Needing advice after sliding genio, not happy with results 2 y after (pictures)

[Maxfactor]

Thank you everyone for your help. Really appreciate.

[Lazlo]

Okay honestly, you look good but yes the indentation is visible. I don't know the state of the art of surgery in Madrid but I think you should consult with someone like Zarnibal or the top people in Switzerland (search around on the board and look at the other threads for doctors names). But there is definitely stuff that can be done for the indentation from HA paste, a bone graft or other bone substitute and even soft tissue augmentation such as fat or various types of permanent filler. That can be done but it will take a bit of work and a really knowledgeable max fac. Don't worry about that, it can be fixed.

Okay, the nerve pain: here's a possible reason, some of the screws etc. are putting pressure on the nerve. I know with the jaw surgery they can after a year remove the screws and plates. Perhaps you can ask one of the doctors if they can do this for a genioplasty. Frankly, I think you'll need to consult with some real experts to have that done. You're young, only 22 which is a baby so you should have very good healing. Definitely take a good dose of vitamins like vitamin B etc. Do not smoke cigarettes at all. The nerve sensation could improve with more time but if it hasn't at the 2 year mark, then you should definitely consult with some other surgeons outside of madrid. I'd check with Arnett and Gunson in the states and Zarnibal, Obswegger and Triaca in Europe. Those are my safest top pics right now. Arnett and Gunson always join their osteotomy sites with HA granules mixed with platelet rich plasma to ensure a smooth result in the osteotomy site with no step off etc.

Don't worry, there's ALWAYS a solution, you just have to find the right person to solve your problem. DOn't lose hope.

[Rico]

Can You tell us who operated You ?

I' made some researches about nerve problem, because I have one mildly  compressed (due to overlooked fracture) and I'm gonna have to decompression with max 50% possible success at it best - just a gamble

First of all.
Nerves may ba damaged permamently or just compressed with /without permament damage.
This is very hard issue to solve. In most cases nothing can be done, but it depends...

You have to check If there is possible compression, by the bone, or any titanium plate /screw
Possible compression are hard to determine, becase sensation nerves are very thin, and mostly it's hard to show them on MRI, and the small canals where they goes insde are too thin to be visible in most CTs

Make some researches if there is any test for the nerves are affected in Your case. Low probality, but nothing to loose - check

Some important things about compressions.
The longer and harder nerves are compressed, then the less chances that decompression will help.
Generaly If you have any compression but not significant, then after 2 years, there is still (but not big) chances that decompression will help (but if you have compression)
Typical sign of significant compression is very noticeable loss of feeling, If You have that, then for 90% nothing can be done after that time
Mild compressions manifests in BARELY or NO noticeable loss of feeling, and often in some sort of pain and prasthesia, especially when You touch - something like oversensitivity.

However when it comes to nerve all of these thing are just a gamble.
So once again
1) check compression
2) if exists, then look for a very skilled surgeon who can decompress such nerve (if your symptoms testify mild compression)
3) if there is nothing you / doctors can check / establish at least at some level of probality then You have to leave it alone - THIS IS THE DARK SIDE OF SUCH SURGERIES. Medicine is still at very weak level.


Lets take me as en example:
High probality of Infraorbital nerve compression. CT shows that the ION canal (under eye) is noticeable lesser in diameter then the other on the healthy side.
Typical symptoms of mild compression: no noticeable or very low loss of feeling (hard to determine) and constant annyoing (but not big) pain, especially when touch
But compressed for almost 3 years now. However duration of the compression is much less critical in mild compression which shows some data
Also I had some sort of test which showed (indirectly) that my nerve is in good condition. Skull nerves are very hard to test, because there is problem with attaching electrodes - like is done for the nerves in the limbs.
Due to annoying pain and high possiblity of the compression my nerve will be decompressed (in the case of surgery, there is no decision yet), but there is no guarantee that it helps, and also there is a little chance  , that surgery will make it worse. So I'm very streesed about that

When I was searching for any surgeon who can decompress the nerve, every second maxfac surgeon refused to help me
I can give You some names of the surgeons who are more prone to help in such situations, but at first You have to know better Your case.

HONESTLY I CAN TELL YOU ALREADY, that chances are low (but no 0%) and the fight is lopsided. YOU CAN TRY TO FIND SOLUTION, BUT PLEASE BE PREPARED FOR UNFAIR FIGHT. Any surgery may make it worse.

Sorry for a long answer and that I probably I repeated some sentences, but I was writing what I thought....diectly from my mind

SOME SOLUTIONS:

• TAKE A CONSULTATION WITH NEUROLOGIST.
• You can try do some small test by injection of long acting cortisteroid near the nerve in possible place of compression. IF there is any reaction and changes to better then there is some "more life" in nerve.
• CONSIDER LASER THERAPY. SOMETIMES IT HELPS.

EDITED:  And one thing I forgot

If after surgery You had completely numb some of the areas and no 100% function after 3 months  that means it was 2nd (often in such surgeries) or 3rd (max, totalled) degree of damage and maybe there is no compression (***). Generally I should have asked about this first, but I forgot   Severely damaged nerves rarely gain its 100% function

*** BUT You could get 1st or 2nd degree of the damage (not very bad) but at the same time nerve was compressed and had not enough place for enough good recovery.

As You see this is very complicated topic and it's very frustrating thing, I know

take a look on classification of nerve injury: http://en.wikipedia.org/wiki/Nerve_injury

[PloskoPlus]

Compete numbness immediately after jaw surgery is the norm.

[Rico]

I edited a little the end of my previous post. Take a look again.

Hmmm I don't know too much about that, but we can do some simple  survey. Never had completely numbness

How many of You have got restored 100% feeling after You had total numbness after jaw surgery ?

I have to correct myself, because the problem is much more complicated. Even in neuropraxia You can loose feeling significantly, but it is restored in 100% within 3 months. If You lose much of feeling and there is only little improvement after 3 months, then the damage was bigger (if there was no compression) and the chances (for 100% feeling) are lower

But I'm waiting for the answers.  I think it's interesting survey

UPDATE: and now I became depressed, when I relised, what I'm going to go through... f... I may end very badly after surgery

[Rico]

MaxFactor:
PLEASE TELL ME HOW SIGNIFICANT THE NUMBNESS IS.
DO YOU HAVE ANY CONSTANT PAIN ? ESPECIELLY ON TOUCH, EVEN SLIGHT ONE

Do You feel cold (take a spoon, and touch by its larger part, then more thin part, etc) ? if yes, how intense ? dulled or not

You wrote, You have some tingling in affected area. They are triggered itself, or when You touch?
Generaly any tigling etc are good sign of that something is going in the nerve (uncertain). However these  symptoms are subjective. Tell me more....

PS Read again my long post, It's little updated

[needadvancement]

I'm considering Genioplasty as well in the future and this is the sort of thing that always makes me apprehensive. I could live with some numbness even if it is permanent, as long as it's not on any teeth. But things that OP describes sound quite awful. Having constant irritation or even pain at those spots is not something anybody should have to live with forever(I certainly hope that this will resolve itself for you). Is it fair to say this is more avoidable the better the surgeon is? I mean if they're opening it up and going to work on the bone should they not be fully aware what and where the nerves are so they won't damage it during the surgery?

[PloskoPlus]

I think it depends on the amount of advancement as well.  The more advancement, the more the nerves get stretched.

[Rico]

I think in 60% this is just a gamble. and all maxfac surgeons has got unhappy patients. One less, the others more.
You can end badly even in very good hands. This is the truth

I'm curious about one thing.
Surgeon is just a man. What happen if a day before he has very stressful argument with someone important for him, then he doesn't sleep well, and after that he is gonna to perform surgery ?  and that time you are a patient.  Perhaps this kind of sh.... influence the surgery outcome.

What You think ?

[Maxfactor]

Hi, thank you for all the answers. I'll try to be more specific about the symptoms. The whole marked area in the picture is hypoaesthetic, numb, but still feeling it, then theres a lower area with very low sensation (also marked) which I expected, since it was an 8mm slide and that's a very typical sequel area. But then theres a paresthesia area that affects both the gum and the skin, and in the gum area, right under the canine and the whole gum under it, especially when eating or talking for a long time, increases numbness and triggers unpleasant feelings in the zone. I would say, unpleasant feelings increase with use o touching (e.g if I sleep with my face that way). Do you think it may be related with stitches? I'm remembering now I had one "buried down" when recovering and the sensitive zone is indeed the same? Any expert opinions?

Also please, notice that while it gives me some trouble on many specific days, overall I'm OK and living a happy life guys, I would say I'm overall (51%?) happy with the procedure in fact (maybe I'm a superficial), feeling kinda unlucky, but you have to always keep in mind what surgery is about (making a big ass wound)

[LoveofScotch]

I probably don't know what I'm talking about; do what you feel is right for you!

I think it's probably safe to say, if left untouched, what you're experiencing is likely permanent. Of course, it could always get better on its own, but I wouldn't hold my breath. A few things to consider, in no particular order...

1)Have your hardware removed
2)Acupuncture (with a really good Acupuncturist)
3)Anticonvulsants (doctors in the U.S. seem to favor Gabapentin, sold under the brand name Neurontin, etc.)
4)Light Therapy (In Light Wellness Systems makes a good product, but so do countless other companies)
5)Methylated B Vitamins (THORNE Research Methyl-Guard Plus is a great product, but there are obviously other options, too)
6)Botox (increasingly being used, with success, for nerve pain)

Also, your English is better than mine, and I would be cautious about eating more with the sole purpose "to fill" anything in/out. I totally wish we could direct where fat goes, but we can't. You could always give it a shot, but your face may stay the same and now you have a gut, or love handles, or a little extra inner thigh, or man boobs. You get the point...

Good luck, and I hope your chin feels better

[Rico]

MaxFactor generally You are too late.
After surgery if nerves are not seriously damaged, then most of the feeling (or at least 50%) should be restored during first 6 months.
Nerveres regenerate for 1-1.5 years.

So good practice [good for all] is to take care about how the nerve regenerates during first few months, at least 6 and if there is no significant further  improvement, then it's best period  (0.5 - 1y) to  consider some "boost regeneration" procedures like: decompressions, light teraphy, taking witamin B, cortisteroid injections etc.

Now it's 2 years after nerve injury. Now there is no more regeneration or even if left some "buffor" (if compression exists) then only a little up-regeneration possible, but good felling, I mean 90-100% is now for 99.9% impossible whatever You do, This is my opinion.
Hyperasthesia in teeth region is also hard to repair, but I think there is possibility to reduce symptoms of damaged nerve malfunction.
Some drugs, like antidepressants, aniticonvulsants (as LoveofScotch mentioned)  - but for many people they are not helpful and have side effects. There is no specific drug for neuropathy. But You can try. Take a consultation with neurologist.

Long acting benzodiazepines often are good to calm nervs in CNS and PNS, and they have very few side effects, beside the one - possible addiction (but on very low doses (not increased over time), its not a big problem) You can also make a try.

I think also You should have uninstalled all plates. Perhaps somehow it helps a little
Unfortunately mostly Your problem is permament. But as I said You can reduce some symptoms. This is possible.

UPDATE: Its good to know that nerves which supply sensation to gum / teeth are very thin and somehow from time to time they may achieve a tiny bit more space after few years, because our skull is in constant very discrete modification. We gets older. Your kina oversensitive teeth may be due to some little compression out there. Compression can kill some of the nerve fibers forever, but some of them still may have some enough space to be alive but too low space to function properly. Simply, You can have some "short circuit" because in compressed nerve mealin shealth are destroyed (you know like electric wires without shealth) But this is uncertain. We still can't look into structure of the nerve on live especially in skull (bad access)

Consider all these thngs you were told and You will see. Nothing more left You

[Rico]

http://www.ncbi.nlm.nih.gov/pubmed/12660613