are there any (meta) studies on how often nerve damage appears after jaw surgery

[kavan]

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.

[InvisalignOnly]

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? 

Yes I am. We can agree to disagree on this.

[InvisalignOnly]

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.

[InvisalignOnly]

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.'

[kavan]

That study is about word usage and as far as that goes where is there any '100%' of all reporting problems.

[InvisalignOnly]

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.

[kavan]

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.

[GJ]

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.

[kavan]

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%.

[GJ]

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....

[kavan]

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.

[Vincent999]

at what point in the recovery would nerve damage likely be permanent? 6 months?

[GJ]

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.

[InvisalignOnly]

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.

[InvisalignOnly]

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.