And it’s not visible on scans... but can be felt on examination.”
This means he would repair the damaged chin muscles. I have done a CBCT scan and will have the results sent to him Monday for further review.
The problem is, I’m not sure I feel comfortable getting a revision done in India. The surgeon seems very confident he can help me, and he’s the only one who’s even suggested some kind of solution other than “blah blah blah scar tissue” or whatever.
Does anyone know if any American or Canadian surgeons KNOW HOW or have experience with repairing a damaged chin muscle from genioplasty?
Because I’ve never heard of this issue EVER, and I’m sure none of you have either. But then why has Dr. Richardson been doing these revisions for almost 2 decades? Does he know something other surgeons do not?
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FWIW it seems it’s the Orbicularis muscle just below the lower lip that is the origin of this stiff feeling (see attached picture), not the mentalis muscle.
I’m not sure who to believe: the surgeons who say it’s nerve damage or Dr. Richardson who’s says it’s an incarcerated muscle.
Evidence for the former is that the NERVES feed into the orbicularis muscle, so perhaps damaged nerves can indeed cause problems with the muscle itself including movement and sensation. Also, apparently there are cases of “stiffness” after wisdom teeth extraction, which would suggest that nerve damage CAN cause a stiff sensation.
Evidence for the latter is that there are so, so, so, so many cases of lower lip/ chin NUMBNESS post-BSSO/ genioplasty but no complaints of stiffness. The question then becomes, why is this problem so rare? Perhaps the nerve damage is SEVRE AND thus causes stiffness. Well, the person I connected with online doesn’t have severe numbness, but does have significant stiffness that has ruined her life. So that’s strange. Is it the type of nerve damage? Or is it additional muscle damage that gives rise to this feeling?
Hard to say when everyone gives you a different answer.
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Did they rule out the hardware pinching the muscles and/or scar tissue around the hardware?
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Did they rule out the hardware pinching the muscles and/or scar tissue around the hardware?
hmm...good question..could be that hardware pinching the muscle is same/similar as incarcerated muscle...muscle 'trapped' in the hardware? .....just googled 'incarcerated muscle' and all I got was inmates in prison doing work outs.
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Did they rule out the hardware pinching the muscles and/or scar tissue around the hardware?
He took a look at my X-Ray and said the screws wouldn’t be an issue for me personally. Some people have large plates there, mine are tiny screws. Although if I do do the revision I can ask him to take them out anyway. He didn’t say anything about scar tissue around the hardware; I believe Zuniga in Dallas is the person to see about that? Apparently he has a special imaging technique to assess scar tissue.
If by “they” you mean my surgeon/ Caminetti, they didn’t really say much of anything. My surgeon said “you probably have a lot of scar tissue and need to massage it” but that’s bulls**t. This is not a scar tissue problem. Caminitti said “Removal of plates/ screws won’t do anything and that it’s a nerve issue.”
Richardson from India is the only one who’s even mentioned “incarceration of the muscle.” Which feels right to me, and he’s very confident. When I pressed him and said the Canadian surgeons all claim it’s nerve damage he seemed a little annoyed and said “I have been revising cases like this since 2002. I know what I am talking about.”
Personally, I don’t think any surgeon would speak so confidently about something they are unsure about. It’s not a big money surgery for him either, between 3-5000 USD.
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hmm...good question..could be that hardware pinching the muscle is same/similar as incarcerated muscle...muscle 'trapped' in the hardware? .....just googled 'incarcerated muscle' and all I got was inmates in prison doing work outs.
LOL oh boy.
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Here’s my scan.(http://) You can see that the screws are small and according to my surgeon fixated directly to the bone, not over the muscle, so it’s probably not causing impingement. I don’t have any plates.
https://imgur.com/a/kbO8kWl (https://imgur.com/a/kbO8kWl)
He wanted me to get a CBCT in order to see the full anatomy better. But regardless he did say the damage doesn’t come up on scans but “can be felt on examination.”
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Alright this is a tricky topic and probably nobody will know anything about it but you never know...
So I had a DJS and genioplasty 7 months ago. Everything is good except I have this extreme lower lip stiffness/ frozen feeling that has persisted. I have numbness too, but surface sensation. The sensation has improved as time has gone on, the stiff feeling is exactly the same. The PROBLEM I have with this stiff feeling is mostly that it affects my speech and my lower lip feels like it lacks proper mobility. It both feels uncomfortable to talk and I sound more garbled than pre-op.
This is not in my head. I have had clients at work ask me at 6 months post op how my recovery is going, and when I say fine but my mouth is really stiff, they say, “I noticed.” So it’s an objective problem, not subjective or in my head.
The surgeons I consulted in Canada, including Cameniti, say that the tightness is from nerve damage; it’s from the nerve playing “tricks.”
However I connected with somebody online who has had similar issues as me and she recommended an Indian craniofacial surgeon who claims he can help. His Instagram page is here: https://instagram.com/drsunilrichardson?igshid=a1l97ihgqgt9 (https://instagram.com/drsunilrichardson?igshid=a1l97ihgqgt9)
According to Richardson, he has been doing revision genioplastys for patients with these issues since 2002. He has sent me 2 surgery videos of such cases where the patients complained of speech issues post genioplasty and were cured after he revised. He claims he can offer me huge if not total relief.
I think he believes there are 2 main causes of this tightness in the lower lip and chin: fixated plate impinging on the muscle, which many of us know of, or accidental incarceration of the muscle complex of the chin, which is something I’ve never heard personally.
He has said to me, “mental nerve damage only causes numbness, not stiffness.”
After reviewing my scan, he said the screws wouldn’t be an issue with me because they are very small, but it’s more about how the segment was brought forward. He continued: “ Usually I see what’s called a incarceration of the muscle or the muscle complex when patients have such complaints. And it’s not visible on scans... but can be felt on examination.”
This means he would repair the damaged chin muscles. I have done a CBCT scan and will have the results sent to him Monday for further review.
The problem is, I’m not sure I feel comfortable getting a revision done in India. The surgeon seems very confident he can help me, and he’s the only one who’s even suggested some kind of solution other than “blah blah blah scar tissue” or whatever.
Does anyone know if any American or Canadian surgeons KNOW HOW or have experience with repairing a damaged chin muscle from genioplasty?
Because I’ve never heard of this issue EVER, and I’m sure none of you have either. But then why has Dr. Richardson been doing these revisions for almost 2 decades? Does he know something other surgeons do not?
India has history of highly advanced civilization. I believe they were the ones who did one of the first rhinoplasties and also came up with the forehead flap to replace nose tissue lost when someone had their nose cut off. The also have history of what's called here 'alternative medicine' and a lot of maxfax papers are written by doctors in India. North America (US and Canada) don't arise from advanced civilizations. So, if you have funds to travel there, why not. Besides, they have a lot of Indian food there.
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India has history of highly advanced civilization. I believe they were the ones who did one of the first rhinoplasties and also came up with the forehead flap to replace nose tissue lost when someone had their nose cut off. The also have history of what's called here 'alternative medicine' and a lot of maxfax papers are written by doctors in India. North America (US and Canada) don't arise from advanced civilizations. So, if you have funds to travel there, why not. Besides, they have a lot of Indian food there.
I may have no choice so I’m not saying I WOULDN’T go, but it is at the other end of the earth. I‘ve never even been to Europe. I’d ideally prefer a NA surgeon, ya know? Not sure why, feel safer maybe. Not that I doubt this surgeons competence; quite the contrary actually. Seems like he does jaw surgeries plus a whole bunch of complex craniofacial surgeries, which most jaw surgeons do not do.
It’s not really a money issue. It would be the same price or more in the US save for maybe $1000 on the flight cost.
I guess the reason I’m asking if that before I commit to this surgery in India I would like a surgeon here to AT LEAST confirm that this type of revision could be beneficial to me. I’m just wondering why no Canadian surgeon would even think of this problem in terms of it being of “muscle damage” etiology. I mean if they dont even think of it in those terms, there’s no way they can fix it either.
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I may have no choice so I’m not saying I WOULDN’T go, but it is at the other end of the earth. I‘ve never even been to Europe. I’d ideally prefer a NA surgeon, ya know? Not sure why, feel safer maybe. Not that I doubt this surgeons competence; quite the contrary actually. Seems like he does jaw surgeries plus a whole bunch of complex craniofacial surgeries, which most jaw surgeons do not do.
It’s not really a money issue. It would be the same price or more in the US save for maybe $1000 on the flight cost.
I guess the reason I’m asking if that before I commit to this surgery in India I would like a surgeon here to AT LEAST confirm that this type of revision could be beneficial to me. I’m just wondering why no Canadian surgeon would even think of this problem in terms of it being of “muscle damage” etiology. I mean if they dont even think of it in those terms, there’s no way they can fix it either.
maybe there is another name for it. maybe 'incarceration' refers to a SUTURE locking the muscle up.
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maybe there is another name for it. maybe 'incarceration' refers to a SUTURE locking the muscle up.
That’s very true. It could be the suture, and that’s what Richardson means by “incarceration.”
However I looked over his conversation with the person I connected with online and he said this:
“Yes the issue is with the muscle being incarcerated with the implant (plates & screws) or the bone cut.”
So incarceration could ALSO be from the cut alone.
Referring to her case (she had large plates and screws fixated) he said: “The plates and screws will need to be removed. And the muscles that are getting pulled and stretched need to be fixed.”
I’m curious how he fixes an incarcerated muscle. Sure if it’s caused by the plates then removal and re-stitching might solve the problem. But if it’s due to what he said above, the “bone cut,” which appears to be the case for ME, I wonder how he would fix the muscles ?
Because he doesn’t elaborate beyond that WRT the “how-to” for obvious reasons and which I respect.
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That’s very true. It could be the suture, and that’s what Richardson means by “incarceration.”
However I looked over his conversation with the person I connected with online and he said this:
“Yes the issue is with the muscle being incarcerated with the implant (plates & screws) or the bone cut.”
So incarceration could ALSO be from the cut alone.
Referring to her case (she had large plates and screws fixated) he said: “The plates and screws will need to be removed. And the muscles that are getting pulled and stretched need to be fixed.”
I’m curious how he fixes an incarcerated muscle. Sure if it’s caused by the plates then removal and re-stitching might solve the problem. But if it’s due to what he said above, the “bone cut,” which appears to be the case for ME, I wonder how he would fix the muscles ?
Because he doesn’t elaborate beyond that WRT the “how-to” for obvious reasons and which I respect.
Ok, the muscle is imprisoned by something. It could be stuck between the bone cut...then 'sandwiched muscles'...so maybe he pulls out the meat between the bread.
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I don’t know, man. I had the same stiffness on right side of my UPPER lip and have most surface sensation. I just think it was nerve trauma that my fat surgeon inflicted on me, which was simply too great to recover from and the stiff feeling is simply how it manifested itself. I mean some people have weird like touching the lip feels like touching the chin - the nerves recovered in a weird way. Get your dentist to inject anaesthetic. If your stiff feeling gets worse, it’s probably the nerve.
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Here’s my scan.(http://) You can see that the screws are small and according to my surgeon fixated directly to the bone, not over the muscle, so it’s probably not causing impingement. I don’t have any plates.
Yeah it's usually those butterfly plates that cause issues. Regarding scar tissue, he should just be able to look at the lower lip to get an idea of what's looming below...you can even look yourself. Is there a lot of scar tissue (white, weird looking) inside your lower lip? Scar tissue can cause the symptoms you're describing, so I'd rule that out before considering anything else.
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FWIW it seems it’s the Orbicularis muscle just below the lower lip that is the origin of this stiff feeling (see attached picture), not the mentalis muscle.
I’m not sure who to believe: the surgeons who say it’s nerve damage or Dr. Richardson who’s says it’s an incarcerated muscle.
Evidence for the former is that the NERVES feed into the orbicularis muscle, so perhaps damaged nerves can indeed cause problems with the muscle itself including movement and sensation. Also, apparently there are cases of “stiffness” after wisdom teeth extraction, which would suggest that nerve damage CAN cause a stiff sensation.
Evidence for the latter is that there are so, so, so, so many cases of lower lip/ chin NUMBNESS post-BSSO/ genioplasty but no complaints of stiffness. The question then becomes, why is this problem so rare? Perhaps the nerve damage is SEVRE AND thus causes stiffness. Well, the person I connected with online doesn’t have severe numbness, but does have significant stiffness that has ruined her life. So that’s strange. Is it the type of nerve damage? Or is it additional muscle damage that gives rise to this feeling?
Hard to say when everyone gives you a different answer.
I think this is more common than you think. I have talked to several people with this problem. Before getting any procedure or revision in the area, I suggest getting an MRN, its an MRI of the nerves. It can show nerve entrapment and muscle problems. I had this done, and the images are nothing short of amazing. Also, there is EMG muscle testing where they can test facial muscles—they do this in stroke patients. I totally believe that the surgeon can diagnose muscle entrapment as it feels totally different than normal tissue, but i would want a nerve and muscle assessment if possible. Since the facial nerves in the area innervate those muscles, I would want to know if part of it is due to nerve damage. An MRN would also show scar tissue—remember in additional to the external scar tissue, there could be INTERNAL scar tissue surrounding that area. John Zuninga in Dallas is one of the few in the country that does this imaging and he also does nerve testing (including the block described by PloskoPlus) Having this information would give you a better idea if muscle repair would help. The link below involves the shoulder but it described the imaging.
https://www.sciencedirect.com/science/article/pii/S0378603X16300171
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—remember in additional to the external scar tissue, there could be INTERNAL scar tissue surrounding that area.
Yep.
This is what I meant above when I said "what's looming below".
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I don’t know, man. I had the same stiffness on right side of my UPPER lip and have most surface sensation. I just think it was nerve trauma that my fat surgeon inflicted on me, which was simply too great to recover from and the stiff feeling is simply how it manifested itself. I mean some people have weird like touching the lip feels like touching the chin - the nerves recovered in a weird way. Get your dentist to inject anaesthetic. If your stiff feeling gets worse, it’s probably the nerve.
Thanks for the reply. I had anaesthetic applied to the lower gums a couple months ago to remove my surgical screws (should’ve been removed earlier) and my lower lip was extremely warbled and crooked when moving it during this time. Is that normal or is that what you get when you apply anaesthetic to a area with damaged nerves? I didn’t notice increased STIFFNESS though FWIW, which clearly originates in the orbicularis muscle for me, not the actual lip.
By the way this stiff feeling is not there only when I move my lower lip. I can feel it almost reverberating in the background at rest. I can feel it a lot when I purse the lower lip just a tad.
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Yeah it's usually those butterfly plates that cause issues. Regarding scar tissue, he should just be able to look at the lower lip to get an idea of what's looming below...you can even look yourself. Is there a lot of scar tissue (white, weird looking) inside your lower lip? Scar tissue can cause the symptoms you're describing, so I'd rule that out before considering anything else.
Yes I do have excessive scarring Inside the lower lip. I PM’d you a pic.
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I don’t know, man. I had the same stiffness on right side of my UPPER lip and have most surface sensation. I just think it was nerve trauma that my fat surgeon inflicted on me, which was simply too great to recover from and the stiff feeling is simply how it manifested itself. I mean some people have weird like touching the lip feels like touching the chin - the nerves recovered in a weird way. Get your dentist to inject anaesthetic. If your stiff feeling gets worse, it’s probably the nerve.
I get what you’re saying and I sorta believe it may be nerve damage too. But why does this surgeon say nerve damage won’t cause stiffness? Maybe It’s possible you also had muscle damage that simply recovered.
I should say that I DO often have a crooked lower lip when smiling :(.
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I think this is more common than you think. I have talked to several people with this problem. Before getting any procedure or revision in the area, I suggest getting an MRN, its an MRI of the nerves. It can show nerve entrapment and muscle problems. I had this done, and the images are nothing short of amazing. Also, there is EMG muscle testing where they can test facial muscles—they do this in stroke patients. I totally believe that the surgeon can diagnose muscle entrapment as it feels totally different than normal tissue, but i would want a nerve and muscle assessment if possible. Since the facial nerves in the area innervate those muscles, I would want to know if part of it is due to nerve damage. An MRN would also show scar tissue—remember in additional to the external scar tissue, there could be INTERNAL scar tissue surrounding that area. John Zuninga in Dallas is one of the few in the country that does this imaging and he also does nerve testing (including the block described by PloskoPlus) Having this information would give you a better idea if muscle repair would help. The link below involves the shoulder but it described the imaging.
https://www.sciencedirect.com/science/article/pii/S0378603X16300171
Alright I guess Zuniga is the guy have to see before making my decision. Any idea as to the cost of the imaging? I called to inquire but the receptionist said she’d get back to me but did not.
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Alright I guess Zuniga is the guy have to see before making my decision. Any idea as to the cost of the imaging? I called to inquire but the receptionist said she’d get back to me but did not.
It was covered by insurance for me, 40 dollar co-pay. I would imagine they have non insurance prices too. I think if you got a referral directly to the office, it would speak things up from trying to make a direct appt, even if its your PCP.
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Ok, the muscle is imprisoned by something. It could be stuck between the bone cut...then 'sandwiched muscles'...so maybe he pulls out the meat between the bread.
Well why can’t any surgeon here in Canada pull the meat out between the bread? Seems like a simple procedure, yet nobody even suggests it?
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Surgery after the age of about 35 increases the risk of nerve injury or other complications. Also, multiple procedures increase the risk.
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Surgery after the age of about 35 increases the risk of nerve injury or other complications. Also, multiple procedures increase the risk.
I’m way under 35
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Sorry to hear about what happened to you - you are certainly not alone with this problem, one of the many reasons I was reluctant to undergo this surgery when I was younger was the fact that I read about speech problems as a possible complication and surgeons I spoke to confirmed this is a possibility.
My two cents (a lot of people will not like me for this but I'm trying to help): USD 3,000.- and upwards is a serious amount of money in India - even if I was determined to have this surgery there, I would negotiate the cost as they are most certainly giving you a higher price than what other people would pay. The fact that someone sounds confident about something does not mean anything, is certainly does not mean they're right. If you have never been to India, you'll get a massive culture shock first. I have spent part of my life in India and have family connections there but would not go there for serious, invasive surgery. If you're planning to do a surgery like this while it's your first time in India... well, good luck. I suggest you go to India for a holiday, not surgery, at least not the very first time you visit. It's an amazing country but it can take some time getting used to.
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Well why can’t any surgeon here in Canada pull the meat out between the bread? Seems like a simple procedure, yet nobody even suggests it?
To address your question of 'then, why don't the NA doctors pull meat from sandwich', it's because a 'COULD BE' isn't a diagnosis of what it is. They would have to diagnose what ever med condition or name of it was something where the muscle somehow got trapped somewhere in vicinity of bone cut OR was just put somewhere where now the muscle has less FREEDOM than prior. This 'incarceration' relates to SOMETHING. It's just that it doesn't relate to a type of usage of that term with your NE doctors
I'm just trying to help 'brain storm' what this could be given the term 'muscle incarceration'. So, it could be muscle kind of 'stuck' between the bone cut. But within a 'could be' scenario, there is always a 'couldn't be'.
Another 'could be' that wouldn't be nerve damage would have to do with re-attaching everything back (muscle, ligament, tendon connections, whatever) after they detach when making dissection inside mouth to move the chin. So, do they re-attach exactly where they were before they detached or do they have to change where they attach to somewhere else due to chin being moved somewhere else than prior? I don't know.
So, we (well not me) don't know exactly what this is. Only what it could be. However, we DO know that through the incision inside the mouth below your lip, things were detached and later had to be attached somewhere. Also, when patients complain of lower tooth show subsequent to getting a chin implant where the incision is through inside of mouth, a PS (who does not put them in via inside mouth) does an operation to re-attach to a better place.
Again, IDK exactly what it is other than to suggest you engage your Canadian docs about the possibility of IF the structures they DETACHED and attached or re-attached after the surgery have something to do with your complaint. So, 'incarceration' could have something to do with the muscles not having the FREEDOM of function they used to have subsequent to their being put somewhere where they lost it. But your NE docs are not going to 'relate' to the
incarceration term because it's probably not in their med lingo to use it the way the Indian doctor is.
I would also suggest you ask the Indian doctor if his operation will involve DETACHING the muscle connections from where they were attached during your surgery and re-attaching elsewhere for better function.
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M
My two cents (a lot of people will not like me for this but I'm trying to help): USD 3,000.- and upwards is a serious amount of money in India - even if I was determined to have this surgery there, I would negotiate the cost as they are most certainly giving you a higher price than what other people would pay.
You got that right. A consultation with him is literally 10x less than my consult with Cameniti in Canada. So you’re right he’s probably jacking up the surgical price. I’m sure I can negotiate somewhat. Even so, $5000 is not a lot of money to be speaking normally again.
The fact that someone sounds confident about something does not mean anything, is certainly does not mean they're right. If you have never been to India, you'll get a massive culture shock first. I have spent part of my life in India and have family connections there but would not go there for serious, invasive surgery. If you're planning to do a surgery like this while it's your first time in India... well, good luck. I suggest you go to India for a holiday, not surgery, at least not the very first time you visit. It's an amazing country but it can take some time getting used to.
Well that’s really the point of this thread. I really wanted to know if anyone’s heard of NA surgeons performing this kind of revision. I don’t want to go to India. I also don’t want to live with this tugging feeling in my lower lip.
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You got that right. A consultation with him is literally 10x less than my consult with Cameniti in Canada. So you’re right he’s probably jacking up the surgical price. I’m sure I can negotiate somewhat. Even so, $5000 is not a lot of money to be speaking normally again.
Well that’s really the point of this thread. I really wanted to know if anyone’s heard of NA surgeons performing this kind of revision. I don’t want to go to India. I also don’t want to live with this tugging feeling in my lower lip.
I think if anyone had heard of it they would have probably posted it. The NA price would probably be even higher if you could find a Dr that does it. Sounds like it's worth pursuing with the Indian doc IMO. Going to India for a few days is a small price to pay for life changing result assuming it works out.
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To address your question of 'then, why don't the NA doctors pull meat from sandwich', it's because a 'COULD BE' isn't a diagnosis of what it is. They would have to diagnose what ever med condition or name of it was something where the muscle somehow got trapped somewhere in vicinity of bone cut OR was just put somewhere where now the muscle has less FREEDOM than prior. This 'incarceration' relates to SOMETHING. It's just that it doesn't relate to a type of usage of that term with your NE doctors
I understand that, my concern is that nobody’s had any interest in diagnosing the problem, only Richardson. He sent me a voice message on Instagram basically saying that speech issues 7 months post-op indicates there is something very wrong. He says he sees more cases like this as more and more surgeons are doing genioplastys. But the surgeons here don’t even think speech problems post-op is indicative of anything. It’s Frustrating. Like it’s not taken seriously. [/quote]
I'm just trying to help 'brain storm' what this could be given the term 'muscle incarceration'. So, it could be muscle kind of 'stuck' between the bone cut. But within a 'could be' scenario, there is always a 'couldn't be'.
Another 'could be' that wouldn't be nerve damage would have to do with re-attaching everything back (muscle, ligament, tendon connections, whatever) after they detach when making dissection inside mouth to move the chin. So, do they re-attach exactly where they were before they detached or do they have to change where they attach to somewhere else due to chin being moved somewhere else than prior? I don't know.
So, we (well not me) don't know exactly what this is. Only what it could be. However, we DO know that through the incision inside the mouth below your lip, things were detached and later had to be attached somewhere. Also, when patients complain of lower tooth show subsequent to getting a chin implant where the incision is through inside of mouth, a PS (who does not put them in via inside mouth) does an operation to re-attach to a better place.
Again, IDK exactly what it is other than to suggest you engage your Canadian docs about the possibility of IF the structures they DETACHED and attached or re-attached after the surgery have something to do with your complaint. So, 'incarceration' could have something to do with the muscles not having the FREEDOM of function they used to have subsequent to their being put somewhere where they lost it. But your NE docs are not going to 'relate' to the
incarceration term because it's probably not in their med lingo to use it the way the Indian doctor is.
I would also suggest you ask the Indian doctor if his operation will involve DETACHING the muscle connections from where they were attached during your surgery and re-attaching elsewhere for better function.
Caminiti said patients often come him to complaining of feeling like they were “sewn up too tight.” This would be in line with what you are saying about not re-attaching the muscles properly, but Caminiti said this is not the case and if just FEELS that way. Well, it FEELS that way to me too. So it’s either he’s right or he just hasn’t come to realize that this may be a real problem. Regardless, how can I ask him
To re-stitch me if he’s not even confident that it’s the source of the problem?
I guess I’m just surprised that the best surgeon in Canada is offering me NO solution.
Richardson wouldn’t divulge too much info on what he would do precisely, probably because he knew I would take his plan to a surgeon here. I don’t know.
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I think if anyone had heard of it they would have probably posted it. The NA price would probably be even higher if you could find a Dr that does it. Sounds like it's worth pursuing with the Indian doc IMO. Going to India for a few days is a small price to pay for life changing result assuming it works out.
I’d probably get it close to free in Canada tbh, since it’s a complication of my surgery.
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So I just got my CBCT back with some interesting findings:
Fixation screw impinges upon right mandibular nerve canal
“A fixation screw in the right posterior mandible appears to impinge upon the superior border of the left inferior alveolar nerve canal and extends through the mandibular alveolar process to extend through the lingual cortical plate. This impinging fixation screw may be the source of the patient's symptoms. The remaining fixation screws in the left mandible appear normal radiographically.“
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Did they rule out the hardware pinching the muscles and/or scar tissue around the hardware?
Hey neat...GJ for the win.
Remove the screw and see if things clear up. Hopefully it didn't actually damage the nerve.
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Hey neat...GJ for the win.
Remove the screw and see if things clear up. Hopefully it didn't actually damage the nerve.
You know GJ, the reason I didn’t take this seriously is because my surgeon never even suggested it as a possibility. Like what in the WORLD man. If I didn’t contact this Indian guy, I’d never have gotten the scan done. Wtf is wrong with people. They couldn’t even rule out possible screw impingement as a common sense, first-line differential diagnosis? What a joke. What if the longer the screw is in there, the more likely the damage will be permanent? I’m about to lose my s**t.
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You know GJ, the reason I didn’t take this seriously is because my surgeon never even suggested it as a possibility. Like what in the WORLD man. If I didn’t contact this Indian guy, I’d never have gotten the scan done. Wtf is wrong with people.
There is A LOT of incompetence in the world...
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Sorry guys, I actually have TWO screws impinging on the nerve canals. See below for the official findings:
Fixation screw impinges upon right mandibular nerve canal
A fixation screw in the right posterior mandible appears to impinge upon the superior border of the right inferior alveolar nerve canal and extends through the mandibular alveolar process to extend through the lingual cortical plate. This impinging fixation screw may be the source of the patient's symptoms. The remaining fixation screws in the right mandible appear normal radiographically.
Fixation screw impinges upon left mandibular nerve canal
A fixation screw in the right posterior mandible appears to impinge upon the superior border of the left inferior alveolar nerve canal and extends through the mandibular alveolar process to extend through the lingual cortical plate. This impinging fixation screw may be the source of the patient's symptoms. The remaining fixation screws in the left mandible appear normal radiographically.
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Sorry guys, I actually have TWO screws impinging on the nerve canals. See below for the official findings:
Fixation screw impinges upon right mandibular nerve canal
A fixation screw in the right posterior mandible appears to impinge upon the superior border of the right inferior alveolar nerve canal and extends through the mandibular alveolar process to extend through the lingual cortical plate. This impinging fixation screw may be the source of the patient's symptoms. The remaining fixation screws in the right mandible appear normal radiographically.
Fixation screw impinges upon left mandibular nerve canal
A fixation screw in the right posterior mandible appears to impinge upon the superior border of the left inferior alveolar nerve canal and extends through the mandibular alveolar process to extend through the lingual cortical plate. This impinging fixation screw may be the source of the patient's symptoms. The remaining fixation screws in the left mandible appear normal radiographically.
So sorry to hear this WTF? I think the best way to proceed is to have someone assess the nerve damage and see whether there is any treatment that might help the damage. That way, you could have the IAN nerve assessed and repaired (repaired means a variety of things) in one procedure. You dont want to let more time pass like what happened to me as i was told the screws “were nowhere near the canal” when they were. You are young and have a good chance of this repairing even if the impingement caused some damage. This is probably why you feel the pain in the background even at rest.
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On your ceph; https://imgur.com/a/kbO8kWl I see screws near where the nerve holes (mandibular nerve canals) would be. But not a radiologist as to know if they were going right through them or impinging on the nerves. The reading certainly makes sense that they are given those screws are near the nerve holes.
I also see screws that look to be going through the tooth roots. But not a radiologist so no idea if the length of the screw stops before it even touches the tooth roots.
Probably explains why hard to tell from the ceph and a CBCT was needed.
Caminetti told you it was most likely nerve damage/nerve issue but also told you removing screws won't do anything. Wonder WHY he didn't offer to remove screws near the nerve holes just incase. Yet the Indian doc told you the screws were too small to be an issue.
Well, the CBCT gives enough info for the screws to be removed IN CANADA. Certainly don't want to go all the way to India just to get screws removed.
I guess if screw removal does nothing, you can then think about going to India.
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So sorry to hear this WTF? I think the best way to proceed is to have someone assess the nerve damage and see whether there is any treatment that might help the damage. That way, you could have the IAN nerve assessed and repaired (repaired means a variety of things) in one procedure. You dont want to let more time pass like what happened to me as i was told the screws “were nowhere near the canal” when they were. You are young and have a good chance of this repairing even if the impingement caused some damage. This is probably why you feel the pain in the background even at rest.
I don’t feel pain just a tension, hard to explain. No pain whatsoever.
So are you saying the screws are likely to have caused damage and that removal won’t do much? Did you have the same issue? Did screw removal help?
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On your ceph; https://imgur.com/a/kbO8kWl I see screws near where the nerve holes (mandibular nerve canals) would be. But not a radiologist as to know if they were going right through them or impinging on the nerves. The reading certainly makes sense that they are given those screws are near the nerve holes.
I also see screws that look to be going through the tooth roots. But not a radiologist so no idea if the length of the screw stops before it even touches the tooth roots.
Probably explains why hard to tell from the ceph and a CBCT was needed.
Caminetti told you it was most likely nerve damage/nerve issue but also told you removing screws won't do anything. Wonder WHY he didn't offer to remove screws near the nerve holes just incase. Yet the Indian doc told you the screws were too small to be an issue.
To be precise I believe both my surgeon and Caminitti were referring to my chin screws when saying removal won’t do anything. Well my surgeon was at least - said it was secured directly to bone and there wouldn’t impingement. He never pointed to or commented to my mandible screws. Even Richardson was focusing on the screws on the chin I believe, because usually a large plate is used there, and also it’s the origin site of the symptoms. So perhaps they all just assumed the screws on the mandible weren’t impinging the nerve canal and focused attention to the chin screws.
Well, the CBCT gives enough info for the screws to be removed IN CANADA. Certainly don't want to go all the way to India just to get screws removed.
I guess if screw removal does nothing, you can then think about going to India.
That’s the easy answer and the most sensible option at this point, however it’s also possible that the STIFFNESS and NUMBNESS are distinct issues, where the muscle entrapment (as Richardson suggests) is causing the stiffness and the screws on the nerve canal are causing my numbness. I am not sure my surgeon can diagnose, assess, and repair an entrapped chin muscle as Richardson can do, in addition to taking out the screws.
Richardson said MENTAL nerve damage doesn’t cause stiffness , only numbness, but did not say whether alveolar nerve damage/ impingement could cause stiffness. This doesn’t really add clarity to the situation.
Perhaps as GJ told me I can ask them to also clean up whatever scar tissue is in there.
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To be precise I believe both my surgeon and Caminitti were referring to my chin screws when saying removal won’t do anything. Well my surgeon was at least - said it was secured directly to bone and there wouldn’t impingement. He never pointed to or commented to my mandible screws. Even Richardson was focusing on the screws on the chin I believe, because usually a large plate is used there, and also it’s the origin site of the symptoms. So perhaps they all just assumed the screws on the mandible weren’t impinging the nerve canal and focused attention to the chin screws.
That’s the easy answer and the most sensible option at this point, however it’s also possible that the STIFFNESS and NUMBNESS are distinct issues, where the muscle entrapment (as Richardson suggests) is causing the stiffness and the screws on the nerve canal are causing my numbness. I am not sure my surgeon can diagnose, assess, and repair an entrapped chin muscle as Richardson can do, in addition to taking out the screws.
Richardson said MENTAL nerve damage doesn’t cause stiffness , only numbness, but did not say whether alveolar nerve damage/ impingement could cause stiffness. This doesn’t really add clarity to the situation.
Perhaps as GJ told me I can ask them to also clean up whatever scar tissue is in there.
There are nerve holes near the chin.
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There is A LOT of incompetence in the world...
Most surgeons just want to see the back of you after surgery and will never, ever admit fault. To me this looks like wilful negligence on top of incompetence. He could've inquired further, ordered scans, instead he was just hoping OP would just simply go away.
The whole profession is in a state of denial about all the nerve damage they cause. The fat bastard who wrecked my ION had the possibility buried in the consent form. Well after I told him that I have all this nerve damage and he refused to see me, he published another one of those zero-information papers that talked up jaw surgery and how great it is - a complete fluff piece. I don't understand how stuff like that gets published at all and he already has a ton of publications. Anyway, in this paper he didn’t mention upper jaw surgery nerve damage as a risk AT ALL, and lower jaw surgery he estimated as 10-14% “according to one study”. This is laughable. Maybe 10-14% have enough damage to be permanently troubled by it, but in reality I’m more willing to believe that 10-14% are the lucky few to have to numbness (that they can perceive) and almost all the rest have some after lower jaw surgery.
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The question is how to avoid nerve damage if the percentages are so high? Surely, there must be a way to reduce nerve damage.
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Somehow I escaped a bimax and genio with zero nerve damage. If only the movements were a bit different!
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I’m at least hopeful now that I don’t have permanent nerve damage and that it’s just the temporary impingement causing my issues. I’ll know soon enough.
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The question is how to avoid nerve damage if the percentages are so high? Surely, there must be a way to reduce nerve damage.
Don’t put screws in the alveolar nerve canal? START there at least.
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Somehow I escaped a bimax and genio with zero nerve damage. If only the movements were a bit different!
You had a top surgeon my friend. I know you didn’t get the aesthetic result you wanted, but as you can see from my case there are a lot of smaller technical things that we take for granted that can go wrong.
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FWIW... I did some quick research (I don’t have much time to spend on this as I work a lot) and the few articles I read basically stated “significant speech impairment” as a possible symptom of alveolar nerve damage.
So I’m hoping screw removal solves everything. If my nerves are damaged because I’ve had screws wedged into my nerves for 7 months, when I’ve been complaining about this problem at 2-3 months, I am going to lose my s**t. And I am going to seriously pursue a lawsuit because I am impaired right now and nobody even TRIED to help.
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FWIW... I did some quick research (I don’t have much time to spend on this as I work a lot) and the few articles I read basically stated “significant speech impairment” as a possible symptom of alveolar nerve damage.
So I’m hoping screw removal solves everything. If my nerves are damaged because I’ve had screws wedged into my nerves for 7 months, when I’ve been complaining about this problem at 2-3 months, I am going to lose my s**t. And I am going to seriously pursue a lawsuit because I am impaired right now and nobody even TRIED to help.
Fingers crossed for you
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There are nerve holes near the chin.
Nerves to the mandible, go in through a hole and come out of a hole. A hole is called a 'foramen' and one hole is to back of mandible and other (mental) one is near the chin. Canals for the nerves are inside the bone. Whole canal is called mandibular canal. The nerve(s) branch off inside of there innervating different parts. Inferior Alveolar nerve is in that canal. Goes in one hole and comes out the other. It has 2 branches and both can innervate parts of the lip.
Hard to find good illustrations on the net. Harvard Med used to (they might still) have a small museum on the top floor of the library where they had a human mandible showing the nerves (and vessels) inside the mandible and in that canal. You could see the nerves branching off to innervate the teeth and other areas. You could also see (imagine) how easy the nerves could get damaged through a BSSO cut or even a chin cut. Anything inside the canal is something they don't see. But they can see the nerves coming out of the holes near the chin. Almost like it would be dumb luck not to damage something inside the canals which are interior to the surface of the bone.
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Nerves to the mandible, go in through a hole and come out of a hole. A hole is called a 'foramen' and one hole is to back of mandible and other (mental) one is near the chin. Canals for the nerves are inside the bone. Whole canal is called mandibular canal. The nerve(s) branch off inside of there innervating different parts. Inferior Alveolar nerve is in that canal. Goes in one hole and comes out the other. It has 2 branches and both can innervate parts of the lip.
Hard to find good illustrations on the net. Harvard Med used to (they might still) have a small museum on the top floor of the library where they had a human mandible showing the nerves (and vessels) inside the mandible and in that canal. You could see the nerves branching off to innervate the teeth and other areas. You could also see (imagine) how easy the nerves could get damaged through a BSSO cut or even a chin cut. Anything inside the canal is something they don't see. But they can see the nerves coming out of the holes near the chin. Almost like it would be dumb luck not to damage something inside the canals which are interior to the surface of the bone.
The question is, did the screw go through the bone and through the nerve, or is it just impinging upon the nerve? If it is the former, I wonder if I’d have total loss of sensation. Since I do have SOME feeling, perhaps the nerve is just impinged. A severed nerve should give complete loss of sensation.
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The question is, did the screw go through the bone and through the nerve, or is it just impinging upon the nerve? If it is the former, I wonder if I’d have total loss of sensation. Since I do have SOME feeling, perhaps the nerve is just impinged. A severed nerve should give complete loss of sensation.
Cuts sever the nerve. Screws just 'screw' with them like irritate them or impinge.
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Fingers crossed for you
Ditto.
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Met with my surgeon. Scheduled for hardware removal next week. Upper and lower since I do have worsened sinus inflammation as well.
He said the nerve is NOT in the canal when the screws go in, in fact they reposition the nerve during the surgery, so he doesn’t know whether screw removal will help. I don’t think he thinks it’s impinging the nerve, but he did say he recommends doing removal anyway. Said something like the screw could be compressing the bone which is impinging the nerve.
But the SCREW itself is not hitting the nerve since during surgery they remove the nerve the canal and reposition it UNDER the canal. I don’t think the radiologist knows this fact.
As to Richardson’s view of muscle incarceration, my surgeon has no idea what he’s (Richardson) is talking about and says the muscle wouldn’t be trapped. There is no muscle to be entrapped, etc. Said he would take a picture of my chin during surgery to show me. But he said he’ll take a look to see if anything is snagged, anyways. But he can’t really comment on what Richardson would do.
Said he will clean up some scar tissue as well.
In summary, I’m way LESS confident that hardware removal will solve my problems since the nerve isn’t even in the canal, and I did not know this 24 hours ago.
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Going to India for a few days is a small price to pay for life changing result assuming it works out.
Let me guess... You've never been to India :)
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So you’re right he’s probably jacking up the surgical price. I’m sure I can negotiate somewhat. Even so, $5000 is not a lot of money to be speaking normally again.
I'm glad you got that scan done and hope the hardware removal won't be too uncomfortable and help with the issues you're facing!
Re: Richardson, I'm sure you'd gladly pay that kind of money to speak normally again and the problem is, he knows that. If he's a good doctor, he doesn't need to charge you a ridiculous amount of money just because he knows you're kind of desperate. I did a quick Google search and he's obviously very active on social media and trying to advertise himself quite aggressively - he might be good at marketing and communicating with you, but that does not make him a good surgeon and there's no evidence he knows something nobody else knows (how likely is that anyway?).
I came across this video posted by him two years ago: https://www.youtube.com/watch?v=oMuqi6X9tPo, in the comments someone asked how much the procedure cost - double jaw surgery - and he replied saying 'between USD 1000 and 5000' - that sounds a realistic price to me for double jaw surgery with genioplasty in India, not for a much smaller procedure like hardware removal or similar.
Anyway, I think you're on thr right track trying to find out if anybody else does the procedure he mentioned to you. Also, something good came out of your search for a solution since you got the CBCT done and are getting the screws removed.
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I'm glad you got that scan done and hope the hardware removal won't be too uncomfortable and help with the issues you're facing!
Re: Richardson, I'm sure you'd gladly pay that kind of money to speak normally again and the problem is, he knows that. If he's a good doctor, he doesn't need to charge you a ridiculous amount of money just because he knows you're kind of desperate. I did a quick Google search and he's obviously very active on social media and trying to advertise himself quite aggressively - he might be good at marketing and communicating with you, but that does not make him a good surgeon and there's no evidence he knows something nobody else knows (how likely is that anyway?).
I came across this video posted by him two years ago: https://www.youtube.com/watch?v=oMuqi6X9tPo, in the comments someone asked how much the procedure cost - double jaw surgery - and he replied saying 'between USD 1000 and 5000' - that sounds a realistic price to me for double jaw surgery with genioplasty in India, not for a much smaller procedure like hardware removal or similar.
Anyway, I think you're on thr right track trying to find out if anybody else does the procedure he mentioned to you. Also, something good came out of your search for a solution since you got the CBCT done and are getting the screws removed.
Thanks very much for letting me know this!!!
I’ll get the hardware removal for free here in Canada, and then will reassess and consider Richardson if nothing improves.
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Met with my surgeon. Scheduled for hardware removal next week. Upper and lower since I do have worsened sinus inflammation as well.
He said the nerve is NOT in the canal when the screws go in, in fact they reposition the nerve during the surgery, so he doesn’t know whether screw removal will help. I don’t think he thinks it’s impinging the nerve, but he did say he recommends doing removal anyway. Said something like the screw could be compressing the bone which is impinging the nerve.
But the SCREW itself is not hitting the nerve since during surgery they remove the nerve the canal and reposition it UNDER the canal. I don’t think the radiologist knows this fact.
As to Richardson’s view of muscle incarceration, my surgeon has no idea what he’s (Richardson) is talking about and says the muscle wouldn’t be trapped. There is no muscle to be entrapped, etc. Said he would take a picture of my chin during surgery to show me. But he said he’ll take a look to see if anything is snagged, anyways. But he can’t really comment on what Richardson would do.
Said he will clean up some scar tissue as well.
In summary, I’m way LESS confident that hardware removal will solve my problems since the nerve isn’t even in the canal, and I did not know this 24 hours ago.
Totally new one on me too that they actually remove the alveolar nerve from the mandibular nerve canal and do that to avoid any injury to it. Fascinating when you consider not even the radiologist knew that when he reported an impinging fixation screw may be the source of the symptoms. But it does look like your doc is entertaining possibly of impingement by screw pressing on bone and will remove screws.
Richardson's view of muscle incarceration, had to be guessed at; 'brain stormed' as to what it could POSSIBLY mean. I mentioned that in a prior post. A 'COULD BE' is not a definite that it is that. But 'could be (s)' are helpful to entertain because posing a 'could be' gives rise to a 'could not be' and that is what helps rule out things.
Must also be a relief to find out he didn't put screws in the alveolar nerve canal.
Don’t put screws in the alveolar nerve canal? START there at least.
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I also had a video call today with Richardson. He reviewed my scan, said the screws are in the RIGHT place and confirmed what my surgeon said: that the nerve is removed from the canal anyway. Said radiologist who wrote the report doesn’t know much and was looking for something.
I think he said screw removal may help my sensational numbness; said damage at 6 months is permanent if there is damage. But even screw removal won’t help my stiffness. On my job of the nerves is to supply sensation, that’s it, stiffness is not a motor nerve problem either as those are not damaged, so it can only be a muscular problem.
In terms of what he WOULD DO, he said (drain?) the fibrosis - by this I guess he means scar tissue - make sure there are no small bits of muscle fragments getting caught anywhere or snagged, and properly re-suture the cuts.
He didn’t really speak much on the INCARCERATION aspect that he mentioned earlier, in this call he was talking more about treating the fibrosis and re-suturing in the correct place. Said jaw surgeons do not think like plastic surgeons in terms of muscles being affected by the bone movements and are solely focused on the bone movements and can sometimes be careless with the re-suturing.
So the few things I took away from this was....
There’s nothing he’s suggested that I cannot get done here in Canada. At the very least I’m sure I can find a plastic surgeon here who can similar things. I’m just wondering if I can get my jaw surgeon to A) take care of the fibrosis and B) perhaps re-stitch me differently, so that I can get this done for free when he does the hardware removal.
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I also had a video call today with Richardson. He reviewed my scan, said the screws are in the RIGHT place and confirmed what my surgeon said: that the nerve is removed from the canal anyway. Said radiologist who wrote the report doesn’t know much and was looking for something.
I think he said screw removal may help my sensational numbness; said damage at 6 months is permanent if there is damage. But even screw removal won’t help my stiffness. On my job of the nerves is to supply sensation, that’s it, stiffness is not a motor nerve problem either as those are not damaged, so it can only be a muscular problem.
In terms of what he WOULD DO, he said (drain?) the fibrosis - by this I guess he means scar tissue - make sure there are no small bits of muscle fragments getting caught anywhere or snagged, and properly re-suture the cuts.
He didn’t really speak much on the INCARCERATION aspect that he mentioned earlier, in this call he was talking more about treating the fibrosis and re-suturing in the correct place. Said jaw surgeons do not think like plastic surgeons in terms of muscles being affected by the bone movements and are solely focused on the bone movements and can sometimes be careless with the re-suturing.
So the few things I took away from this was....
There’s nothing he’s suggested that I cannot get done here in Canada. At the very least I’m sure I can find a plastic surgeon here who can similar things. I’m just wondering if I can get my jaw surgeon to A) take care of the fibrosis and B) perhaps re-stitch me differently, so that I can get this done for free when he does the hardware removal.
That sounds consistent with Reply #25 by me on this thread discussing 'DETACHING and ATTACHING back' as another 'could be' scenario which is not nerve damage.
In terms of what he WOULD DO, I will leave it to you to determine from him (or guess) what is meant by 'draining' scar tissue.
Sufficient info has been garnered/gathered in this process in addition to your having 2 direct communication channels with both doctors for a decision to be made.
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I’ll get the hardware removal for free here in Canada, and then will reassess and consider Richardson if nothing improves.
Good luck, I so hope you'll see some improvement! It would make me feel more confident about surgery too, as currently I'm still deliberating whether I even want this surgery due to the possible complications. Speech issues would be a real problem for me and could affect my career. You're young (unlike me), I'm sure you have a good chance of recovering well.
If you're still considering India, I can recommend a really good website - it has a lot of active members, both Indians and Westerners (including Americans / Canadians) with a lot of experience on different aspects of life in India. Some of the Western members have lived in India for years so they have a realistic idea of how things work over there. It's called IndiaMike (https://www.indiamike.com/india), you can register and post your question in the forum section. Most likely nobody will have any idea of jaw surgery but there will be people with experience of getting medical treatment / surgery in different kinds of hospitals. There might even be someone that knows about this particular doctor, or has read stuff about him in local languages, or they might know the hospital he works at.
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Good luck, I so hope you'll see some improvement! It would make me feel more confident about surgery too, as currently I'm still deliberating whether I even want this surgery due to the possible complications. Speech issues would be a real problem for me and could affect my career. You're young (unlike me), I'm sure you have a good chance of recovering well.
If you're still considering India, I can recommend a really good website - it has a lot of active members, both Indians and Westerners (including Americans / Canadians) with a lot of experience on different aspects of life in India. Some of the Western members have lived in India for years so they have a realistic idea of how things work over there. It's called IndiaMike (https://www.indiamike.com/india), you can register and post your question in the forum section. Most likely nobody will have any idea of jaw surgery but there will be people with experience of getting medical treatment / surgery in different kinds of hospitals. There might even be someone that knows about this particular doctor, or has read stuff about him in local languages, or they might know the hospital he works at.
The hospital he works at is called 'Richardson ' like is HIS name as in his own hospital. I don't have the link at my fingertips right now .
ETA: https://facesurgeon.in/
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The hospital he works at is called 'Richardson' like is HIS name as in his own hospital. I don't have the link at my fingertips right now.
That's right, he owns a hospital - so basically he can do whatever he wants there as nobody will ever check on him (and no, don't count on the Indian government to check a hospital or demand any standards are maintained). I Googled him again and apparently he completed more than ten thousand facial surgeries; he is 'the best maxillofacial surgeon' in Oman and a 'visiting professor' at Stanford University; he also does rhinoplasties; meanwhile, his CV is extremely vague and it's unclear where he actually worked and what he did for the past several years, no mention of him having trained in plastic surgery (but he does rhinoplasties!) etc. He speaks several languages including Spanish and German. Maybe, just maybe, this guy sounds a bit too good to be true...
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That's right, he owns a hospital - so basically he can do whatever he wants there as nobody will ever check on him (and no, don't count on the Indian government to check a hospital or demand any standards are maintained). I Googled him again and apparently he completed more than ten thousand facial surgeries; he is 'the best maxillofacial surgeon' in Oman and a 'visiting professor' at Stanford University; he also does rhinoplasties; meanwhile, his CV is extremely vague and it's unclear where he actually worked and what he did for the past several years, no mention of him having trained in plastic surgery (but he does rhinoplasties!) etc. He speaks several languages including Spanish and German. Maybe, just maybe, this guy sounds a bit too good to be true...
I agree his website was a little sketchy. Is he board certified?
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Basically, Richardson keeps spamming the internet with his achievements (such as https://www.quora.com/Why-should-I-prefer-Dr-Sunil-Richardson-over-other-maxillofacial-surgeons), but I cannot find a single independent source that would verify that anything he says about himself is even true. It's just his own marketing pitch being repeated online over and over again, calling him 'the best maxillofacial surgeon' in India, Oman etc.
India is a large country with thousands of maxillofacial surgeons, many of whom work in reputable hospitals in big cities like Mumbai or in other countries, the Middle East etc. How did this guy decide he's 'the best'? He certainly has a lot of confidence, a worrying amount, in fact. If you Google 'the best maxillofacial surgeons in India', you'll get a lot of results and this Richardson guy will be nowhere near among them. Anyway, I'll drop this subject now and let everyone make up their own mind.
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Is he board certified?
Board, what board lol? This is India. I am sure the guy has lots of colourful, shiny certificates, his walls are probably covered in them. I highly doubt there's even a way to verify whether he has any degress (not saying he hasn't, but verifying it would be another story). For the record, he's not listed here: https://www.aomsi.com/WebPages/MemberSearch.aspx. Even the name Richardson sounds a bit strange to me - I mean OK, there are Anglo-Indians and others with Western surnames in India, but Richardson? Weird.
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Board, what board lol? This is India. I am sure the guy has lots of colourful, shiny certificates, his walls are probably covered in them. I highly doubt there's even a way to verify whether he has any degress (not saying he hasn't, but verifying it would be another story). For the record, he's not listed here: https://www.aomsi.com/WebPages/MemberSearch.aspx. Even the name Richardson sounds a bit strange to me - I mean OK, there are Anglo-Indians and others with Western surnames in India, but Richardson? Weird.
There's at least one international board and an OMS association specific to India:
https://www.ibcsoms.org/Index.aspx
https://www.aomsi.com/WebPages/AboutAomsi.aspx
I don't know much about them but it would be 'some' kind of evidence in his favor if he were.
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That's right, he owns a hospital - so basically he can do whatever he wants there as nobody will ever check on him (and no, don't count on the Indian government to check a hospital or demand any standards are maintained). I Googled him again and apparently he completed more than ten thousand facial surgeries; he is 'the best maxillofacial surgeon' in Oman and a 'visiting professor' at Stanford University; he also does rhinoplasties; meanwhile, his CV is extremely vague and it's unclear where he actually worked and what he did for the past several years, no mention of him having trained in plastic surgery (but he does rhinoplasties!) etc. He speaks several languages including Spanish and German. Maybe, just maybe, this guy sounds a bit too good to be true...
Is that not the same or equivalent to a doctor in US owning his own surgical suite?
A maxfax doctor can do rhinos given they are moving the base of the nose in Lefort 1.
His website lists certificates for CV and certificates: https://facesurgeon.in/cv-and-certificates/
Perhaps regarding oversight of Indian gov as to owner operated hospitals/practices in venue of dentistry you're familiar with the BUDGET options?
I've never been to India. But I have watched a lot of YT videos where they have these STREET DENTISTS that perform dental work on the street.
ref= https://www.youtube.com/watch?v=qoBYttpiqg8
His web site has him posing in front of a portrait which appears to be the Sultan of Oman. In the corner of the portrait is the Sultan in his 'naval' uniform. Not to digress, but years back in early 1990's, I was invited on the Sultan's ship (Tall Ships) and I had an autographed photo from the Sultan and hung it on my wall. I remember a neighbor taking some kind of umbrage or offence that I had a photo of a leader of a Muslim country on my wall and not the US president or something like that. Perhaps extraneous info and nothing to do with portrait of the Sultan on R's website. But the only other thing I'm able to ID with here is a suspicious reaction to me coincident with having a picture of the Sultan of Oman.
As to his posing with people (who could be 'Grand Wazoos' of some kind), his YT photo has him posing with someone who might be a maxfax. Looks sort of familiar but I can't pin point. I'm including screen shot here.
I have nothing to add that is either highly suspicious or highly trustful of him.
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Looks like he has/had a private practice in Oman
https://facesurgeon.in/private-oral-and-maxillofacial-surgery-practice-in-muscat/
Also YT video from Oman
https://www.youtube.com/watch?v=jAMr_g5I0po
Worked at Starcare Hospital in Oman
Oman very rich (small) country. As to gov oversight, not like India. I'd imagine there would be high standards to vet the surgeons.
The only thing kind of 'weird' to me is that I didn't see the video from Starcare Oman in his video collection.
This is not to challenge 'suspicion' of doctors who do a lot of self promotion as I've challenged that sort of thing myself. I would imagine that IF he decided to sign up here and answer a lot of questions he would be welcome by members. Yes/No?
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Yes. At the very least we would have a better sense of his character and competence.
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Is that not the same or equivalent to a doctor in US owning his own surgical suite?
A maxfax doctor can do rhinos given they are moving the base of the nose in Lefort 1.
His website lists certificates for CV and certificates: https://facesurgeon.in/cv-and-certificates/
Perhaps regarding oversight of Indian gov as to owner operated hospitals/practices in venue of dentistry you're familiar with the BUDGET options?
I've never been to India. But I have watched a lot of YT videos where they have these STREET DENTISTS that perform dental work on the street.
Interesting story re: Sultan of Oman!
Re: street dentists in India, yes this does happen, of course they aren't qualified dentists, but there are many people that don't have access to 'proper' dentists and / or cannot afford their fees. On the other end of the spectrum, they also have highly qualified dentists - typically working in big cities - using the latest technology and charging (almost) Western prices. And there's everything in between these two extremes.
I had no idea that maxfac doctors could also do rhinoplasties without additional training - interesting.
Re: doctor owned surgical suites, I have no idea how this works in the USA and also don't know the legal framework behind it in India, but there are always stories in Indian newspapers about private hospitals offering unnecessary treatment, malpractice, overcharging patients and so on. There's practically nothing patients can do in these cases. Here is an article about this from a lawyer's perspective (it's quite long though - he's basically saying 'there is no accountability'): https://timesofindia.indiatimes.com/blogs/the-irreverent-lawyer/greed-and-the-rise-of-medical-malpractice-in-india/. I think this can be hard to imagine from an American perspective - at least I keep hearing that in America, patients can sue doctors quite easily and successfully.
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Oman very rich (small) country. As to gov oversight, not like India. I'd imagine there would be high standards to vet the surgeons.
This is not to challenge 'suspicion' of doctors who do a lot of self promotion as I've challenged that sort of thing myself. I would imagine that IF he decided to sign up here and answer a lot of questions he would be welcome by members. Yes/No?
Yes, that's exactly what people imagine until they start living in the Middle East lol (but you're right, more accountability than in India). He keeps posting that he worked at that hospital but does not say when, for how long, and in what capacity etc. Anyway, of course, I'd personally welcome posts by any surgeons including Dr Richardson. To get it straight, I don't think he isn't a doctor or anything along those lines, I'm just highly sceptical about him saying he can perform some special procedures that nobody else can, basically. (Yes, I'm also sceptical about his ten thousand surgeries and so on, but that's purely because I'm a suspicious sort of person :) ).
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I will say that Richardson is indeed very confident the he can help me. For example he said pinch your mentalis muscle and and pull, and try moving your lower lip to speak, you’ll feel tightness. To be fair to him, he does “get” my problem. Seemed actually very routine to him. On the other hand, my surgeon just has nothing at all to say about the stitching, about any muscle incarceration, nothing.
He did a Skype consult with me for free. He also did mention off hand that if I didn’t want to come to India I may be able to find someone there.
So that’s what I’m trying to do at the moment. It appears that a craniofacial/ plastic surgeon is the kind of specialist who would know all about muscular problems in the face. There’s one Dr. Antonyshyn at sunnybrook in Toronto I’ll be consulting... same title as Richardson.. craniofacial/ plastic surgeon.
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Interesting story re: Sultan of Oman!
Re: street dentists in India, yes this does happen, of course they aren't qualified dentists, but there are many people that don't have access to 'proper' dentists and / or cannot afford their fees. On the other end of the spectrum, they also have highly qualified dentists - typically working in big cities - using the latest technology and charging (almost) Western prices. And there's everything in between these two extremes.
I had no idea that maxfac doctors could also do rhinoplasties without additional training - interesting.
Re: doctor owned surgical suites, I have no idea how this works in the USA and also don't know the legal framework behind it in India, but there are always stories in Indian newspapers about private hospitals offering unnecessary treatment, malpractice, overcharging patients and so on. There's practically nothing patients can do in these cases. Here is an article about this from a lawyer's perspective (it's quite long though - he's basically saying 'there is no accountability'): https://timesofindia.indiatimes.com/blogs/the-irreverent-lawyer/greed-and-the-rise-of-medical-malpractice-in-india/. I think this can be hard to imagine from an American perspective - at least I keep hearing that in America, patients can sue doctors quite easily and successfully.
The article talks about PROFIT INCENTIVE in medicine. I mean profit incentive also plays a big role in US medicine too as does extreme difficulty for patients to pursue malpractice cases. Of course, there are differences between medicine in India and in US but both share some similarities in venue of profit incentive and difficulty in suing. So, VERY DIFFICULT for patients to sue US doctors. The 'system' has it that expert witnesses (like other doctors) have to be hired and that part is extremely costly. It's done. But a lawyer who takes on a case on contingency has to see big chance of winning BIG in situations where patients can't pay up front for the lawyer to pursue. Then he/she takes BIG chunk of change from the winnings. So, profit incentive there too. (There's a joke about lawyers: 'Why don't sharks attack lawyers?...Professional courtesy..')
Yes. In US and in Europe, docs can own their own surgical outfits. I don't know of all the technicalities though. Just that some kind of approval is needed and the outfits are not all in 'hospitals'. But of course, some could be within hospitals.
Anyway, this Indian doc looks to have a private hospital and most likely would have a board of directors involved. But I have no idea about Indian gov monitoring or quality control of private hospitals or even for public ones. I guess I would attribute a lot of vigilance to OMAN though and he did practice in their hospital.
Although I've been to neither Oman nor India, I can't imagine Oman having some things you will find in India. eg. the RAT TEMPLE where thousands (millions?) of rats are revered, have private COOKS to feed them daily and you've gotta enter the temple with your shoes off. Then there are those yogis in India that cover themselves with the ashes from burned (human) bones and make a practice of eating carrion found near on the shores of the Ganges. Maybe it's just me. But I think those would be major attractions for any tourist to India.
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Yes, that's exactly what people imagine until they start living in the Middle East lol (but you're right, more accountability than in India). He keeps posting that he worked at that hospital but does not say when, for how long, and in what capacity etc. Anyway, of course, I'd personally welcome posts by any surgeons including Dr Richardson. To get it straight, I don't think he isn't a doctor or anything along those lines, I'm just highly sceptical about him saying he can perform some special procedures that nobody else can, basically. (Yes, I'm also sceptical about his ten thousand surgeries and so on, but that's purely because I'm a suspicious sort of person :) ).
Well, there are a lot of problems in the 'Middle East' and I guess I parallel Oman with Brunei as not having conflict from antagonistic factions or s**t stirring from US covert operations. Although Brunei probably has no conflict with (human) head hunters in nearby Borneo.
OK. I digress. But maybe there would be option for him to go to Oman to visit the Indian doctor. Oman is closer. No idea if flight times would be longer though. I mean, the R says he's the best doctor in OMAN. So, easy enough for the OP to ask if possible to see him in Oman.
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Board, what board lol? This is India. I am sure the guy has lots of colourful, shiny certificates, his walls are probably covered in them. I highly doubt there's even a way to verify whether he has any degress (not saying he hasn't, but verifying it would be another story). For the record, he's not listed here: https://www.aomsi.com/WebPages/MemberSearch.aspx. Even the name Richardson sounds a bit strange to me - I mean OK, there are Anglo-Indians and others with Western surnames in India, but Richardson? Weird.
He's not on the aomsicom search. So, legit question why not. Membership logo of same is on his website.
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OK, so the guy probably toots his own horn a lot over the net for a broader base of patient recognition outside of India. But I was reading some of his professional articles (published in legit venues) and those seems OK. As to how many surgeries a doctor does, there is really no way to cross reference it. What's clear is that he's very confident in his abilities and wanting to be recognized outside of India (medical tourism) and making direct appeal to patients. That's the new trend with younger doctors. Just to say, I find published papers something in his favor but have nothing against his horn tooting seeming suspicious.
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The article talks about PROFIT INCENTIVE in medicine. I mean profit incentive also plays a big role in US medicine too as does extreme difficulty for patients to pursue malpractice cases. Of course, there are differences between medicine in India and in US but both share some similarities in venue of profit incentive and difficulty in suing. So, VERY DIFFICULT for patients to sue US doctors. Anyway, this Indian doc looks to have a private hospital and most likely would have a board of directors involved. But I have no idea about Indian gov monitoring or quality control of private hospitals or even for public ones. I guess I would attribute a lot of vigilance to OMAN though and he did practice in their hospital.
Although I've been to neither Oman nor India, I can't imagine Oman having some things you will find in India. eg. the RAT TEMPLE where thousands (millions?) of rats are revered
I see - I didn't know it was difficult to sue in the USA, I really don't know anything about their system except for what I read in newspapers. In India, the additional problems are the court system and the fact that it's easy to bribe or intimidate people including police, other doctors, witnesses etc. It's considered normal for cases to drag on for many, many years, even decades, so it does not make sense for a potentially disabled client (who already lost a lot of money) to spend even more money and several years of his or her life attending court hearings.
Re: rats, obviously the 'rat temple' is an extreme example and there are a lot more interesting things in India than that. It's a great country with a fascinating culture and history, but not a typical destination of choice for elective medical treatment. I have visited Oman and other neighbouring countries several times for business, I'd say that it's about equally common to see rats on the street in India and the Middle East (it's not super common but it does happen from time to time). It's not uncommon in London either, and I hear it's the same in New York City.
It's an interesting suggestion you made about the OP visiting the doctor in Oman instead of India. I think it's a great idea if OP can afford it (Oman would be way more expensive in every ways). It's closer to him, it would be much less of a culture shock, it's a beautiful country with generally nice people and personally I'd feel much safer in a private hospital in Oman. Once he is in Oman, he could then fly to India for a holiday and just enjoy the country instead of worrying about medical treatment there. India is way, way more interesting for a tourist than tiny, boring and safe Oman :)
At the end, I guess it's all down to luck. I had emergency medical treatment in a government hospital in India and am eternally grateful to the doctors that treated me (for a ridiculously low amount of money), they did an excellent job. On the other hand, I had a minor elective surgical procedure with a Western European doctor at the best and most expensive hospital in a Middle East country, and the doctor messed up big time and I have an ongoing problem ever since (I could have sued but can't face the stress, decided to just live with it). So you never know, but you still want to make a choice that seems best and most rational in the circumstances.
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s**t stirring from US covert operations.
This made me think - you spent some time at MIT right? Did you ever run into Chomsky? I know he was there pursuing his theory of Universal Grammar in the Linguistics and Philosophy department and (somewhat ironically) doing research for the DoD. He's also a Professor Emeritus there now
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This made me think - you spent some time at MIT right? Did you ever run into Chomsky? I know he was there pursuing his theory of Universal Grammar in the Linguistics and Philosophy department and (somewhat ironically) doing research for the DoD. He's also a Professor Emeritus there now
Of course I did. He was active professor. Courses were very popular and filled up fast. He was friends with another Grand Wazoo professor of mine and came to brunch at our dorm.
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Of course I did. He was active professor. Courses were very popular and filled up fast. He was friends with another Grand Wazoo professor of mine and came to brunch at our dorm.
Dang. That's awesome. Depending on one's opinion of him I guess lol
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Dang. That's awesome. Depending on one's opinion of him I guess lol
Even though his courses filled up fast, I still could have gotten in ('strings' via the house master). However, TBH, in venue of psychology, I liked the Harvard professor, BF Skinner better (behaviorism) about whom Chomsky was critical. For 'humanities', I took Fine Arts at Harvard and considered 'vacation' to be away from institute. Besides, a lot of his political theory was 'coals to Newcastle' to me at the time or it just came through via 'osmosis' because most of the dorm was taking his course(s).
Counter-Gov stuff was in venue of 'fun' hobbies or extra-curricular activities including but not limited to screwing with the secret service on campus. One 'sunny day' prank included intercepting their lines and asking; 'Do you think it's going to rain today?' (They wore overcoats/raincoats.) Another was for a bunch of people from the dorm to don rain coats, dark glasses and ear pieces and just walk around near the agents and pretend to be talking to each other. House master who was pretty good friends with Chomsky found the pranks funny. So, not something he would reprimand the dorm residents for. Nor would Chomsky be type to reprimand for either. In fact, at the time, running joke was that the 'I' in CIA was an oxymoron. The dorm was a bastion for magnetizing certain types who were 'groupies' or protégés to a select collection of professors. The institute always had a problem with it. President would be hit with complaints. Complaint would go to house master about certain activities/proclivities of the occupants. It would be laughed at as a request for us to DUMB DOWN. The attitude at the time (not by prez though) was that if any of these 'intelligence' guys had any issue with being spotted or pranked with, they would need to smarten up. Later,in recent years, the institute decided to DEMOLISH the dorm.
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in venue of psychology, I liked the Harvard professor, BF Skinner better (behaviorism) about whom Chomsky was critical
It would make sense for Chomsky to be critical of behaviorism given his linguistic theory. In his view, consciousness (and language acquisition) are made possible via inherent 'schematics' that exert strong behavioral influence. I'm not sure where the present literature stands on the question.
Counter-Gov stuff was in venue of 'fun' hobbies or extra-curricular activities including but not limited to screwing with the secret service on campus. One 'sunny day' prank included intercepting their lines and asking; 'Do you think it's going to rain today?' (They wore overcoats/raincoats.) Another was for a bunch of people from the dorm to don rain coats, dark glasses and ear pieces and just walk around near the agents and pretend to be talking to each other. House master who was pretty good friends with Chomsky found the pranks funny. So, not something he would reprimand the dorm residents for. Nor would Chomsky be type to reprimand for either. In fact, at the time, running joke was that the 'I' in CIA was an oxymoron.
Sounds like a blast
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I see - I didn't know it was difficult to sue in the USA, I really don't know anything about their system except for what I read in newspapers. In India, the additional problems are the court system and the fact that it's easy to bribe or intimidate people including police, other doctors, witnesses etc. It's considered normal for cases to drag on for many, many years, even decades, so it does not make sense for a potentially disabled client (who already lost a lot of money) to spend even more money and several years of his or her life attending court hearings.
Re: rats, obviously the 'rat temple' is an extreme example and there are a lot more interesting things in India than that. It's a great country with a fascinating culture and history, but not a typical destination of choice for elective medical treatment. I have visited Oman and other neighbouring countries several times for business, I'd say that it's about equally common to see rats on the street in India and the Middle East (it's not super common but it does happen from time to time). It's not uncommon in London either, and I hear it's the same in New York City.
It's an interesting suggestion you made about the OP visiting the doctor in Oman instead of India. I think it's a great idea if OP can afford it (Oman would be way more expensive in every ways). It's closer to him, it would be much less of a culture shock, it's a beautiful country with generally nice people and personally I'd feel much safer in a private hospital in Oman. Once he is in Oman, he could then fly to India for a holiday and just enjoy the country instead of worrying about medical treatment there. India is way, way more interesting for a tourist than tiny, boring and safe Oman :)
At the end, I guess it's all down to luck. I had emergency medical treatment in a government hospital in India and am eternally grateful to the doctors that treated me (for a ridiculously low amount of money), they did an excellent job. On the other hand, I had a minor elective surgical procedure with a Western European doctor at the best and most expensive hospital in a Middle East country, and the doctor messed up big time and I have an ongoing problem ever since (I could have sued but can't face the stress, decided to just live with it). So you never know, but you still want to make a choice that seems best and most rational in the circumstances.
Well, to be more precise, anybody can sue. The matter with malpractice claims is prevailing which is contingent on expert witnesses which in turn is a lot of expense for the patient. Doctors have malpractice insurance which basically pays their legal defense bills.
A patient could have medical insurance to pay for an operation. So, if they sue the doctor the insurance paid to do the operation and the patient wins, the insurance plan could demand the part to most of the winnings. That is example of plight of poor in US who have insurance by state or gov.
As to India, doctors there are often wanting private pay medical tourism. So more incentive for them (I would think) to do good job. Clearly the OP got in touch with another who went to the Indian doctor and had good things to say about him. So, it's like that and maybe more so than all the self horn tooting you spotted on Richardson's promo material. He would have incentive to do good job on OP because that's a way he gets referrals from patients outside of India.
I was looking more at R's website. Some of the things he does are 'quick' things like mole removal or skin fixes. So, small stuff could be part of high number of 'procedures'. Notable ones (which, of course will be longer) would be fixing facial deformities, birth defects, things that cause speech defects, accidents etc. So, for that sort of thing, there would be nothing but satisfied patients. Can't imagine any complaints.
Background in fixing facial deformities; maxillo-facial, cranio-facial will also include some plastic surgery because the deformities would also be found in soft tissue. Hence, he does rhino. Also, sewing up lip in cleft lip patient is soft tissue work and stitching technique is PS and. I'll also mention again what I said in one of my earlier posts. India, as an ANCIENT culture had medical advances where the first rhinos (and I'm talking fixing noses that were chopped off) came from there. So, I would imagine that there would pride involved with some Indian doctors as it relates to a culture with history of medical advances. I mean North America doesn't arise from any advanced civilization. I would not be surprised (nor something I personally would fault him for) if he drew from cultural history as it relates to medicine to consider himself even better than NA doctors.
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It would make sense for Chomsky to be critical of behaviorism given his linguistic theory. In his view, consciousness (and language acquisition) are made possible via inherent 'schematics' that exert strong behavioral influence. I'm not sure where the present literature stands on the question.
Sounds like a blast
For linguistics, I admired professor Harald Reiche. http://news.mit.edu/1994/reiche-0817
He was extremely cultured, impeccably dressed urbane and a classicist. This set him apart (and to me 'above') in my eyes, from Chomsky and other MIT pros who had large followings.
Yes, some stuff was fun. But on the other hand, people were jumping off buildings and hanging themselves in the basement due to competition of getting straight 'A's.
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For linguistics, I admired professor Harald Reiche. http://news.mit.edu/1994/reiche-0817
He was extremely cultured, impeccably dressed urbane and a classicist. This set him apart (and to me 'above') in my eyes, from Chomsky and other MIT pros who had large followings.
Yes, some stuff was fun. But on the other hand, people were jumping off buildings and hanging themselves in the basement due to competition of getting straight 'A's.
Well, I'm sure nobody would accuse Chomsky of being either "impeccably dressed" or "urbane". Could be an endearing quality to some though.
Interesting window into that world. Sad to hear about the suicides. I have some friends that have gone onto Hopkins for med school. Apparently it's a tough transition to go from being a big fish in a little pond to being surrounded by sharks.
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Well, I'm sure nobody would accuse Chomsky of being either "impeccably dressed" or "urbane". Could be an endearing quality to some though.
Interesting window into that world. Sad to hear about the suicides. I have some friends that have gone onto Hopkins for med school. Apparently it's a tough transition to go from being a big fish in a little pond to being surrounded by sharks.
After the suicides came the humor parody magazine special 'Suicide' edition. Best buildings and bridges, how to tie a noose and sample notes to leave behind for all responsible for not giving you an 'A'. Although not well received by the institute admin either, the sad part was grading was on a curve where to get the A, one needed to be way on the other side of spectrum of the average where TESTS were designed for that. The jumpers or 'ropers' had a meta-program going on in their heads (from parents) of; 'Get all A's', 'Be a doctor.' 'Get into Harvard med.'
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I got the hardware removed. I noticed the familiar stiff feeling right under the lower lip immediately post-op, and was disappointed. Now I have to go through another recovery for nothing.
And no it’s not “too early to tell.” I’ve come to know this stiff feeling and I can differentiate it from the other temporarily stiff areas induced by the surgery/ incisions.
The more I look into what IAN nerve injury entails, the more I’m seeing that Richardson may be right, that stiffness as a symptom is not supported in the literature or in his clinical experience. In fact, even my surgeon said the same, that the literature doesn’t support stiffness as a symptom.
For instance, right now I have completely numbness on one side of my upper lip. But there isn’t a strong sensation of stiffness or tightness when I scrunch the lip. So numbness does not equal stiffness.
As to why Richardson knows all about this and the surgeons here do not, he says he sees more complications in India. Fair enough. I should also clarify that by muscle incarceration, he simply means a muscle that isn’t functioning properly. Doesn’t have to mean “entrapped.” That’s why I was swapping the word “damaged” in there in my descriptions.
I probably will have to get another revision done with him... I don’t like to accept things until I’ve tried everything.
The problem for me is I still don’t understand what the heck he would attempt to do as a treatment. He says he doesn’t know until he accesses the “mistake.” But he could give me examples, like “for one patient I noticed they had X problem with the mentalis and so I did Y and it improved the symptoms” etc.. but none of that.
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Sorry to hear the hardware removal didn't work out. That sucks. I agree you should pursue every lead you have.
I should also clarify that by muscle incarceration, he simply means a muscle that isn’t functioning properly. Doesn’t have to mean “entrapped.” That’s why I was swapping the word “damaged” in there in my descriptions.
Entrapment is literally a synonym for incarceration, so I'm hoping this is something that just got lost in translation and he's not bulls**tting you
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The problem for me is I still don’t understand what the heck he would attempt to do as a treatment. He says he doesn’t know until he accesses the “mistake.” But he could give me examples, like “for one patient I noticed they had X problem with the mentalis and so I did Y and it improved the symptoms” etc.. but none of that.
I think you should think about this. Nerve damage is not something that you just fix with a surgery, if that was the case it would be a major break through for paralyzed people etc. Selling hope is a very good business. Look at the weight loss industry, it's the easiest theory in the world, eat less and exercise more, but still selling magical fixes is a big business. Sure, seek advice, but also make sure you know exactly what he's going to do before buying anything. Doing another surgery on the nerves may not only not help, but also cause more damage.
You say you know it's not too early, I can't argue with that. But the body and nerves are amazing. They find new paths and there are stories where it suddenly happen after 2 years. I've recently become interested in vitamin B complex, I talked to one patient who was told by the doctor that they give this in high dosages to people who've had their finger cut of and reattached. I also talked to one patient who had problems getting the feeling back after orthognatic surgery, but the day after starting treatment started getting some buzz. Sure, it's anecdotes and case studies, but on the other hand totally harmless and can be done while consulting for other things.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4904479/
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I think you should think about this. Nerve damage is not something that you just fix with a surgery, if that was the case it would be a major break through for paralyzed people etc. Selling hope is a very good business. Look at the weight loss industry, it's the easiest theory in the world, eat less and exercise more, but still selling magical fixes is a big business. Sure, seek advice, but also make sure you know exactly what he's going to do before buying anything. Doing another surgery on the nerves may not only not help, but also cause more damage.
You say you know it's not too early, I can't argue with that. But the body and nerves are amazing. They find new paths and there are stories where it suddenly happen after 2 years. I've recently become interested in vitamin B complex, I talked to one patient who was told by the doctor that they give this in high dosages to people who've had their finger cut of and reattached. I also talked to one patient who had problems getting the feeling back after orthognatic surgery, but the day after starting treatment started getting some buzz. Sure, it's anecdotes and case studies, but on the other hand totally harmless and can be done while consulting for other things.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4904479/
The problem as I’m trying my best to lay it out, is that it may not be nerve damage. I DO have nerve damage but it’s not really a bother. It’s the stiffness that’s a bother. Nowhere in the literature does it mention this as a symptom.
So let’s say my nerves do recover eventually, that doesn’t mean the stiffness will go away. Richardson believes they are separate problems.
He made it clear before I got the hardware removed that it wouldn’t help my main problem, but may or may not relieve the numbness some.
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i too have stiffness, not at the lip, that's just loss of sensation, but on the right side of the muscle covering the chin, feels heavy and i can really feel it pull when i stretch my mouth. f**k I'd give it a shot with the Indian guy. It would be amazing to fix this.
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My upper was like this for a long time on one side, now it just has this "diffuse numbness", which feels like it's burnt. I think what you have is the aftermath of severe nerve trauma or as my fat old butcher told me "it's just numbness". Nerve trauma can manifest itself in all sorts of ways. Some are completely numb, many a little, and a few, like us, get this abhorrent paraesthesia instead.
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The problem as I’m trying my best to lay it out, is that it may not be nerve damage. I DO have nerve damage but it’s not really a bother. It’s the stiffness that’s a bother. Nowhere in the literature does it mention this as a symptom.
So let’s say my nerves do recover eventually, that doesn’t mean the stiffness will go away. Richardson believes they are separate problems.
He made it clear before I got the hardware removed that it wouldn’t help my main problem, but may or may not relieve the numbness some.
If it's a separate problem, it needs to be explained in some way what the problem is if it's not the nerves. I understand that there can be a distinction between nerves for sensation and mobility, but it's still nerves. And nerves for mobility is definitely cut during jaw surgery as well, if you see people coming out of jaw surgery, it's not just that they can't feel, they can't move or make facial expressions either.
If it's not the nerves, I guess it have to be that the muscle is cut. That also heals, but if it's big enough there might be some intervention to reattach it. Muscles break in other context in the body, it can happen when lifting something heavy, or the achilles tendon can break when running. The intervention to fix the achilles tendon is normally to let it grow back naturally and then stretch it. So even muscles heal. If something is really cut off, it's subject to necrosis and death.
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i too have stiffness, not at the lip, that's just loss of sensation, but on the right side of the muscle covering the chin, feels heavy and i can really feel it pull when i stretch my mouth. f**k I'd give it a shot with the Indian guy. It would be amazing to fix this.
That’s interesting, I’m astonished it doesn’t affect your speech.
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If it's a separate problem, it needs to be explained in some way what the problem is if it's not the nerves. I understand that there can be a distinction between nerves for sensation and mobility, but it's still nerves. And nerves for mobility is definitely cut during jaw surgery as well, if you see people coming out of jaw surgery, it's not just that they can't feel, they can't move or make facial expressions either.
If it's not the nerves, I guess it have to be that the muscle is cut. That also heals, but if it's big enough there might be some intervention to reattach it. Muscles break in other context in the body, it can happen when lifting something heavy, or the achilles tendon can break when running. The intervention to fix the achilles tendon is normally to let it grow back naturally and then stretch it. So even muscles heal. If something is really cut off, it's subject to necrosis and death.
That has nothing to do with the motor nerves being cut. The muscle tissues have been cut so that’s why you can’t make facial expressions. Also you have incisions everywhere in your mouth and so making a facial expression would pull at the stitches. Everything is also swollen profusely. Swollen tissue Is filled with water and makes movement difficult - temporarily.
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My upper was like this for a long time on one side, now it just has this "diffuse numbness", which feels like it's burnt. I think what you have is the aftermath of severe nerve trauma or as my fat old butcher told me "it's just numbness". Nerve trauma can manifest itself in all sorts of ways. Some are completely numb, many a little, and a few, like us, get this abhorrent paraesthesia instead.
It’s hard to say is your feeling of stiffness is what I’m referring to when I say stiff. Another word I use is frozen. My lip feels fat in the middle when I move it even just a little, like something is bunching up under the lip and pulling. When I speak for longer than a few sentences I start to notice it’s lack of mobility and it occupies my attention and becomes bothersome. Is that what you had?
Because I know people who have this issue still almost 3 years post-op. Does that mean you both had the same symptom? Or are you using the same words to describe different phenomenon? I don’t know.
Because I guess I also have some stiffness in my upper lip still from the surgery. But it’s not something I notice in day to day life or that’s impairing in any way. Certainly not enough to make a stink about it. I also have TMJ problems in one jaw and barely even mentioned it to my surgeon. So you can imagine it’s a pretty distressing problem if I’m still going on about it at 8 months post op.
Does anyone know if relocating the nerve from the bony canal during surgery is a normal procedure? Because I’d bet this is where it got so severely damaged.
I guess my surgeon wasn’t so good afterall.