I'm totally confused / stressed / anxious / depressed / dont know what to do

[Rico]

look at the beginning of the thread . I explained this. There are pictures. You can see line of the overlooked fracture.  No problem with orbital.  Only malar bone gone inward about 3-4mm (its too little to get significintlly decreased orbital volume causing diploplia) and rotated resulting in flat cheek. - no cheek prominence. The bone has to be cut on the fracture line and moved to the original position. In the maxillary bone there is infraorbital canal where is infraorbital nerve which supplys feeling to this part of the face:



Because the line fracture went throught the canal, there is now compression. Generally its compressed too long, but fortunately the compression is mild and I still have good feeling, but I feel pain on the whole area. Decompression at this stage gives a chance that pain may go away ..however its a gamble, because of the time which passed. But researches shows that often it helps even in prolonged cases

Decompression surgery is very simple. Problem is with moving this bone without a big risk. When you move zygomatic bone, then volume of the orbital increases and the eye may sunken causing diploplia. It must be done perfectly. But I want to do it all in one surgery

[geijutsu]

OK, I just reread the thread and it seems like your final post confirms the questions I had in mind.

It does seem logical to go to a doctor with osteotomy background around that area. But the question is, do you actually know if MM has enough experience with malar osteotomy that distracts the entire orbito-malar complex? This is not child's play as the work involves maneuvering around the very delicate tissue of the eyes. Why not get the infraorbital nerve decompression surgery and then get an implant as falcoa suggested? It's a) far less risky and b) you'll achieve much better symmetry between your left and right malar bones. I saw a doctor in the US who did an orbital reconstruction on some very serious trauma victim. He used a custom implant that achieves 99% symmetry between the left and right orbits and is very much as straight forward as slapping on a jigsaw puzzle in its right place. All this malar ostetomy talk sounds unnecessary to me for something that has a high risk, moderate reward outcome.

[geijutsu]

Trust your instincts FFS!

It's too late to do that when her mind is monkeying all over the place. I don't get a good feeling from any of this tbh.

[Rico]

It does seem logical to go to a doctor with osteotomy background around that area. But the question is, do you actually know if MM has enough experience with malar osteotomy that distracts the entire orbito-malar complex?

So you still thinking, that I should make a consultation with oculoplastic. ?  DO YOU KNOW SOME VERY SKILLED ONES IN EUROPE ?

I was thinking about implants, but too many doctors do not recommend it in my case, even Dr Z.....Zygomatic arch is also involved...too big implant has to be used to cover all of that. additionaly how you put implant not damaging zygomatic nerves ?. Look at 3 small holes on the side of zygoma.

BTW ..Refering to MM answer, my father told me, that MM put me under wall [can I say that in english?  any idiom useful?]. I have no guarantee and dont know how much money the will return me if I cancel surgery one day before, or just accept decompresion surgery.
He told me that, its strange, that professionalist is not patient for the patients and additionally he used blackmail.  - prepay or you will be on his black list forever

so I have to cancel surgery in Brussels. I dissapointed in MM. I used to have high hopes on him

Please correct sometimes my english It will be helpful for me to level up it

[Gregor Samsa]

This is typical behaviour from Mommaerts and he told me almost exactly the same thing when he told me that he doesn't want me as a patient anymore. It's amazing that he hasn't learnt a damn thing and still continues with his "I'll fix it" bulls**t and expects the patients to just accept what he says. That's exactly how you end up with patients that have unrealistic expectations.  It sucks that you've already paid half the amount but surely they will pay you back if you cancel the surgery? They might charge you an administrative fee or something but unless you've signed a contract already then I don't see how they can legally withhold the money.

[geijutsu]

So you still thinking, that I should make a consultation with oculoplastic. ?  DO YOU KNOW SOME VERY SKILLED ONES IN EUROPE ?

I was thinking about implants, but too many doctors do not recommend it in my case, even Dr Z.....Zygomatic arch is also involved...too big implant has to be used to cover all of that. additionaly how you put implant not damaging zygomatic nerves ?. Look at 3 small holes on the side of zygoma.

BTW ..Refering to MM answer, my father told me, that MM put me under wall [can I say that in english?  any idiom useful?]. I have no guarantee and dont know how much money the will return me if I cancel surgery one day before, or just accept decompresion surgery.
He told me that, its strange, that professionalist is not patient for the patients and additionally he used blackmail.  - prepay or you will be on his black list forever

so I have to cancel surgery in Brussels. I dissapointed in MM. I used to have high hopes on him

Please correct sometimes my english It will be helpful for me to level up it

Unfortunately, I don't know any occulplastic surgeon in Europe. Having said that, I don't think you absolutely need them. I made the recommendation early on when I thought that you're complaining from orbital/eye problems. But seeing as the main complaint is related to the zygomatic bone being rotated inwards then a doctor who has experience working in the area like a craniomaxillofacial surgeon can help you, too.

You can still get the sandwich osteotomy (green line) to correct the zygomatic arch problem then get implants/filler for the rest of the zygomatic bone, depending on the severity of the problem. Try to fix your main concerns at first then evaluate the other stuff. If I were you, my main priority would decompressing the infraorbital nerve to relieve the pain and reset the zygomatic arch to its right position. Having everything done all at once adds more probability for error. So focus on these two things for now, and see how you malar bone looks after surgery.

As for the nerve holes, implants are typically designed in a way to allow the passage of the nerves through them without placing any pressure on the nerve, all of this can be worked out either by the doctor or during the planning of the custom implant.

Seeing as I don't have any experience with MM, I cannot dissuade you to look elsewhere, but looking around MM's patient in this forum should give you an idea whether you like to continue with him or not.

[Rico]

generaly I can't contine with MM now, because He didnt answer me, if he can make another aproach to get access to zygomatic arch. His actual approach will cause zygomatic nerves damage. Look at my letter and what MM replied
For example: if he cen get access to the zygomatic arch from temple (under hairs) but didnt answered. I'm 1200kms from Brussels and he cant even give me a little more information via mail. HE EVEN DO NOT WANT TO REBOOK SURGERY in order to give us a little more time to make more consultations because of little missunderstanding. For me its strange behavior

doing 2 or 3 surgeries ?  Most Surgeons told me that I should do it at once, because its not good to cut skin in the same place more then once.

In Poland there is project which allow to make an implant using steam cells. You know you can have your own bone. Ive been told that perhaps nowadays is still too early, but such technology should be available in few years. I think that implants are more popular in USA

I dont know If I want any foreign object in my body.

WHAT ALL OF YOU THINK ABOUT THE SITUATION MM LEFT ME IN ?

[Rico]

This is typical behaviour from Mommaerts and he told me almost exactly the same thing when he told me that he doesn't want me as a patient anymore. It's amazing that he hasn't learnt a damn thing and still continues with his "I'll fix it" bulls**t and expects the patients to just accept what he says. That's exactly how you end up with patients that have unrealistic expectations.  It sucks that you've already paid half the amount but surely they will pay you back if you cancel the surgery? They might charge you an administrative fee or something but unless you've signed a contract already then I don't see how they can legally withhold the money.

Gregor : SEE WHAT I WROTE TO YOU IN PM....AND THEN CONTINUE TO READ

No I haven't paid yet.

I wrote this to him one week ago: His answers are in red color.
-------------------------------------------------------------------------
Hello Professor

We are going to have last consultation one day before surgery in order to talk about some small issues like whether augumentation of the orbital floor will be necessary or not, if will, then which material ..I prefer my own bone,…. You talked about some computer simulation, etc


I don’t know how much time are You going to give me on the consultation, but since I better write in english [I don’t use it in regular talk] I decided to write down all my concerns. I tried to visualise how this surgery looks like and during this process I encounterd two rather small , but important issues.

1. afraid of lost feeling in the area supplied by small zygomatic nerve. You told that this small nerve/nerves may be cut during accessing to zygomatic arch through the mouth and MOST people do not feel any distirbuances, but its unclear from the medical point of view. Perhaps just in case better try to save this small nerve/nerves. I fill nervous about this. I will discuss with you about incision in other place to get access to zygomatic arch and the disadvantages of the another approach. I hope it will be possible to have some another options.
I am not sure there is a way to avoid this.

2. Infraorbital nerve decompression. The outcome is a gamble. I know. OK. However I very care to do it ONCE and never back to the problem again. For example if the procedure will not help in the proper amount of the time after surgery [pain will be still exist] I i’m not gonna think “OK it didnt helped, but perhaps there is still compression deeper on the orbital floor” I’m thinking about exploring the whole canal and orbital floor to be sure about that - in that way I will feel more comfortable. I have read few months ago that in that case its good to explore the whole canal and orbital floor [if its save], because broken orbital floor can also compress somewhere the nerve, but it musn’t be in that case. I dont know if the CT can answer that. I saw whole article but I lost it. This is just an abstract:http://europepmc.org/abstract/med/17237691
I did recently a decompression for a German doctor. I was surprised it helped, even immediately.

That all my concerns.  Nothing else. Of course we will discuss about that during consultation.
I hope that will not discourage You to help me, especially at this stage. Let me just know, is still OK ?

----------------------------------------------------

Please note, that I just informed him about my concerns and didn't require any consultations via mail. I just wanted to know if he will be able to change some procedures. I was very anxious about this. I cant just go out from home/work and go to talk to him, because I live 1200kms from Brussels.
The problem was about destroying the nerves. His answer was so unclear that I wrote to him again. The message I copied here earlier in this thread

[Rico]

I got answer from Dr Triaca (exactly from his secretary).  He can't help me, this is what he probably said - probably because I'm not sure due to very strange quality of service in reception.

First of all domain Pyramide.ch [where he works] is banned. I tried to send form 3 differrent accounts. Nothing helped.
I sent one week ago using their website - no answer, so I didn't know if they had received.   [something strange in syntax correct me]
Today I made a call to the receptionist and they told me that Doctor can't help me. For God Sake.. They could have answered me that via mail. My mail addresess are not banned.

BTW stupid receptionists I told them that they should send mails from any account, for example from gmail to see the error about ban. I think they didnt get it

F.... my case seems to scare the best surgeons.

When it comes to Switzerland, I also was thinking about Dr Sailer, but 50 000 Euros is too much for me. That told me his secretary - average cost

[geijutsu]

generaly I can't contine with MM now, because He didnt answer me, if he can make another aproach to get access to zygomatic arch. His actual approach will cause zygomatic nerves damage. Look at my letter and what MM replied
For example: if he cen get access to the zygomatic arch from temple (under hairs) but didnt answered. I'm 1200kms from Brussels and he cant even give me a little more information via mail. HE EVEN DO NOT WANT TO REBOOK SURGERY in order to give us a little more time to make more consultations because of little missunderstanding. For me its strange behavior

doing 2 or 3 surgeries ?  Most Surgeons told me that I should do it at once, because its not good to cut skin in the same place more then once.

In Poland there is project which allow to make an implant using steam cells. You know you can have your own bone. Ive been told that perhaps nowadays is still too early, but such technology should be available in few years. I think that implants are more popular in USA

I dont know If I want any foreign object in my body.

WHAT ALL OF YOU THINK ABOUT THE SITUATION MM LEFT ME IN ?

At the end of the day, you can choose to do whatever you feel is better suited for you. I'm just giving you options based on if I was in your place and had the same problem.

[Rico]

At the end of the day, you can choose to do whatever you feel is better suited for you. I'm just giving you options based on if I was in your place and had the same problem.

Thank You. However, actually, I have no options.

I've heard that very good is Professor Sandro Pelo and Dr. Swennen
but most surgeons do not make full osteotomy (which gives the best result) so for 50% they wont help. Of course I will send a request to get initial information
Who can also be helpful in Europe ?

[Modigliani]

Are you sure maxfac surgeons are the best option to help you? What about craniofacial docs, what do they do?

[Gregor Samsa]

I agree with Modigliani. There are trauma surgeons that work in the ER who see facial fractures almost every single day. Many maxfac surgeons are dentists with a speciality training in jaw surgery so I'm not sure how much experience they have with this kind of stuff (the path to becoming a maxfac surgeon differs in some countries though). You need to broaden your search. Since you live in Poland then I think Germany will be the best option for you since it's going to be cheaper and Germany in general has some of the most highly trained surgeons in Europe.

Paul Johnson and Sneddon in the UK might be able to help you since they have rigorous training and Sneddon has also worked as a trauma surgeon for many years (or maybe I have him mixed up with someone else). It's probably going to be more expensive in the UK than in Germany though.

[Rico]

After trauma I didn't need surgery. it was simple fracture. In such case surgeon just pull the bone out using a hook and the bone go into its position and thats all. Of course in very bad cases surgery is needed. HOWEVER DO NOT MIX OLD FRACTURE WITH FRESH FRACTURE. COMPLETELY DIFFERENT THINGS. Fresh fracture is 9999999999999999999999999999999999999999999999999999999999x easier to repair

This doctor should have told me that that I should have gone to see max-fac surgeon [those days I didnt know about that specjalisation] Doctor who every day see traumas of the face - neurosurgeon and work in hospital didn't know that there was risk of fracture. I went to neurosurgeon - which is a colleague of my father in order to take a best possible care - What a paradox. Neuroseurgeon because after trauma I felt a little strange feeling and nothing more but a little bruise. Bruise masked a little deformation. 

Modigliani: Ok but give me more info about craniofacial, names , etc - I thought, craniofacial is for upper part of face and general skull.. .max-fac for mid and lower parts.

Gregor Samsa: I had consultation with of the best surgeo in Germany. He hasn't got full solution for me. Generally the same like in Poland. They are afraid of double vision.... Wonder why MM isnt afraid about this.

I feel I wont find help and always will feel a little strange about this

[Modigliani]

Ok but give me more info about craniofacial, names , etc - I used to think craniofacial is for upper part of face.. .max-fac for mid and lower parts.

You might be right, I'm just so used to associating them with jaw work. Can your father not advise the best way to proceed?