jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: lookism on October 03, 2020, 02:00:33 AM
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preferably ordered by technique
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I don't know about studies but based on anecdotal evidence including personal experience, I'd say 100% of people suffer nerve damage, especially from lower jaw surgery / genioplasty. Surgeons should be more honest with patients about this instead of saying stuff like 5-10-20 whatever percent. Almost everyone will experience lasting nerve damage, it's the luck of the draw how bad it will be or what form it will take (numbness, altered sensation, pain etc.). I guess there is a very lucky minority, probably young people mostly, that truly recover full 'original' sensation but I think that must be very rare.
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So first of all, immediately where the cut was peformed, you will loose all sensation forever and at the beginning you will have maybe some missfeelings. For example at the beginning when I touched my scar at the hip, it felt like a needle would sting me. That occurs for every scar, your scar has no sensation at all forever.
Surgeon says that High BSSO has less chance to damage your mandible nerve than a normal BSSO. In fact your sensation will be forever diminished around the area. That is total normal and occurs in every kind of surgery what we could possible have. For example, I didn't even have a genioplasty nor a jawsurgery, just a upgraft of my lower incisors. My bottom lip lost definitive some sensation, the stimulus has to be much higher now, only then I will feel something. Younger people just cope it better than older people.
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Surgeon says that High BSSO has less chance to damage your mandible nerve than a normal BSSO. In fact your sensation will be forever diminished around the area. That is total normal and occurs in every kind of surgery what we could possible have.
Numbness or diminished sensation is one thing, altered sensation is another. For example in my case, I do not have really numb spots, but on one side of my lower lip / chin the feeling is different, it's hard to explain, it feels like there's something there. I'm lucky that this isn't disturbing (and might still go away - I'm only two months post op) but I can well imagine that some people have a constant uncomfortable feeling or even pain, and sadly there is not much they can do about it.
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Maybe I shoulded be more excact. I mean with around the area, exactly the spot where you were cut. So normally if you touch your gum where the cut was performed it should be numb. For example I have some spots on my body where birthmarks were cut out. This spots are numb forever.
Of course I know that "lookism" meant the altered sensation or numbness, which occurs around the lip area and so on, but I just wanted to mention that scars are numb forever and so your gum, what can be strange if you kissed before and now you don't really feel her tongue on your gum or you don't really feel the food which is stucked behind your philtrum.
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just wanted to mention that scars are numb forever and so your gum, what can be strange if you kissed before and now you don't really feel her tongue on your gum or you don't really feel the food which is stucked behind your philtrum.
I don't know about other people but I don't have any numbness inside my mouth and / or in the gum area at all after surgery, I can feel everything everywhere.
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preferably ordered by technique
Have you bothered doing a search for any such studies or are you wanting others here to do your homework for you.
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I just wanted to mention that scars are numb forever and so your gum, what can be strange if you kissed before and now you don't really feel her tongue on your gum
Weird. I haven't lost any sensation. Also, why is her tongue on your gums?
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Sorry, I was a little bit absent. So to last question, maybe that is a bit too much information but let just say, that is the usually way how we kiss.
So you didn't loose any sensation on the spot where the cut was performed? I mean the spot is really small and it is really only the spot where he cut your gums open, everything around don't loose any sensation. I don't know how much the sensation is gone, but if I try every scar on my body somehow to tickle, it is not possible anymore. I didn't try to sting it with a needle, maybe then I would feel something.
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my brother had bsso and had zero nerve problems. not even a feeling of numbness. so the claim that nerve damage is inevitable is not true.
would be nice to read some statistics about it but i dont know where to search.
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my brother had bsso and had zero nerve problems. not even a feeling of numbness. so the claim that nerve damage is inevitable is not true.
would be nice to read some statistics about it but i dont know where to search.
Your brother is very lucky then. I am a member of a Facebook group for jaw surgery patients with hundreds of active members, and whenever this question comes up, pretty much 100% say they suffered lasting nerve damage and / or numbness (and the vast majority are very young). Most people say they get used to it and it does not bother them after some time, but very few say they genuinely never suffered any damage.
Regarding statistics, even if there were any, I don't see how they would be reliable. The experience of nerve damage / numbness is highly subjective, so much so that if you complain about it to the surgeon afterwards, you are likely to be told you are imagining it - this is anecdotal evidence I gathered from Facebook posts. There is no objective way to 'measure' nerve damage. They could measure total numbness if they really wanted to - no idea if anybody actually tried to do that (I doubt it; maxillofacial surgeons probably don't want you to know how common it is).
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Your brother is very lucky then. I am a member of a Facebook group for jaw surgery patients with hundreds of active members, and whenever this question comes up, pretty much 100% say they suffered lasting nerve damage and / or numbness (and the vast majority are very young). Most people say they get used to it and it does not bother them after some time, but very few say they genuinely never suffered any damage.
Regarding statistics, even if there were any, I don't see how they would be reliable. The experience of nerve damage / numbness is highly subjective, so much so that if you complain about it to the surgeon afterwards, you are likely to be told you are imagining it - this is anecdotal evidence I gathered from Facebook posts. There is no objective way to 'measure' nerve damage. They could measure total numbness if they really wanted to - no idea if anybody actually tried to do that (I doubt it; maxillofacial surgeons probably don't want you to know how common it is).
I think they themselves don't want to know. In general, I think they are quite optimistic about nerve damage rates to the point of delusion.
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I think they are quite optimistic about nerve damage rates to the point of delusion.
Agreed. When surgeons tell patients they are imagining it, they probably believe that (that it's all in the mind). I suspect OP is asking the question because he wants to reassure himself that if he does not get this or that movement, he will probably not suffer nerve damage - truth is, with jaw surgery, risk of nerve damage is very high / very real. I believe people should be made fully aware of that and only agree to the surgery if they feel the high risk of nerve damage is worth it.
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I am no expert in this field, but as far as I know there are instruments which can measure how damaged your nerve is. So if somebody would really make this effort, you could make a reliable study. But as you said before, the surgeons don't want to know that.
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Are you actually claiming that members found on a facebook group where '100% of them' all report nerve problems are more reliable than studies conducted via a scientific statistical method? :o
Now, I'm not discounting that nerve issues happen. They do and different sample groups will yield different observations as to the percentage of nerve issues. Those will, in turn be relayed as potential risks on a legal release form. What I'm saying here is that your contention is not a scientific one because it resolves to contending that all people will have nerve issues and those who DON'T get them are just 'lucky' and scientific observation or study thereof is learned in a facebook group and that is preferable to having a background in science.
Your brother is very lucky then. I am a member of a Facebook group for jaw surgery patients with hundreds of active members, and whenever this question comes up, pretty much 100% say they suffered lasting nerve damage and / or numbness (and the vast majority are very young). Most people say they get used to it and it does not bother them after some time, but very few say they genuinely never suffered any damage.
Regarding statistics, even if there were any, I don't see how they would be reliable. The experience of nerve damage / numbness is highly subjective, so much so that if you complain about it to the surgeon afterwards, you are likely to be told you are imagining it - this is anecdotal evidence I gathered from Facebook posts. There is no objective way to 'measure' nerve damage. They could measure total numbness if they really wanted to - no idea if anybody actually tried to do that (I doubt it; maxillofacial surgeons probably don't want you to know how common it is).
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my brother had bsso and had zero nerve problems. not even a feeling of numbness. so the claim that nerve damage is inevitable is not true.
would be nice to read some statistics about it but i dont know where to search.
Here's a link I posted in the educational section. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342970/
However, some background in science is needed to 'digest' information aimed at an audience where it's a given they have a scientific background. It's also needed to know how to search for other studies of similar material.
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Are you actually claiming that members found on a facebook group where '100% of them' all report nerve problems are more reliable than studies conducted via a scientific statistical method? :o
Yes I am. We can agree to disagree on this.
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there are instruments which can measure how damaged your nerve is
I highly doubt that and even if there were, there is nothing that can measure how the damage subjectively feels to an individual. This is like migraines: they can be debilitating to the point of making someone effectively disabled, but there is no objective way to measure how 'bad' they are.
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For those that really like scientific studies, I found one on this subject that I think is useful: https://europepmc.org/article/pmc/pmc2869201 (Qualitative Descriptors Used by Patients Following Orthognathic Surgery to Portray Altered Sensation). Food for thought: 'most studies conducted over the past 20 years have found that neither the incidence nor complexity of patients’ subjective impairment is captured by abnormal results on an individual neurosensory test. (...) investigations on patient-based “subjective” evaluations have been quite limited in the scope of the response options provided patients: for example, yes or no, or a few verbal descriptors primarily focused on reduced sensitivity or numbness.'
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That study is about word usage and as far as that goes where is there any '100%' of all reporting problems.
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That study is about word usage and as far as that goes where is there any '100%' of all reporting problems.
It is a 'qualitative' study, if you know so much about science, you will understand what that means and why it is more relevant to someone actually contemplating jaw surgery than a quantitative study with numbers. As far as I am aware you never actually had jaw surgery yourself, neither are you planning to have it - if it is your hobby to read scientific articles about it, carry on :). I am not going to get involved in pointless arguments. If you were my friend actually planning to get jaw surgery and told me you believed that your chance of any nerve damage is like 1% because that is what you read in a study, I would advise you as a friend that the real chance of damage is probably way higher, so you should only agree to jaw surgery if you want it badly enough to accept the very real and high possibility of nerve damage, that can take the form of numbness, altered sensation etc. This advice might not be based on scientific data but is actually helpful to a real prospective jaw surgery patient in real life.
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Be that as it may that it's a qualitative study, it's assumed that people wanting to know about nerve damage subsequent to jaw surgery are wanting information that relates to it medically. Although one could convey chances of nerve injury are 'way higher than 1% or less as you say you would relay to a friend, my refutation here refers to your statement that 100% will have nerve injury and by the way, I don't need to be a patient of jaw surgery to know what I know about it. In fact, I'm able to garner and digest a lot of info about the topic matter because I'm inclined toward science and always have been. The point here is I wanted to include some objectivity to your subjective statement.
It's normal to have different sensations/feelings post maxfax surgery and for an average length of time. But the study you cited on how patients describe post operative changes in sensations isn't one that substantiates '100%'of patients have 'nerve damage' post maxfax surgery. It just conveys that of the 100 percent of patients who participated in the study asking them to describe their post operative sensations (or non sensation if numbness) reported a variety of them that could be broken down into sub percentages that could be broken down into a common descriptive terms.
As to Neuroanatomy, it would be the trigeminal nerve and it's various branches that could be damaged and this would be peripheral neuropathy. Although nerve damage of that sort (relative to maxillo-facial surgery) have low to high ranges, depending on a variety of factors, if one wanted to gather legit information about tri-geminal neuropathy subsequent to maxfax surgery, articles that described much more than just the terms patients use to describe sensations after surgery would be what to look for.
Now, as to descriptive terms of language I would use to decribe the statement of: '100% patients (getting maxfax surgery) have nerve damage.', I would describe it in the venue of ALARMIST SEMANTICS. SEMANTICALLY speaking, one could say '100%' of patients having maxfax surgery have 'nerve damage'. But that doesn't differentiate normal post op alteration in sensations from a permanent injury. One could also use the same kind of 'speak' to say;
'100%' of patients getting maxfax surgery have 'BONE DAMAGE'.
It is a 'qualitative' study, if you know so much about science, you will understand what that means and why it is more relevant to someone actually contemplating jaw surgery than a quantitative study with numbers. As far as I am aware you never actually had jaw surgery yourself, neither are you planning to have it - if it is your hobby to read scientific articles about it, carry on :). I am not going to get involved in pointless arguments. If you were my friend actually planning to get jaw surgery and told me you believed that your chance of any nerve damage is like 1% because that is what you read in a study, I would advise you as a friend that the real chance of damage is probably way higher, so you should only agree to jaw surgery if you want it badly enough to accept the very real and high possibility of nerve damage, that can take the form of numbness, altered sensation etc. This advice might not be based on scientific data but is actually helpful to a real prospective jaw surgery patient in real life.
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The chance of permanent nerve damage is high. Nobody knows the exact number because most cases aren't reported. I know whether I had damage or not was never reported to any journal or scientific study, and pretty much everyone I speak to about the surgery didn't have their data reported. It would be interesting to see how they decide which data to report. A surgeon told me nerve damage is much higher than is reported, and sometimes they knowingly and willingly "sacrifice" the nerves to make the proper cuts. I was told figure at a minimum 20%. I wish I asked how they decide which cases to report.
The general consensus is piezosurgery helps with it.
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The chance of permanent nerve damage is high. Nobody knows the exact number because most cases aren't reported. I know whether I had damage or not was never reported to any journal or scientific study, and pretty much everyone I speak to about the surgery didn't have their data reported. It would be interesting to see how they decide which data to report. A surgeon told me nerve damage is much higher than is reported, and sometimes they knowingly and willingly "sacrifice" the nerves to make the proper cuts. I was told figure at a minimum 20%. I wish I asked how they decide which cases to report.
The general consensus is piezosurgery helps with it.
I'm not contending it's low. I'm contending it's not 100%.
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I'm not contending it's low. I'm contending it's not 100%.
Definitely not 100%. I had no nerve damage...
I was told by someone reputable figure on 20%, and figure sometimes they knowingly sacrifice nerves, so I'd say around that range is a good starting point. My hunch is it's a bit higher due to the human nature/bias of not wanting to report bad outcomes, and publications not wanting to hear them....
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Definitely not 100%. I had no nerve damage...
I was told by someone reputable figure on 20%, and figure sometimes they knowingly sacrifice nerves, so I'd say around that range is a good starting point. My hunch is it's a bit higher due to the human nature/bias of not wanting to report bad outcomes, and publications not wanting to hear them....
There a lot of different factors that go into the risk assessment of it. For example it gets higher with age. It can get extremely high for oral pathology cases where they remove tumors (because they grow into the nerves). Stuff like perm numbness, I think, is the most common adverse sequella (as opposed to something like total severing a branch of the trigeminal nerve). I would hope the doctors open topic on risks with reference to what ever risk group the patient is in. Ultimately it's more of a matter of risk in what ever doctor's hands who is doing the surgery. Kind of like skiiing. Good skiers have lower risk (compared to average risk) of breaking a leg than beginners do.
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at what point in the recovery would nerve damage likely be permanent? 6 months?
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at what point in the recovery would nerve damage likely be permanent? 6 months?
It can come back after that, but no feeling at 6 months would be a bad sign.
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as to descriptive terms of language I would use to decribe the statement of: '100% patients (getting maxfax surgery) have nerve damage.', I would describe it in the venue of ALARMIST SEMANTICS. SEMANTICALLY speaking, one could say '100%' of patients having maxfax surgery have 'nerve damage'. But that doesn't differentiate normal post op alteration in sensations from a permanent injury. One could also use the same kind of 'speak' to say;
'100%' of patients getting maxfax surgery have 'BONE DAMAGE'.
Okay I understand your point of view now and I can see how what I wrote can be seen as alarmist, but I see it more as realist, even though I should not have written 100% - maybe 99 or 95 or something. Yes you are right, 100% have bone damage lol, but equally 100% also get their nerves messed up to an extent, even if some lucky people recover from that really well and it does not affect their everyday lives on the long run.
The problem with answering questions about 'nerve damage' is that it is quite subjective what we consider 'nerve damage', unless someone gives a clear definition. What I personally meant was that the nerves get messed up, after surgery there is some numbness or altered sensation in - let's say almost - 100% of cases and I personally believe that very few gain their full original feeling back everywhere, specifically after lower jaw surgery and genioplasty. I believe that the majority only end up with a few numb spots that they aren't constantly aware of and it does not cause functional problems; and quite a few end up with a degree of numbness that does affect them (slight problems with speech, not feeling food on the chin etc.), and others end up with constant tingling, pulling, pain or other forms of altered sensation. I know this isn't a scientific study but this is what I've gathered from hearing about people's experiences.
My point is that when you ask doctors about this, they will most likely tell you - presumably based on studies they read - that only a small percentage of people get nerve damage and in almost all cases it takes the form of numbness that the person isn't even aware of. While in practice, it appears that lasting nerve damage, that does affect the person's quality of life, is actually very common - let's say I am wrong and it's not 100 per cent but 'only' 20 per cent, that is still a very high percentage.
Many / most people who had a 'good' outcome, like myself, probably feel that the surgery was still worth it for them even though they suffered a degree of permanent nerve damage. All I am saying is, when people make a decision about whether to get the surgery or not, they should be realistic about the chance of nerve damage rather then thinking oh it's so rare it will never happen to me and even if does it will be nothing etc. For example in my case, I was really sure I would get nerve damage because of my age, so for me it's actually a relief that it is not as bad as I expected. But if someone is a totally normal looking guy to start with, getting surgery to look more masculine or whatever and they think nerve damage will never happen to them, they might end up regretting their decision when it's too late.
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at what point in the recovery would nerve damage likely be permanent? 6 months?
Good question. I am only 3 months post op so it's relatively early days, but I have this 'altered sensation' thing on one side of my lower lip / chin and personally I am pretty sure this will be permanent. It's hard to explain, but I know my body and it feels like this is here to stay. I am hoping that over time I will get used to it to the extent that I will not be constantly aware of it any more, so that will feel like it's 'improved'. That's what happens with the numbness too, in many cases it never goes away but the person gets used to it so they think it's better.
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Good question. I am only 3 months post op so it's relatively early days, but I have this 'altered sensation' thing on one side of my lower lip / chin and personally I am pretty sure this will be permanent. It's hard to explain, but I know my body and it feels like this is here to stay. I am hoping that over time I will get used to it to the extent that I will not be constantly aware of it any more, so that will feel like it's 'improved'. That's what happens with the numbness too, in many cases it never goes away but the person gets used to it so they think it's better.
no, no if you don't have recovery in the first few weeks I'd say it's permanent. But okay, give it like 2 months.
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no, no if you don't have recovery in the first few weeks I'd say it's permanent. But okay, give it like 2 months.
This. When after a few months you're told "wait 9 months, 12 months, 18 months..." it's just your surgeon trying to get rid of you. It may get better, but it's highly unlikely to ever feel normal.
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I agree with both of you, in most cases these changes are probably permanent. What I see on Facebook is lots of people posting stuff like 'I'm still numb after 4 - 6 - 8 months, when will this go away' and others replying saying it never went away for them. The surgeon will tell you it will go away after several months, but in reality very few people say they were numb for months and then got the feeling back.
The other thing they tell patients to fob them off is when you feel something in the area - the kind of feeling I have - and they say that's a good sign because the nerves are 'waking up'. No your nerves aren't waking up lol - they've been damaged, that's why you have the strange feeling and just be happy if it's not pain or not too disturbing.
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I highly doubt that and even if there were, there is nothing that can measure how the damage subjectively feels to an individual. This is like migraines: they can be debilitating to the point of making someone effectively disabled, but there is no objective way to measure how 'bad' they are.
As far I understood this method does it: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/nerve-conduction-studies#:~:text=A%20nerve%20conduction%20velocity%20(NCV,patches%20attached%20to%20your%20skin.
So it should be possible to do it on a smaller scale.
Also it is not really bluffing if a surgeon says you should wait 4-8 months, because swelling can also deminish your sensation. I had for example a stagnation in my recovery in the 3rd month, but in the 4th month I got really a boost in my recovery. I would say holding your judgment until the 12th month is a good attitude. After that I would consider as too long for a human being to wait more.
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It is not really bluffing if a surgeon says you should wait 4-8 months, because swelling can also deminish your sensation. I had for example a stagnation in my recovery in the 3rd month, but in the 4th month I got really a boost in my recovery. I would say holding your judgment until the 12th month is a good attitude. After that I would consider as too long for a human being to wait more.
That's an interesting test; if they tested a few thousand jaw surgery patients like that, I'd be curious to see the results. Re: recovery, obviously there are individual differences, I'm sure some people experience improvement even after several months but that does not seem to be the rule.
Anyway, I did some research and found this study that is interesting to me: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0091055. "The incidences of subjective NSD [neurosensory disturbance] after maxillary procedures were 16.2%, 13% and 9.8% at post-operative 6 months, 12 months and 24 months, respectively; the incidences of subjective NSD after mandibular procedures were 35.4%, 36.6% and 34.6% at post-operative 6 months, 12 months and 24 months, respectively." So according to this, patients have a realistic chance to recover from nerve damage caused by upper jaw surgery, whereas those who reported damage from lower jaw surgery at 6 months post op, seemed to have the same problem 2 years post op (and the rate was roughly one in three patients; 35%). Another interesting sentence from the study: "Although a systematic review showed 12.8% of the patients had persistent NSD [neurosensory disturbance] by objective measurement after an orthognathic surgical procedure, the reported incidences of subjective NSD after orthognathic surgery varied in the literature and could be as high as 87%".
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never damage happens with every surgery. the question is just how close it will heal back to 100%. chances are very high to only gain back 70-90% of before surgery sensation
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Okay I understand your point of view now and I can see how what I wrote can be seen as alarmist, but I see it more as realist, even though I should not have written 100% - maybe 99 or 95 or something. Yes you are right, 100% have bone damage lol, but equally 100% also get their nerves messed up to an extent, even if some lucky people recover from that really well and it does not affect their everyday lives on the long run.
The problem with answering questions about 'nerve damage' is that it is quite subjective what we consider 'nerve damage', unless someone gives a clear definition. What I personally meant was that the nerves get messed up, after surgery there is some numbness or altered sensation in - let's say almost - 100% of cases and I personally believe that very few gain their full original feeling back everywhere, specifically after lower jaw surgery and genioplasty. I believe that the majority only end up with a few numb spots that they aren't constantly aware of and it does not cause functional problems; and quite a few end up with a degree of numbness that does affect them (slight problems with speech, not feeling food on the chin etc.), and others end up with constant tingling, pulling, pain or other forms of altered sensation. I know this isn't a scientific study but this is what I've gathered from hearing about people's experiences.
My point is that when you ask doctors about this, they will most likely tell you - presumably based on studies they read - that only a small percentage of people get nerve damage and in almost all cases it takes the form of numbness that the person isn't even aware of. While in practice, it appears that lasting nerve damage, that does affect the person's quality of life, is actually very common - let's say I am wrong and it's not 100 per cent but 'only' 20 per cent, that is still a very high percentage.
Many / most people who had a 'good' outcome, like myself, probably feel that the surgery was still worth it for them even though they suffered a degree of permanent nerve damage. All I am saying is, when people make a decision about whether to get the surgery or not, they should be realistic about the chance of nerve damage rather then thinking oh it's so rare it will never happen to me and even if does it will be nothing etc. For example in my case, I was really sure I would get nerve damage because of my age, so for me it's actually a relief that it is not as bad as I expected. But if someone is a totally normal looking guy to start with, getting surgery to look more masculine or whatever and they think nerve damage will never happen to them, they might end up regretting their decision when it's too late.
Keep in mind my counter commentary was specifically in reference to a claim that '100%' get perm nerve damage. My perspective is that of someone with a highly rigorous scientific background. So, I viewed this as an 'emotional' or subjective assessment and not a scientific one.
Basically, I have no problem with your admonishing people (and think it's a GOOD idea) that they risk permanent altered sensations subsequent to maxfax surgery. Nor do I have any question that studies differ from sample group to sample group or that risks may be under reported or just not universally agreed on... and for those who don't have the wherewithal (basic high school science grounding to know HOW to even look for studies or how to think beyond looking in the mirror and not liking their face).... to those types (which are making up an overwhelming majority of new sign ups), perhaps it IS just a more USEFUL way to discourage them (especially the ones wanting maxfax for 'aesthetics only') that they will all have perm nerve damage afterwards.
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Keep in mind my counter commentary was specifically in reference to a claim that '100%' get perm nerve damage. My perspective is that of someone with a highly rigorous scientific background. So, I viewed this as an 'emotional' or subjective assessment and not a scientific one.
Oh okay, this is all a misunderstanding then - my bad. I was never meant to say everyone will get permanent nerve damage; I think I was trying to say that everyone's nerves will be severely affected by the surgery, and many (probably the majority) will never recover full original sensation. I obviously expressed that in a stupid way and you're absolutely right to point that out. (I also agree with your points re: some recent new posters but would rather not dwell on that.)
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Oh okay, this is all a misunderstanding then - my bad. I was never meant to say everyone will get permanent nerve damage; I think I was trying to say that everyone's nerves will be severely affected by the surgery, and many (probably the majority) will never recover full original sensation. I obviously expressed that in a stupid way and you're absolutely right to point that out. (I also agree with your points re: some recent new posters but would rather not dwell on that.)
OK. All good.